Shortage of hospital doctors due to new Labour Code provisions

Amendments to the Labour Code mean that hospitals have less recourse to overtime on the part of doctors and must pay the same rate for work on standby as for standard working hours. The primary aim of the reform was to improve the quality of medical care by ensuring that doctors would not be too tired to work during excessive periods of overtime. Nevertheless, the situation has incurred substantial costs for employers, and some hospitals are negotiating separate agreements with doctors in order to avoid staff shortages.

The new Labour Code has caused certain problems for hospitals in the Czech Republic, such as a reduction in the number of permitted overtime hours and the inclusion of work on standby in regular working hours. The amendments to the code mean that the number of doctors’ overtime hours is cut by half and that they should receive the same pay for time on standby as for normal work. Until now, doctors had received half-pay for time on standby even if they were not actually required to work.

The purpose of the amendment to the Labour Code was to improve the quality of medical care, particularly so that patients were not treated by tired doctors who may spend up to four days at work without taking any rest time. However, the new legislation has caused various problems for hospitals and medical facilities. Increasing pay for doctors on standby and simultaneously paying newly recruited doctors is going to cost the larger hospitals tens of millions of Czech koruna. The costs incurred by smaller hospitals as a result of the new Labour Code will also run into millions.

High costs of new regulations

Another persisting problem for hospitals is how to resolve the reduction in the permitted scale of overtime from the original 816 hours a year, provided for by the old Labour Code, to the reduced number of 416 hours annually in the new code. The situation is most complicated in the larger hospitals. For example, the Hradec Králové Teaching Hospital (Fakultní nemocnice Hradec Králové, FN HK) has calculated that the large reduction in overtime hours will require the hospital to take on approximately a hundred new doctors. Combined with the fact that doctors will no longer receive half-pay for time on standby but will now receive full pay, the changes in the Labour Code will cost hospitals around CZK 100 million (about €3.5 million as at 28 March 2007).

A number of hospitals have already started looking for new staff. In terms of recruitment, the Director of FN HK, Leoš Heger, stated: ‘We have issued several dozen advertisements. We will stop taking on doctors at the turn of spring and summer, when new medical graduates will be available. This year we will definitely be taking on more staff than before’. However, hospitals and other medical facilities are faced with the problem of a shortage of experienced doctors, as many of them have left the country to work in Germany and the UK. In light of this, hospitals will have to rely principally on graduates of medical faculties.

The Minister of Health, Tomáš Julínek, wants to alleviate the problems faced by hospitals struggling as a result of a shortage of doctors on account of the amended Labour Code. Minister Julínek is seeking to attract doctors from abroad, in particular from Bulgaria and Romania, to Czech hospitals. The project to bring in doctors from these countries is now taking shape, with Czech language courses on offer, for example, to encourage doctors to relocate.

Legislation forces hospitals to circumvent law

Some hospitals do not have enough funds to recruit new doctors and are dealing with the problem by signing agreements on work activity with doctors in addition to their regular employment contracts. These agreements allow these doctors to work up to 80 hours extra a month. However, the Labour Code prohibits this kind of agreement being made for the same work as the doctor does during normal working time. Nonetheless, the hospitals have found a way to get around this: the doctor’s employment contract covers ordinary treatment of patients, while the work agreement covers standby duty. This approach is being taken at Thomayerova Hospital (Fakultní Thomayerova nemocnice, FTN), the hospital at Stod u Plzně and dozens of other hospitals throughout the country. The original objective of the new legislation – to improve the quality of patient care – thus remains unattained.

According to the Chair of the Association of Czech and Moravian Hospitals (Asociace českých a moravských nemocnic, AČMN), Eduard Sohlich, one solution is to introduce an ‘emergency system’. In this regard, he considers such a system to be ‘a non-stop service in a hospital that receives patients, takes care of them and treats them; those that require further treatment are only then transferred to the appropriate departments in hospitals’. In this case, hospitals do not need to have so many doctors on duty.

Soňa Veverková, Research Institute for Labour and Social Affairs

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