Doctors take strike action

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The Finnish Medical Association launched a strike on 12 March 2001, with doctors in municipal hospitals and health centres involved in rolling industrial action. The main issue at stake is pay, with the municipal authorities offering an wage increase of 5.5%, and doctors demanding a rise of 20%. The background to the strike is a continuing crisis in Finnish public healthcare.

The Finnish Medical Association (Suomen Lääkäriliitto, SLL), representing doctors, decided not to sign up to the two-year centralised national incomes policy agreement concluded in December 2000 (FI0012170F). Instead it started negotiations with the Commission for Local Authority Employers (Kunnallinen Työmarkkinalaitos, KT) over a separate collective agreement. KT offered a pay increase of 5.5% over two years in line with the central incomes policy agreement, but this was rejected by SLL, which issued a strike warning on 1 February 2001 (FI0102176N). The doctors demanded a pay increase of 20% for regular working time. Furthermore, they sought changes in their increasingly pressurised working conditions and a reduction in the stress of emergency duties, with the aim of preventing the drain of medical staff from the public sector.

The negotiations between SLL and KT, led by the national conciliator,Juhani Salonius, did not result in any rapprochement. During the bargaining, KT did not shift from its offer of a 5.5% increase over two years. According to SLL, this offer would not have guaranteed a satisfactory wage development for doctors working in the municipal sector - whose pay has, in the union's view, lagged behind the general wage development.

On 12 March, SLL carried out its threat and started strike action.

Rolling strike without endangering lives

About 11,000 doctors are employed in Finland municipal sector. The SLL strike action means that between 4% and 13% of them are on strike in any given week - the action is being conducted as a rolling strike, whereby doctors take it in turn to stop work. Doctors working in university hospitals and health centres in the largest municipalities are going on strike in different weeks.

During the strike, doctors are obliged to carry out the so-called "protection work" that is necessary in order to prevent the health or lives of citizens from being endangered. SLL has promised to supply sufficient staff for protection work, if additional doctors are needed for some reason. The following activities, among others, will remain outside the sphere of the strike: cancer research and treatment; psychiatry; paediatrics; pathology; abortions; health visiting; child guidance and child health clinics; and intoxicant and drug units.

Public health sector problems behind dispute

Underlying the doctors' dispute is a crisis in public healthcare. The deep economic recession in Finland at the beginning of the 1990s hit public services hardest and they have not yet recovered. About 50% of the municipal sector budget goes toward public social and health services, which were cut heavily during the recession, and the majority of doctors work in hospitals and health centres owned by municipalities. Even though the recession ended some years ago, some municipal authorities still insist on further savings in the treatment of patients.

In this context, according to SLL, work pressure has been intensifying constantly and emergency duties have become more onerous than before. Doctors say that they no longer have the time or opportunity to treat their patients as well as they would like to. The strike action by SLL is aimed at improving doctors' working conditions and wages and enhancing their "ability to cope". The obligation to perform emergency duties is part of a doctor's work and cannot be refused, and many doctors have to work around the clock. Older doctors in particular find night work unreasonably onerous.

According to SLL, the continuous speeding up of work and increasing expectations have resulted in doctors becoming exhausted and thus seeking to leave the municipal sector. An increasing proportion of them are moving to the private sector, moving abroad, or dedicating themselves to research. "Burn-out" symptoms among doctors have increased, and many have been applying for part-time pensions.

Information war on pay

A key issue in the doctors dispute is pay, and the parties involved have been conducting an "information war" on this issue. SLL members find the wages in their profession to be insufficient, and are demanding an immediate wage increase of 20%. According to KT, however, the wage tables frequently referred to by SLL indicate merely the basic salaries. SLL often refers to wages of under FIM 20,000 per month, but the employers stress that basic salaries constitute only 50% to 70% of doctors' total income and are supplemented with various bonuses. Joint wage statistics produced by KT and SLL show that, for instance, health centre doctors earn FIM 25,233 per month, assistant physicians in training posts FIM 21,424 and other hospital doctors FIM 28,442 a month.

The regular working time of hospital doctors is 38.25 hours per week, while emergency duty involves an additional 11.4 hours. The regular working time of health centre doctors is 37 hours per week, with approximately 4.5 hours of emergency duty.

Commentary

The doctors' strike is a result of public sector savings and rationalisation measures. A number of trade unions representing other public sector employee groups did not sign up to the 2001-2 incomes policy agreement and threatened strike action in order to achieve higher increases than the general wage rise (FI0012170F). However, these groups, often made up largely of women - such as kindergarten teachers and social workers - do not constitute a pressure group in the same way as doctors do. These groups ultimately did not strike and accepted an increase in line with the incomes policy agreement.

Another factor in the background of the doctors' dispute is changes in the value attached to professions, at a time when successful businesses in the private sector can provide very highly paid jobs. The doctors consider that their pay is lagging behind the general wage development. One may ask whether the object of this comparison is correct.

The doctors' strike is also closely linked with the question of whether or not there will be good free public healthcare in Finland in the future. Finnish public healthcare has been first class, and well regarded internationally. However, the healthcare situation changed dramatically during the 1990s. Working conditions have become poorer, even if there was clearly room for increased efficiency. Now it seems that recent developments have been the last straw, and many doctors have moved abroad, to the private sector and into research.

In the event that the doctors succeed in achieving their demands, this will mean cuts in other budget areas. Finnish citizens may be prepared for this prioritisation, as opinion polls indicate that they see free healthcare as the most important municipal service. The situation is politically difficult, though, because it is difficult to take away resources from other areas. However, if their wage demands are not met, it is likely that doctors will start to operate more in the private sector, and the public sector will crumble even more. If this occurs, it may be appropriate to question the appropriateness of a situation where the public sector, at considerable expense, trains doctors for the private sector.

The economic situations of municipalities vary considerably, and some are better off than others. There are some examples of municipalities that have paid, on their own initiative, higher wage increases than required by collective agreements in order to attract doctors. The poorer municipalities cannot afford high wage increases. Those with a good economic situation face a choice of political priorities. Is there greater willingness to invest in ice hockey stadiums instead of health care? The doctors' strike has also aroused a desire for higher wage increases in other public healthcare professions. If the doctors succeed now, then in the next bargaining round it will the nurses' turn. The "vicious circle" in public health care will thus continue in the future, after the doctors' strike - which is expected to last a long time - has ended. (Juha Hietanen, Ministry of Labour)