Slovenia: Doctors' agreement could destabilise public sector salary system

After six months of tough negotiations and industrial action by doctors, the government and the doctors’ trade union finally signed a collective agreement in March 2017. Doctors achieved most of their demands, which related to working standards as well as wages. The annual cost of the agreement has been initially estimated at €50 million.

Background

The Trade Union of Doctors and Dentists of Slovenia (Fides) began calling on the government for changes to the pay and working standards of doctors and dentists in mid-2015. However, the government did not engage with the union's demands until the end of October 2016, when Fides announced that its members would take industrial action. The doctors’ work-to-rule began on 8 November with their decision to stick strictly to a 40-hour working week but with a threat to step up their protest if an agreement was not reached

This was not the first time the doctors had resorted to industrial action; however, the protest was viewed as one of the most significant protests by medical professionals in Slovenia in the past 20 years. (The doctors’ longest industrial action had lasted for more than three weeks in 1996, with two shorter episodes in 2002 and 2010.)

On 22 November, industrial action was temporarily suspended (until 22 January 2017) as agreement was reached between the Minister of Health, Milojka Kolar Celarc, and the representative of Fides, Konrad Kuštrin.

At the beginning of March 2017, however, Fides announced more industrial action when it was discovered that the documents produced to implement the doctors’ demands did not follow the agreement. The action was called off when further negotiations were successfully concluded. The Minister of Health and Fides say this agreement will lead to shorter waiting times, with doctors being rewarded for greater efficiency and additional work.

Agreement’s main provisions

Most of the doctors’ demands referred to working standards and wages. The government and Fides agreed on four out of five of these demands (see table below).

The procedure for meeting the demands was set out in the agreement that led to the suspension of industrial action, and in two annexes to the doctors’ existing collective agreement. Both annexes provide a clearer description of the roles of the medical profession within the public sector salary system. The first one introduces standards and norms of doctors’ work. The second one includes the following elements.

  • Changes are made to the job descriptions of specialists.
  • The job descriptions of young specialists are made the same, irrespective of how long they have been specialists.
  • Changes are made to the job description of doctors and dentists who have a licence but who are not specialists.
  • Two new job descriptions are introduced.

A rough estimate of the cost of this agreement has been put at €50 million per year, giving doctors salary increases of about 15–20%. Some €14 million will be spent on better evaluation of the medical profession and €36 million will be spent on the scheme to shorten waiting times and on a more flexible way of rewarding doctors.

Summary of the agreement between the government and Fides
Demand Outcome
The approval of working standards and norms and their implementation, with pay for activities that exceed the norms Approved – a special government project to shorten waiting periods in healthcare and to enhance the quality of medical treatment will be launched. This project will give doctors’ extra pay for exceeding the norms and achieving shorter waiting periods.
Promotion above the current 57th salary grade to the 65th (highest) grade for carrying out tertiary activities (the most demanding operations and medical interventions), with additional pay for tertiary activities for those already on this grade Not agreed in these negotiations
‘Additional work’ carried out for private employers should be regulated exclusively by the Employment Relationships Act Approved
The standardisation of basic salaries for all specialists under the same working conditions and with equal career performance Approved – two new job descriptions introduced
Payment under contracts, which should not be determined by the rules of the public sector salary system, and payment for continuous (24-hour standby) healthcare, which must be paid according to the individual’s salary grade and with full allowances for unfavourable working time Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Historic moment for health minister and doctors’ union

The minister stressed that:

These are the first ever standards and norms in the Slovenian healthcare system. This agreement is a breakthrough in the public sector, also from the perspective of rewarding civil servants. Regarding this, a special government project for shortening the waiting periods will be launched in April and will last for about a year; it will seek to develop a model of good practice in rewarding medical staff.

Konrad Kuštrin of Fides added:

[he] thanked the government for listening to them and accepting their arguments. The introduction of standards and norms for the doctors’ work is in his opinion an historic event. Until now, the doctors’ work was dictated by the employers, and sometimes the increased workload has led to unsafe working conditions for the doctors as well as the patients.

Consequences for broader public sector unity

The Fides agreement has upset the Union of Health and Social Security of Slovenia (SZSVS, representing nurses, midwives and nursing technicians) and other public sector unions representing civil servants in areas such as state administration, education, science, culture, veterinary medicine, police, customs, the fire brigade and the army.

The nurses’ union has demanded the immediate start of negotiations on working standards and norms for the other medical professions, arguing that it is not just doctors who will shorten waiting times.

All the other public sector unions claim that the unity of the public sector salary system in Slovenia is being seriously endangered, as the variable wage component would apply only to doctors and no one else. The unions add that the agreement for doctors is only the second deviation from the unified salary system for public servants since it was launched in 2008 and follows the agreement for police officers signed in June 2016. They believe that this kind of separate approach destroys the wage system’s unity and that similar requests can now be expected from other public sector professions.

Commentary

Leaving aside any argument about the actual demands of the doctors and the police, a ‘Pandora’s Box’ has now been opened. The wage agreement for police last year was the first deviation; now the doctors have followed suit.

The momentum of the second part of the political cycle and the lack of unity on the part of the government was in the doctors’ favour. However, the government was fully aware of the possible consequences of the negotiations. In the end, faced with the seriousness of the medical industrial action, it chose to accept most of the doctors’ demands. Nevertheless, last years’ accession to the demands of police officers was a precedent. More effort should have been made then to prevent, or at least mitigate, all further industrial action, including that of the doctors.

Accepting the doctors’ demands will surely trigger demands by other professional public sector groups, firstly by the rest of the medical professions and then other professions, for parity with the doctors depending on the level of educational attainment and complexity of the work. It will be a real test for the unity of the wage system, which has lasted for several years. 

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