Doctors and dentists hold protest strike

In late May 2004, the Trade Union of Doctors and Dentists of Slovenia (FIDES) organised a one-hour warning strike to support demands over the regulation of its members' working time. The union subsequently gained a number of concessions from the Ministry of Health. This was the latest development in FIDES's long-standing dissatisfaction with doctors' and dentists' workload and pay, and with the healthcare system as a whole.

There has been an antagonistic relationship between the medical profession and the Ministry of Health (Ministrstvo za zdravje Republike Slovenije, MZRS) for some years (see [Report on the situation of doctors in Slovenia](http://www.fems.net/Inglese/Rapporti nazionali/Slovrapuk.htm), Andrej Sikovec, FEMS, 2003). This was illustrated by successful strikes organised by the Trade Union of Doctors and Dentists of Slovenia (Sindikat zdravnikov in zobozdravnikov Slovenije, FIDES) in the mid-1990s. These strikes represented a watershed in strike activity in the public service sector at that time (SI0211101F). FIDES is a member of the European Federation of Salaried Doctors (FEMS).

Working time controversy

At present, the main area of controversy focuses on the duration and organisation of doctors' working time, as regulated by the Law on the Doctor’s Service (LDS, amended in 2002) although there are also other issues on which the two sides do not agree. The LDS concerns only doctors and dental medicine doctors who perform healthcare activity as 'doctor’s service' (ie the professional or occupational activity of doctors) in accordance with the law regulating health are and with the LDS.

According to Andrej Sikovec (see report cited above), the founder and the first president of FIDES, only a few weeks after the application of the amended LDS - which changed the rules on overtime work and compulsory daily and weekly rest periods for doctors - it became clear that the new regulations could not meet the everyday need for medical overtime work. So the LDS was changed once again in parliament, as usual against the recommendations of the medical profession. Under the amended LDS, doctors are allowed to work for 32 hours without interruption. In order to work for more than 16 hours a day, each doctor should sign a written consent.

In detail, the LDS (Article 41d, subchapter on working time) provides that doctors have the right to a minimum daily rest period of 12 uninterrupted hours and a minimum weekly rest period of 24 uninterrupted hours. If necessary to ensure the provision of healthcare to an agreed extent, daily and weekly rest periods can be varied, while maintaining the minimum as an average, over a period of two months. In order to ensure the execution of a 'turn of duty', a doctor's working time can last up to 32 hours without interruption. For working time lasting more than 16 hours without interruption, the written consent of the doctor is necessary.

FIDES prepared an example of a written consent form for shifts of over 16 hours, stating not only that the doctor agreed to work but also specifying the payment for that work. Most doctors signed this consent form and sent it to the directors of health institutions. The directors proposed their own type of written consent, without any provisions on payment, but the doctors refused to sign it. Many doctors worked night shifts and were on call in a way that was not in accordance with the law, according to FIDES.

FIDES organised public protests about the situation. It argued that these protests, as well as defending the professional interests of doctors, also sought to warn the public about the problems of: doctor shortages; doctors being overburdened with overtime work; a lack of financial means for healthcare; and bad management of health institutions. However, FIDES alleged that its protests were misrepresented by the government in an attempt, with the help of the media, to turn public opinion against doctors and create a view that doctors are responsible for the poor situation of the health system in Slovenia. However, FIDES claims that this attempt by the government did not succeed.

One-hour warning strike

Recently the gap between FIDES and the Ministry of Health widened again and the controversy culminated on 25 May 2004 when FIDES organised a one-hour general warning strike by its members. The strike demands concerned the duration and the arrangement of working time of doctors, as follows.

• It should be possible for the working time of doctors and dentists to begin before 08.00 so that they can prepare for their work with patients before the health institution or establishment opens. The LDS determines that as a rule the working day of doctors in the public healthcare service should not begin before 08.00.

• As a rule, a working time arrangement that does not guarantee the doctor or dentist at least 12 hours of uninterrupted rest each day and at least 24 hours of uninterrupted rest each week should be allowed only with the agreement of the institution concerned and the doctor or dentist. The collective agreement for doctors and dentists should specify cases where such an arrangement of working time can be introduced unilaterally by the employer.

• It is necessary gradually to abolish the notion of a 'turn of duty' and replace it with a more suitable way of ensuring urgent medical provision.

• Until the final abolition of the 'turn of duty', it should be used only to ensure urgent medical help. 'Non-effective hours' should be regarded as those when the doctor or dentist must be within reach of the workplace in order to ensure urgent medical help, but has no other work obligations or responsibilities. When a doctor or dentist on duty has some other obligation or responsibility in addition to being within reach, this should be counted as 'effective working time'.

• The duration of periods of 'permanent readiness' and the arrangements for them should be regulated by an agreement between the health institution and the doctor or dentist. In exceptional cases, these issues could be unilaterally decided by the employer, but only in such a way that there should be no more than five periods of 'permanent readiness' per month, and such periods should last more than 16 hours on Monday to Friday or 24 hours on Saturdays, Sundays and holidays. A doctor or dentist should be placed on permanent readiness on Saturdays, Sundays and holidays only once a month.

FIDES members were bound to provide urgent medical assistance during the warning strike, to the extent determined in Article 46 of the LDS, and to determine with the cooperation of the management of health institutions the way in which urgent medical assistance was to be provided in individual departments.

There was subsequently a degree of reconciliation between FIDES and the Ministry of Health, and the two sides have come to an accord, with the Ministry agreeing with many FIDES demands.

Commentary

FIDES claims that nobody is satisfied with the Slovene healthcare system: patients are dissatisfied with long waiting lists, doctors with their heavy workload and low pay, insurance bodies with their losses and excessive expenditure, and the government with budgetary problems. In 2003, the Health Insurance Agency of Slovenia (Zavod za zdravstveno zavarovanje Slovenije, ZZZS), in the face of considerable losses, proposed a new programme of spending restrictions and savings. However, the plan was opposed strongly by the trade unions as being unselective and as limiting rights.

In 2003, the Ministry of Health issued a healthcare reform proposal (SI0311103F), subsequently approved by the government, that aims to solve the problems. One of the most contentious proposals was the transfer of premiums for voluntary supplementary health insurance to the compulsory health insurance system. Dusan Mramor, the Minister of Finance, later rejected this important part of the reform because of its adverse macroeconomic consequences. FIDES is of opinion that the reform was merely a measure taken by the government to satisfy the public. (Stefan Skledar, Institute of Macroeconomic Analysis and Development)