Medical practice bill raises quality concerns
Güncelleme Tarihi:
by Ayşegül Aydoğan Atakan
Oluşturulma Tarihi: Haziran 06, 2009 00:00
ISTANBUL - Representatives of medical associations are opposed to a bill seeking to restrict doctors from working in both the public and private sectors. They say if enacted into law the bill will result in poorer health care in the country.
A draft bill preventing doctors who work in hospitals from also working in private hospitals or clinics will negatively affect the health system in Turkey, say medical associations Medical associations say university research hospitals will not have enough doctors after the bill passes into law as it is expected that doctors will choose private clinics over state hospitals because they can earn more.
If this expectation comes true, then the university hospitals where newly qualified doctors are educated and trained will lack experienced teacher doctors. Another scenario says the private clinics will be closed down and doctors will be working extra hours in state-run hospitals to compensate their decreasing income. The full-time draft bill is also criticized as it is believed it will result in longer queues at hospitals and bring an end to patients’ right to choose their doctors in the future. The Turkish Doctors’ Association, or TTB, Experts Associations Platform and unions oppose the bill.
Dilemma
The draft bill introduces new regulations to doctors’ working conditions. According to the bill, doctors who work part-time in university hospitals will not be allowed to be self-employed in their spare time. Also, doctors who have private clinics will not be allowed to work at any other health care locations. In short, the bill would prevent doctors who work in public or university hospitals from working in a private hospital or clinic at the same time.
The bill says those who violate the law would be fined. There are around 10,000 private clinics owned by doctors in Turkey. That means around 15,000 doctors, some doctors share the same clinic, and around 10,000 personnel will be affected by the bill, as some will choose to shut down their clinics and others will quit working in hospitals.
In Turkey, there are around 110,000 doctors, and most of them work in public hospitals. More then 20,000 doctors work in private hospitals. According to research conducted by the Turkish Health Union, or Türk Sağlık-Sen, more than 9,000 doctors will face the dilemma of choosing public or private institutions. The full-time system has already been introduced in some state hospitals. Around 80 percent of doctors working in research and training hospitals are already working full-time.
Supporters of the bill, on the other hand, say it has been prepared to ease access to quality health services, which is mentioned in the part citing the justification of the bill. The justification part says doctors can work in three different places: public institutions, private institutions that have a contract with the Social Security Institution, or SGK, or private institutions without a SGK contract. Doctors will be able to work in more then one health institution if they seek to, according to the bill, which added that when necessary, a doctor working in a university hospital would also be able to work in education or foundation hospitals. This system will raise the income of doctors, the bill states. It also aims to decrease working hours from 45 to 40 hours a week.
Reward or punishment?
The new system aims to reward doctors in accordance with the number of patients they treat per day. Some estimate that the highest professor can earn 14,000 Turkish Liras under this system. The system will not increase the current income of the doctors, but will give doctors a chance to increase their income by getting a good share from the working capital fund of the hospital depending on their performance.
However, a regular doctor who earns 2,000 liras monthly could get 4,000 liras through this system. But, doctors will have to work extra hours in order to earn that money. In order to get a good income, doctors will be working more than nine hours a day and spending all their time with patients rather than teaching their students. That may increase the risk of malpractice. The bill has been under preparation for two years and will soon be introduced to Parliament.
Meanwhile, the full-time law was introduced in 1965 and 1978 but removed after a short time because it was unsuccessful.
If this expectation comes true, then the university hospitals where newly qualified doctors are educated and trained will lack experienced teacher doctors. Another scenario says the private clinics will be closed down and doctors will be working extra hours in state-run hospitals to compensate their decreasing income. The full-time draft bill is also criticized as it is believed it will result in longer queues at hospitals and bring an end to patients’ right to choose their doctors in the future. The Turkish Doctors’ Association, or TTB, Experts Associations Platform and unions oppose the bill.
Dilemma
The draft bill introduces new regulations to doctors’ working conditions. According to the bill, doctors who work part-time in university hospitals will not be allowed to be self-employed in their spare time. Also, doctors who have private clinics will not be allowed to work at any other health care locations. In short, the bill would prevent doctors who work in public or university hospitals from working in a private hospital or clinic at the same time.
The bill says those who violate the law would be fined. There are around 10,000 private clinics owned by doctors in Turkey. That means around 15,000 doctors, some doctors share the same clinic, and around 10,000 personnel will be affected by the bill, as some will choose to shut down their clinics and others will quit working in hospitals.
In Turkey, there are around 110,000 doctors, and most of them work in public hospitals. More then 20,000 doctors work in private hospitals. According to research conducted by the Turkish Health Union, or Türk Sağlık-Sen, more than 9,000 doctors will face the dilemma of choosing public or private institutions. The full-time system has already been introduced in some state hospitals. Around 80 percent of doctors working in research and training hospitals are already working full-time.
Supporters of the bill, on the other hand, say it has been prepared to ease access to quality health services, which is mentioned in the part citing the justification of the bill. The justification part says doctors can work in three different places: public institutions, private institutions that have a contract with the Social Security Institution, or SGK, or private institutions without a SGK contract. Doctors will be able to work in more then one health institution if they seek to, according to the bill, which added that when necessary, a doctor working in a university hospital would also be able to work in education or foundation hospitals. This system will raise the income of doctors, the bill states. It also aims to decrease working hours from 45 to 40 hours a week.
Reward or punishment?
The new system aims to reward doctors in accordance with the number of patients they treat per day. Some estimate that the highest professor can earn 14,000 Turkish Liras under this system. The system will not increase the current income of the doctors, but will give doctors a chance to increase their income by getting a good share from the working capital fund of the hospital depending on their performance.
However, a regular doctor who earns 2,000 liras monthly could get 4,000 liras through this system. But, doctors will have to work extra hours in order to earn that money. In order to get a good income, doctors will be working more than nine hours a day and spending all their time with patients rather than teaching their students. That may increase the risk of malpractice. The bill has been under preparation for two years and will soon be introduced to Parliament.
Meanwhile, the full-time law was introduced in 1965 and 1978 but removed after a short time because it was unsuccessful.