From a medical professionals point of view, there are two long-standing issues that Polish governments have failed to address – chronic underfunding and poor working conditions. Current healthcare spending in Poland is one of the lowest in Europe; the Polish government spends 4,4% of the gross domestic product (GDP) on healthcare, whereas predictions of the Organisation for Economic Co-operation and Development (OECD) suggest a minimum of 6,8% GDP expenditure is needed to maintain a functioning healthcare system. In addition, the number of doctors per 1000 inhabitants is 2,2, an indicator that has not changed for more than 20 years, being one of the lowest in Europe (European average being 3,4/1000). Due to the low number of available health professionals, voluntary overtime has become the expected norm by employers. According to the EU Working Time Directive and Polish labour law, the working week for doctors should not exceed 48 hours. The EU Directive intends to protect young doctors from the dangers of overtime and ensures adequate rest periods. Studies have shown that following the 48-hours-a-week rule reduces the chance of making mistakes. Nonetheless, there is a possibility to opt-out from this Directive. Doctors can extend their working-hours, but they cannot reduce the time needed to recuperate.
Opt-out in its current form has led to a situation, where it is estimated that the typical junior doctor in Poland works 60 to 90 hours in a week in one workplace. The European Junior Doctors have warned that the opt-out can be dangerous because it can be used for work exploitation and should therefore be considered carefully. In addition, trade unions have also argued against the use of individual opt-out on the basis that the Working Time Directive is essential to protect health care professionals and the public.
As such, the problems stemming from the lack of medical professionals are further exacerbated by low salaries and large-scale migration of doctors. In 2016, the average salary of a junior doctor in Poland was 3.13 euros per hour, with fully trained specialists receiving only slightly more. As a result, more than 89% of doctors in Poland need to work extra hours to support their family. After a series of recent protests, the Polish government has said it will increase salaries to 4.17 GPB per hour (4.68 euros per hour). Since 2005, almost 10,000 doctors and more than 2,500 dentists have left Poland. This emigration of health care professionals is not specific to Poland. A recent POLITICO analysis of European Commission data has found pronounced emigration of (especially young) health care professionals from Eastern and Southern Europe to Western European countries with higher healthcare spending. Health spending per capita varies drastically between EU countries, from 816 euros in Romania to more than 4,000 euros in Luxembourg, Germany and other Western European countries.
Finally, Polish trainees are often required to work outside their chosen specialty, which compromises the quality of their specialty training. As the number of residencies in Poland is limited and often does not match demand for specialists, trainees wishing to undergo training in a particular specialty may have to do so unpaid.
From the patient’s perspective, current low healthcare spending, which results in low salaries, excessive working hours, poor training and high emigration rates, leads to consequences that are of serious concern. According to the OECD Health at a Glance Report 2017, Poland has long waiting lists for surgical procedures compared to other European countries. Patient waiting lists for ambulatory diagnostic procedures are often several years long. In addition, compared to other OECD countries, Poland doesn’t perform well on policy-focused child well-being, indicating policy improvements should be a priority. For example, infant mortality in Poland is above average and almost three times as high as that in Iceland and Sweden, the countries with the lowest infant mortality rates. Also, child mortality and rates of suicide among Polish boys are higher than average.
Last year, Young EAP showed its full support to our Polish colleagues in their efforts to promote the standards for their patients. Like the World Medical Association, we urged the Polish Prime Minister to step in and negotiate an acceptable solution. So far, the Polish government has committed to increasing healthcare expenditure to 6 percent of GDP by 2025. Considering the current pressing issues at hand, this offer was deemed too slow and falling short of the minimum 6,8% recommendation. As such, we find it regrettable that a sufficient solution has not been found, and that our Polish colleagues have been forced to take the next step in their protests, by limiting their workload to 48 hours per week (following the EU Working Time Directive and Polish labour law) since the beginning of January this year.
We therefore would like to reiterate our previous positions and continue to encourage the Polish government to actively involve the Polish junior doctors in seeking solutions to the issues at hand and also learn from experiences in other European countries faced with similar problems. We support and emphasize the European Junior Doctors recommendations that rest periods are to be respected in order to protect the physicians’ health and ensure the quality of care. Also, we would like to highlight that several European examples of alternatives to the opt-out in the health sector exist. Several countries, including Estonia and Hungary, have taken measures to persuade health care professionals to stay, for example increasing wages or providing funding for medical services. Finally, training standards exist for the content and quality of training in core paediatrics within European countries and should be used as guidance.
A healthcare system relies on its healthcare professionals. Acceptable working conditions for healthcare professionals and the quality of their training are the cornerstones of public health and patient well-being and as such should be priorities for any government in Europe.
About the authors
Allan Metsar is a member of Young EAP. He is a first year paediatric resident at Tallin’s Children’s Hosptial in Estonia. He is a member of Young EAP.
Katarzyna Wiaçek is a member of Young EAP. She is a paediatric resident at the Department of Paediatrics at the Regional Hospital nr 2 in Poland.
Sian Copley is member of the RCPCH Trainees’ committee and of Young EAP. She is a 3rd year paediatric trainee at the Health Education North East in the UK.
Lenneke Schrier is the European Junior Doctor Representative to the European Academy of Paediatrics. She is a 4th year paediatric trainee at the Leiden University Medical Center in the Netherlands.
Dr. Stefano del Torso is the European Academy of Paediatrics’ Executive Director and the Chairman of the European Academy of Paediatrics Research in Ambulatory Settings network – EAPRASnet. He is a Specialist in Pediatrics and Cardiology , works as Primary Care Paediatrician in Padova, Italy , and is also the President of CHILDCARE WORLWIDE- CCWWItalia Onlus, a non-profit association organising humanitarian initiatives for children in developing countries .