Mon, Oct 10, 2016 page6

• Medical staff in a labor act bind

  • By Shih Shou-chuan 施壽全
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  Whether doctors should be included in the Labor Standards Act (勞動基準法) has been debated for a long time. The Ministry of Health and Welfare has decided to implement the inclusion, which is to take effect in September 2019.

  The announcement has inevitably sparked further debate. Doubts and questions that were raised have to be examined and treated objectively. Two questions remain: How to deal with the impact the policy is likely to have on hospital operations, and how to safeguard the public’s rights to medical attention.

  The biggest concern is that residents are limited to 88 hours maximum per week and attending physicians have no maximum working hours at all. This is why Taiwan struggles to meet medical needs 24 hours per day. If working hours are trimmed after the new law takes effect, hospitals are likely to be short-handed in providing care for patients.

  However, precisely because of the peculiarities of the medical profession, Article 84 of the act allows alternative working hours to be negotiated for “professional workers with designated responsibilities.”

  If the ministry could take into account the human resources factor as it gradually goes about implementing the maximum of 88 working hours, hospitals might be able to avoid immediate operational difficulties. However, one issue that requires serious consideration is whether it would be possible to implement all complementary measures after the number of working hours are cut and hospitals experience a shortage of doctors.

  To prevent repercussions for patients, it would be necessary to provide supplementary personnel. This responsibility falls on the shoulders of nurses. Although nurses are certified, their work often touches on gray areas that are not protected by law.

  There are deliberations on the introduction of physician assistants, but there is a long way to go before that can become a reality. Therefore, the date that the act is set to take effect should not be determined until the conditions are ripe for implementation.

  Medical professionals have been discussing the possibility of stratification and patient referral. By better allocating resources, hospitals at different levels could meet their responsibilities and workloads would be fairly distributed and prevent employees being overworked.

  The problem is that the medical environment is M-shaped. Reform takes time and effort. Although this is the goal, it will not happen overnight, so it is of little use to solve the problem of overwork.

  Some people have said that as a result of staff shortages, it would be necessary to recall doctors working in remote areas, and in order to compensate for staff shortages, authorities might reintroduce state financed programs for medical students.

  However, this program has failed in the past. To revitalize it, complementary measures must be in place to ensure that students receive sufficient training to work professionally and independently, and that they are willing to accept assignments in remote areas.

  If they break the contract, they should be penalized, but if the punishment is too severe, it might give the impression that the government is taking these preventive measures because it sees medical students as thieves. If the punishment is too light, there could be too much room for manipulation.

  How to strike a balance to make it reasonably effective requires a lot of thought.

  If the number of working hours can be renegotiated, the residency training program, which medical associations fear might be compromised, would theoretically be little affected. The most essential issue concerning medical personnel is how to properly allocate doctors so that medical resources satisfy the demands of society.

  In Taiwan, internal medicine, surgery, gynecology and obstetrics, pediatrics and emergency are the five least popular departments for many reasons. In part it has to do with medical practitioners’ values: They do not want to engage with arduous and trouble-making departments. Medical practitioners who lack passion and devotion are not be able to attain a sense of achievement or feel proud of what they do.

  However, passion and devotion are what you are born with, not something that can be imposed. Sometimes people who have passion and devotion unfortunately get involved in medical disputes, which could be quite discouraging.

  To revitalize these short-handed departments, it is necessary to amend the Medical Care Act (醫療法) and formulate legislation that addresses medical disputes, so doctors, who believe their calling is to save lives, can be free from criminal liability. If that can be done and more people are willing to work in unpopular departments, the affects of the act can be much attenuated.

  Shih Shou-chuan is Mackay Memorial Hospital’s superintendent.

  Translated by Ethan Zhan
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