The young doctor was on duty in 11 wards at once. Ministry of Health: unacceptable
- Every sixth resident has to be on duty in several hospital departments at the same time, often unrelated to his specialization
- The Residents' Agreement has asked the Ministry of Health for an interpretation of the regulations regarding the implementation of specialization training by doctors and dentists in the residency mode.
- - Resident doctors should not be directed to work other than that which is in line with the training program - the Ministry of Health dispels doubts
- He also points out that the ministry only finances shifts performed as part of the specialization program and it is unacceptable to send residents to shifts within the scope of their specialization to several departments at the same time
It's not uncommon for resident physicians to be on duty in multiple hospital departments simultaneously. They often lack the substantive support of more experienced colleagues, even though their primary goal is to learn.
The absurdities and pathologies in this area were confirmed by the results of a survey conducted last year by the Residents' Agreement among approximately 1,100 doctors undergoing specialization.
"The issue of 24-hour on-call duty and the lack of support from specialists during on-call duty proved to be a particularly pressing problem. Furthermore, one in six doctors admitted that during their specialization training, they had to work on duty in several departments simultaneously, including departments not included in the training program," says Sebastian Goncerz, chairman of the Residents' Agreement of the Polish Physicians' Trade Union (OZZL).
Such practices violate the terms of the agreement between the Ministry of Health and the hospital. "Secondly, they impact the quality of training, as the program is intended to enable physicians to acquire the knowledge necessary for a given specialization. By assigning them to departments unrelated to their specialization, the hospital prevents them from learning what they should have learned during training," notes the chairman of the Agreement.
The record holders were able, as Goncerz points out, to send a resident to be on duty in 11 departments simultaneously, where he had a total of about 300 patients under his care.
Often, the requirements, internships and procedures provided for in the specialization program were not implemented by the centers, and doctors in training were regularly used to fill staff shortages.
Therefore, the Residents' Agreement has requested the Ministry of Health to interpret the regulations regarding the implementation of specialization training by physicians and dentists through residency. Rynek Zdrowia has obtained the Ministry's response on this matter.
The Department of Medical Personnel Development at the Ministry of Health admitted in an official letter that residents are sent to training units to train and implement the training program, and not to "patch up" staff shortages at the center.
"As a rule, a resident physician should not be referred to work other than that specified in the training program ," Mariusz Klencki, director of the ministerial department of human resources development, noted in his interpretation. He quickly added, however, that in exceptional and justified cases, the head of the unit may make such a referral.
He also pointed out that the Ministry of Health only finances medical shifts performed as part of a specialization program , and only in the number resulting from that program, by physicians undergoing specialization training in residency. "If the number of shift hours actually performed by residents is higher, the unit finances this 'surplus' from its own funds and cannot be reported in the settlement of the residency contract," he explained.
However, he considered it unacceptable for a resident to be on mandatory medical duty within his specialization in more than one organizational unit of a training unit at the same time.
- A resident doctor on mandatory duty may be directed to other organizational units only as part of a consultation - emphasized Klencki.
Additionally, he noted that while completing a mandatory training course, a resident is not obliged to perform medical duties unless he or she consents to this.
"The community desperately needed to take such a decisive stance," says Sebastian Goncerz. "The Ministry of Health's interpretation confirms that a resident physician's primary purpose is to learn during their specialization training. Of course, they are also an employee during this time and perform work-related duties, but these duties cannot conflict with the specialization program," he emphasized in an interview with Rynek Zdrowia.
The Ministry of Health also reminded in its official position that the issue of specialization training is regulated by the provisions of the Act on the professions of physician and dentist and specialization programs in a given field.
"Regulations (...) generally do not specify which healthcare services physicians may perform. Therefore, it is assumed that a physician with a license to practice, including a resident, is entitled to practice without restrictions, and therefore may perform any procedures and tests," the department head noted.
He also noted, however, that Article 10 of the Code of Medical Ethics states that a physician should not exceed his or her professional skills when performing diagnostic, preventive, therapeutic, and certification activities. If these exceed his or her skills, "he or she should consult a more competent colleague."
- While the law formally allows the provision of all health services, ethical standards set certain limits in this respect - emphasized Mariusz Klencki.
In response to questions related to the performance of mandatory medical duties, he also noted that, in accordance with Article 16f, paragraph 3 of the Act on the Medical and Dental Professions, a resident is obliged to perform duties specified in the program of a given specialization:
- within the maximum working time specified in the Act on Medical Activity,
- or to work in shifts, if the specialization program provides for it, and also when the doctor undergoing training and the head of the specialization work on the same shift,
- or work equivalent working hours, if the specialization program so provides and this system is applied to all doctors in the accredited unit.
He then reminded that the unit director is responsible for the duty schedule, who, in consultation with managers and heads of departments, determines the number of hours on duty and their number for each doctor so that it is consistent with the work of the entire unit.
In practice, this means that "depending on the work system adopted in a given unit (standard, shift, equivalent), medical on-call shifts may be performed for various hours." They may be 8, 12 , or 24 hours. "It is important that in the unit's billing period, e.g., a month, they do not exceed an average of 10 hours and 5 minutes per week ," noted the director of the Department of Medical Personnel Development.
He also informed that any gross irregularities in the implementation of specialization training should be reported to the Ministry of Health.
Following the publication of the survey results, residents discussed them with former Minister of Health Izabela Leszczyna. "After presenting the data, the Minister admitted that the irregularities described in the survey should be countered. We look forward to continued cooperation in this regard with the new leadership of the ministry," Goncerz emphasizes.
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