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About a quarter of medical graduates do not enter the Czech healthcare system every year. Some of them go abroad and enter hospitals, most often in Austria or Germany.
It is these states that are currently very often argued against the background of the planned protest of about six thousand doctors who want to fight for more favorable working conditions. Today, the representative of doctors is waiting for another round of negotiations with the Ministry of Health.
Seznam Zpravy therefore turned to five Czech doctors who work abroad to find out what the reality of the German and Austrian healthcare is like. And it turns out that the problems encountered by Czech doctors are hard to imagine for our southern and western neighbors. Starting with endless overtime and ending with low wages.
“If I lighten things up a bit, I earned money for a new vacuum cleaner in two years of work. My friend, who finished school anyway and went to Germany, arrived in a new car that he paid for in cash,” recalls Vojtěch Danihel with a bit of exaggeration about his beginnings in a Czech hospital.
He always wanted to devote himself to intensive medicine in the Czech Republic. But he quickly sobered up as he looked over his payslips. So he decided to move to Germany. He left in 2015 and saw the change immediately.
“I earned twice as much for standard working hours without night shift and service hours than with five shift shifts in the Czech Republic,” describes Danihel. With overtime and after recognition of years of service, it even jumped to three times.
Money is not the only reason for Czech doctors to go abroad, but it is a crucial aspect. In Austria and Germany, doctors also have tabular salaries. Unlike the Czech ones, you can make a living with them. A domestic doctor has no chance to reach the decent level of a university graduate without overtime.
“My basic salary is 3,500 euros (about CZK 86,000) for 40 hours a week. In addition, each night service is reimbursed with a flat rate, which varies depending on how many services I do per month, the more services, the higher the flat rate, but on average it is 200 euros (about 5 thousand CZK) per night service. In addition, there is an hourly rate – during the afternoon it is a normal amount, at night it is 200 percent,” explains Barbora Zelenková, another of the Czech doctors abroad. She works in Linz, Austria.
At the same time, Zelenková has not yet started her specialized education, so she is at the lowest level of the medical table, which in the Czech Republic would mean barely 40 thousand crowns gross. At the same time, with certification, he can reach 1.7 times his current salary in Austria. In the highest category are primary care physicians, who have roughly three times the basic salary of a starting doctor, without overtime, bonuses or services. However, it is necessary to add that in Austria there are higher levies, including fees to the medical chamber.
Similarly, the currently protesting Czech doctors would also like to readjust the salary tables. They are asking the Ministry of Health to increase salaries according to expertise from 1.5 times to three times the average salary. So far, however, the ministry has not even begun to act on such a step, although these demands are part of the memorandum that the doctors concluded with the then government in 2011 after the protest action Thank you, we’re leaving.
Violation of the Labor Code? Unthinkable
But Czech doctors don’t go abroad just because of poor salaries. They often run away from excessive overtime work that goes beyond the scope of the Labor Code. In Austria or Germany, there is no such thing as doctors having multiple contracts with medical facilities, and laws were completely circumvented in this way.
“In Germany, it is now the case that if a doctor has more than four night shifts per month, their remuneration is increased. However, the maximum allowed to work is 24 hours, and it is completely out of the question for a person to stay at work after the service, as it usually happens in the Czech Republic,” adds Danihel.
At the same time, full-weekend shifts are also common in Czech hospitals. Although of course such a practice is against the law.
“Unlike in the Czech Republic, in Germany I have the certainty that the work I do will not be lost anywhere in the reports, and I will also be adequately paid,” says Daniel Slavčev.
He and his wife went to Germany right after school. What deterred them from joining the Czech healthcare system was the fact that they would have to work in endless shifts without proper remuneration.
Young doctors in the Czech Republic are now trying to negotiate amendments to the Labor Code. They are offering the Ministry of Labor and Social Affairs a concession that they will nod to legalizing 24-hour shifts, but they want additional payments for them. That is, something that is quite common not only in German-speaking countries. However, the Ministry has so far refused to accept the doctors’ comments.
Dismal working conditions and reluctance to change anything lead young doctors anywhere but to the Czech healthcare system. At the same time, even in Germany or Austria, problems with compliance with the rules are being solved. But doctors have a chance to call for change.
“At the hospital where I started, it happened that our overtime hours started to increase. So we went to the hospital management, where we argued that they couldn’t force us to work more than four 24-hour shifts a month. So the hospital employed extra doctors for services and the number of services decreased. So when we got together, they arranged it,” adds Daniel’s wife Barbora.
However, if a Czech doctor wants to return to his homeland, he is often faced with a very hard clash with the reality to which he has long since grown accustomed.
“When I was considering returning to the Czech Republic, I had a human resources officer on the phone who vehemently explained to me that you can’t go home after work, so it’s illegal for 32 hours straight. But they say she sleeps on duty, which I don’t know how she could have known if she never worked there,” discouraged doctor Martina (her last name is not given on request, but the editors know it) to return from Germany. Today he works in Bavaria and has no plans to return.
Non-transparent Czech Republic
However, graduates of medical faculties go to German-speaking countries immediately after school for another reason. In the Czech Republic, the path to certification is very complex and non-transparent. Without it, doctors cannot work completely independently.
“For me, it was the main reason why I went to Germany. After five years, I was admitted to the attestation without any problems, I didn’t miss anything, I had everything completed and signed,” adds Martina.
At the same time, a number of young doctors in our country complain that their leaders condition their admission to the certification exam with a number of concessions. For example, they must violate the labor code and take extra services. Seznam Zpravy described some of these cases in a recent article. It is also one of the points about which the Section of Young Doctors of the Czech Medical Chamber intends to protest.
“I find it absolutely terrible when the Minister of Health (Vlastimil Válek, editor’s note) says that he had no idea what was happening in the hospitals, and he is a doctor himself,” comments Zelenková on the words of the head of the Department of Health.
Válek stated some time ago that he was surprised by the information that there should be violations of the labor code in hospitals. He promised to investigate the situation and if wrongdoing is proven, it is a signal to him that the director of the hospital in question should be dismissed.
“We also left because of the certification system. In Germany, compared to the Czech Republic, it is completely simple. We don’t have to constantly deal with whether the workplace has accreditation or whether they will let us take the exam. Everyone takes this into account completely automatically, and it is not a problem to leave for another workplace for, say, half a year,” adds Daniel Slavčev.
The Czech health system is thus against itself. Although it faces a shortage of doctors in basically all specialties, it puts up so many obstacles for them that dozens of them prefer to go abroad every year, just like the Five Czechs in Austria and Germany approached by Seznam Zrávami.
And would any of them like to return to the Czech Republic?
“If the basic salary were increased, many doctors would perhaps not consider going abroad at all, or would even return,” Slavčev states as a basic condition.
“I wouldn’t go to a Czech hospital,” responds Danihel simply.
“I would like to return to the Czech Republic someday, but only if the overall working conditions improve. I don’t know why I should voluntarily go back to a system that is so much worse than the one I work in now,” Zelenková thinks.