Von Ärztemigration sollen alle profitieren – nicht nur die Aufnahmeländer
Ärztemigration darf nicht zum Nachteil ärmerer Länder sein. Deshalb sollten alle Länder danach streben, genügend Ärztinnen und Ärzte auszubilden, um den eigenen Bedarf zu decken. Dafür hat sich die erste Internationale Konferenz der Ärztegewerkschaften stark gemacht, die auf Einladung des Marburger Bundes am 13./14. Juni 2016 in Berlin tagte. Die Vertreterinnen und Vertreter der Ärztegewerkschaften aus 24 Ländern sprachen sich in einer abschließenden Resolution zugleich für einen intensiven Austausch über Fragen der Migration von Ärzten aus. Zuwanderungswillige Ärzte sollten über die Arbeitsbedingungen, die Anerkennung medizinischer Zertifikate und die erforderlichen Sprachkenntnisse im Aufnahmeland informiert sein. Auch sollten sie möglichst frühzeitig auf Ärztegewerkschaften aufmerksam werden, die im Migrationsland den Ärzten mit Rat und Tat zur Seite stehen.
In einem zweiten Block diskutierten die Gewerkschafter auf der Berliner Konferenz über Arbeitszeiten von Ärzten. Dabei wurde deutlich, dass in allen Ländern Verstöße gegen die gesetzlichen Höchstgrenzen an der Tagesordnung sind. Überlange Arbeitszeiten stellten nicht nur eine Gefahr für Patienten dar, sondern bedrohten auch die Gesundheit von Ärzten. Dadurch verliere der Arztberuf an Attraktivität und verschlimmere im Ergebnis auch den Ärztemangel in vielen Ländern, heißt es in der gemeinsamen Resolution der Tagungsteilnehmer. Die Ärztegewerkschaften forderten die verantwortlichen Behörden auf, die bestehenden Arbeitszeitbegrenzungen durchzusetzen. Zugleich kündigten sie an, allen Versuchen einer Aufweichung von Gesundheits- und Sicherheitsstandards in den Arbeitszeitregelungen energisch entgegenzutreten. Ziel müsse es sein, Arbeitszeiten in dem Umfang zu reduzieren, wie dies den Wünschen und Bedürfnissen von Ärztinnen und Ärzten entspreche.
World Medical Journal
Migration of doctors and working time arrangements from an international perspective
The main aim of the first international conference of doctors’ unions was to build a network between doctors’ unions around the world and to discuss common problems and challenges. In his opening speech the Chairman of the Marburger Bund, Rudolf Henke, pointed out that such an exchange of experience and information will not only help to improve working conditions for doctors but contribute, in the end, towards better care for patients. Lutz Stroppe, a high ranking civil servant who reports to the German Minister of Health, emphasised the important role that foreign doctors play in maintaining high quality medical care in Germany. At the same time he considered the possible negative effects the emigration of doctors might have on the source countries. With his welcoming speech he reached representatives of 24 different nations from five continents.
Participants from 11 countries made use of the opportunity to give on the first day a snapshot presentation on the topic of emigration from and/or immigration of doctors to their countries. As the situation in the different countries is diverse the speakers were free to focus on those issues that are of special interest to their union. The representative from the Sindicato Médico do Rio Grande do Sul, for example, reported on the exploitation of Cuban doctors who take part in a government programme and work in underserved rural areas in Brazil. Presentations given by the Austrian Medical Chamber, Swedish Medical Association and Hong Kong Doctors’ Union explained the system of recognition of foreign diploma and the integration process of foreign doctors. In order to facilitate the free movement of doctors the representative of Sindicato Médico del Uruguay drew upon practical experiences to advocate better co-operation between countries and a facilitation of the recognition process of foreign diplomas.
Major push factors which make doctors leave their country such as poor working conditions, bad training opportunities, unemployment or political circumstances where pointed out by the Tanzania Medical, Dental and Pharmaceutical Workers’ Union, Portuguese National Federation of Doctors, Bahamas Doctors’ Union, Myanmar Medical Association Young Doctor Society and Slovak Doctors' Trade Union. Workforce shortages in New Zealand as well as low retention rates of foreign trained doctors where elaborated on by the New Zealand Association of Salaried Medical Specialists.
After the presentations, Armin Ehl, Chief Executive Officer of the Marburger Bund, opened the floor for a fruitful discussion which resulted in the adoption of a resolution. The participants supported the implementation of the 2010 WHO Code of Practice on the International Recruitment of Health Personnel. It was particularly stressed in the statement that all countries should strive to train enough doctors to meet their own internal needs. Furthermore, the participants agreed that doctors’ unions should ensure that migrant doctors enjoy the same working conditions as domestically trained doctors and do not suffer any discrimination. All doctors’ unions present agreed to disseminate relevant information to foreign doctors and to co-operate with one another in order to support migrant doctors.
The main topic of the second day of the conference was the working time of doctors. As all EU member states have to adhere to the European Working Time Directive (EWTD) the key elements of this Directive were explained by Richard Pond, Policy Officer of the European Federation of Public Service Unions (EPSU). Pond also described the continuous fight of EPSU to safeguard the health and safety provisions of this directive.
Examples of the transposition of the EWTD into national law were given by the German Marburger Bund, Slovak Doctors' Trade Union, Portuguese National Federation of Doctors and Austrian Medical Chamber. All four presentations focused on the average maximum weekly working time and the assessment of on-call periods as working time in theory and in practice. Whereas the Austrian Medical Chamber explained that the use of the opt-out clause will be gradually phased out so that from July 2021 onwards, the average maximum weekly working time in Austria will be 48 hours, appalling working time arrangements of up to 120 hours per week were reported by the Jamaica Medical Doctors’ Association. Doctors in Jamaica severely compromised not only their own physical and mental health but, as a result, are not being able to give appropriate care to their patients.
Long working hours are also a problem in Hong Kong. The presentation from the Hong Kong Doctors’ Union showed that while the average weekly working time of people in Hong Kong is 50 hours many doctors work more than 65 hours a week. A recent survey conducted by the Hong Kong Doctors’ Union revealed that over 92% of the participants longed for a significant reduction in their working time. The Union of Employees in the Health and Social Protection of Serbia also complained that due to a shortage of doctors, long working hours of doctors are a reality. However, so far Serbian doctors are not willing to take action. Other interesting snapshot presentations were given by the Sindicato Médico del Uruguay, Bahamas Doctors’ Union, Myanmar Medical Association Young Doctor Society and New Zealand Association of Salaried Medical Specialists before the audiences engaged in a lively discussion.
Again a resolution was adopted in which the participants demanded that patient safety and the health and safety of doctors should be the guiding principles of any working time regulations that cover doctors. The participating doctors’ unions called upon the responsible authorities to enforce existing working time laws and expressed their will to fight against any attempts to reduce the health and safety provisions in existing working time regulations. Moreover, the union leaders wanted to reduce long working hours in accordance with their members’ needs and preferences.
The Marburger Bund who organised the meeting in mid-June in Berlin was delighted that the Sindicato Médico del Uruguay expressed an interest in holding a follow-up conference in Uruguay next year. Also the Bahamas Doctors’ Union are considering hosting a future meeting of doctors’ unions. It is likely that the international co-operation between doctors’ unions will thrive.