By: Nina Žoher
“The healthcare remains a key priority for this government’s operation. And there is no doubt about it,” assured Prime Minister Golob last year in the temple of democracy. Instead of rolling up its sleeves in practice and directing all efforts towards arranging the healthcare system, the government recently even went as far as restricting the right to strike for doctors, which, in practice, of course, will not solve the public healthcare issues.
The ongoing doctors’ strike, the longest so far, now extending into the 4th month, shows no signs of ending. Since the very beginning, the government has been waging a campaign against doctors, accusing them of being only concerned about money and not the well-being of patients, forgetting that the strike was initiated due to their failure to fulfil the agreement signed with the Fides union in January last year. As the government fails to fulfil its promises and demonstrates through its actions that it does not understand the true state of healthcare by not seeking solutions to address the issues, Fides continues to persist with the strike. They simply cannot accept that in our country, “the definition of public healthcare relies solely on the readiness of doctors and other healthcare workers to work overtime every week”.
Many notice a significant lack of understanding of how the system managed by the Ministry of Health operates. This is evident, among other things, by the recent stance expressed by the ministry after a meeting with hospital directors. Despite witnessing increasing delays in non-urgent surgeries, they insist that despite the doctors’ strike, there has been no deterioration in hospital conditions. “The explanations from the minister and her aides, claiming that healthcare conditions are not worsening, and that the system is functioning well, while only 60 percent of the elective surgical programme is being carried out, demonstrate a profound misunderstanding of the system they manage,” noted renowned cardiologist Dr Samo Vesel on social media platform X.
Doctors are visibly concerned about the state of healthcare
Doctors are significantly more concerned about the state of healthcare than the ministry, as evidenced by several letters they have released to the public during the strike.
“In recent weeks, certain words and phrases have been echoing in our ears: Hippocrates, gods in white, amphibians, gluttons… A lot of ink has been spilled against us because the country’s leadership spares no means to denigrate our profession,” warned doctors from Ptuj General Hospital in a critical letter. “Despite having had job postings for one or more internists at Ptuj General Hospital for several years, we remain without candidates,” they explained regarding the staff shortage, adding that they have also been unsuccessful in recruiting reinforcements from former Yugoslav countries. According to them, the existing staff covering multiple workstations simultaneously and taking on more shifts is the only way to address the staffing crisis.
Due to demographic changes and an aging society, the demand for healthcare services will increase each year, while there is a significantly insufficient number of doctors in Slovenia. According to them, without changes in public healthcare, Slovenia is heading towards its painful demise. “Using medical ethics to cover up one’s own inactivity and incompetence in solving public healthcare issues is laughable and immature. We strongly condemn such behaviour!” emphasised the doctors from Ptuj.
“JUST AS PUBLIC HEALTHCARE IS THREATENED TODAY, THE OLDER DOCTORS CANNOT RECALL SUCH A TIME.”
So many lies and deception about healthcare have never been seen before
“Just as public healthcare is threatened today, the older doctors cannot recall such a time. Members and non-members of Fides are united in agreeing that there has never been so much lying and deception about healthcare,” warned the Slovenj Gradec doctors in a letter, emphasising that the strike is a reflection of years of impossible working conditions. “If politicians would listen to us, they would realise the true state of our public healthcare, they would be concerned, and genuinely willing to find solutions,” they believe. They argue that to find a solution, we must first acknowledge “that we have a serious problem, which can only be solved by establishing normal working conditions in public healthcare…” According to them, the government’s procrastination is unacceptable, and it is becoming increasingly clear that the government “actually does not want solutions for public healthcare and is the one depriving patients of the right to adequate treatment.”
“We have had enough of labelling those who work extra as ‘profiteers’ and ‘two-faced’. We have worked more because we wanted to maintain a high level of healthcare services in Slovenia,” assert the determined employees of Izola General Hospital. They also point out that even nurses are setting records in overtime and shift work. “All healthcare staff are driven by ethical considerations for overtime.”
The government is only seeking shortcuts with decrees and measures, which further complicate the work
Family doctors have also had enough. As they say, for a decade now, they have been warning that there will be a significant decline in family doctors in the coming years, as nearly a quarter of doctors in general practices will retire. They are concerned about calls to “further increase the number of assigned patients per doctor”. According to them, with the help of appropriate measures, the government should relieve doctors of administrative tasks, “but unfortunately, with decrees and measures, the government is only seeking shortcuts and mathematical paths that further complicate the work,” they criticise. Since the ministry responded to their warnings with deception and relativisation of the situation, they responded with another letter, signed by even more family doctors. In this letter, among other things, they pointed out that when the ministry talks about an increase in the number of all doctors by 31 percent and general and family medicine doctors by 32 percent, it fails to mention that from 2013 to 2022, the number of insured persons increased by 100 thousand, and the number of insured persons over 65 increased by 26 percent. The fact that “only 22 candidates applied for the current call for specialisation in family medicine for 70 available positions” is, in their opinion, evidence that dramatic times are ahead.
They do not have a single idea of how to organise healthcare
After seeing on January 1st of this year that the announced healthcare reform, which was supposed to bring a more accessible healthcare system and shorter waiting times, would not happen, we have now witnessed the proposal for a law on healthcare digitalisation. This expects healthcare workers to enter healthcare documentation into the central electronic healthcare system. According to them, this should facilitate patient healthcare management. According to Finance, “it is also proposed that the Health Insurance Institute (ZZZS) may not pay for services to the provider until they are recorded in the central healthcare information system”. However, because the proposed law, which was sent for a one-month discussion, includes the introduction of fines, and doctors who do not consistently enter patient data into eKarton face the possibility of temporary revocation of their medical license for up to five years, there is unrest among doctors. “They do not have a single idea of how to organise healthcare. Whatever they touch, they break,” said Dr Federico V. Potočnik, criticising the proposed legislation.
“Do patients need doctors who know medicine, or perhaps you have elected and need bureaucrats who have no clue about medicine but know how to type and manage data?! Instead of patients, we will only be entering data,” said critical Dr Tina Bregant, who said that the last time she was in the office, she realised that she was only looking at patients for 60 percent of the time, spending 40 percent of the time typing, managing referrals, medications – in other words, paperwork… Dr Alenka Forte also believes that doctors’ criticisms are entirely justified. Regarding the proposed law on digitalisation, she explained to Nova24TV that it places digitalisation at the level of the law, but that it does not represent “any added value for the healthcare system itself, quality, and safety of treatment”.
She cautioned that it is not evident from the draft law whether the information system for primary healthcare will be unified, as there is no mention of a unified eKarton. “It is also not evident whether digitalisation will raise the substantive level to a higher degree.” In her opinion, doctors should only focus on the patient and diagnostics. She believes that the system is primarily designed for system control, providing various databases for all kinds of analysis and processing. “We are becoming totally monitored – patients and healthcare workers.” The Slovenian Medical Chamber is also outraged by the law. “I do not even know if the person who proposed this understands what this means. This means that the next day, that doctor will no longer be in the family practice,” warned Dr Bojana Beović, President of the Slovenian Medical Chamber, speaking for 24ur programme.
Will doubling the permissible waiting time solve the problem of unacceptable waiting?
While the Ministry of Health announced the abolition of very rapid referral levels just last year, they have now come up with the idea that by forming a regulation, which is supposed to come into effect in May, they will address the unacceptable waiting times for referrals with a very rapid level, the number of which, according to them, is increasing, so they will increase the permissible waiting time from 14 to 30 days. However, in this specific case, Young Doctors, who believe that “Milčinski could have written a sequel to Butalci book just from the topics at the Ministry of Health,” warn that the whole point is to be able to report in 3 months that the number of those waiting has decreased. “Why do we allow them to throw sand in the gears?” they still wonder on social media X. “Another regulation prepared without proper consideration and necessary coordination,” they believe in Fides.
“WITH DECREES AND MEASURES, THE GOVERNMENT SEEKS ONLY SHORTCUTS AND MATHEMATICAL PATHS THAT FURTHER COMPLICATE THE WORK.”
Only dictatorships have so far been able to afford to change the rules in the midst of a strike
The fact that only dictatorships have so far been able to afford to change the rules in the midst of a strike was critically pointed out by the leader of SDS Janez Janša in relation to the recently adopted government amendment to the law on medical service, which expands the range of services that doctors must provide during a strike. He says this is entirely unacceptable from the perspective of the spirit of the Slovenian constitution and the fundamental principle of democracy. The Fides does not hide its disappointment, as according to them, the amendment represents a “grossly disproportionate and excessive interference with the constitutional right of doctors to strike and effectively abolishes this right”. They see its adoption as a dangerous precedent that will not only affect the right to strike of doctors. “Such behaviour means that the government can take the right to interfere with the constitutional rights of all public sector employees unilaterally and arbitrarily from a position of power. In democratic systems, the decisions of authorities are not absolute,” they emphasised, announcing that, trusting in the rule of law, they will initiate a process of assessing the constitutionality of the amendment before the Constitutional Court of the Republic of Slovenia. According to them, the government, by insisting on the adoption of the amendment, has once again shown that it “truly does not understand the state of Slovenian public healthcare”. “By adopting unreasonable measures, the situation will only worsen, and unfortunately, we will be further away from actual solutions,” they concluded.
