At home: the government has decided to reassign doctors and restrict second jobs

In a letter, Interior Minister Sándor Pintér informed the president of the Hungarian Medical Chamber and representatives of the parliamentary factions about how the government decided on the decree implementing the Law on the legal relationship of doctors.

There was a long debate on the details, with the rerouting rules contained in the law rejected by the vast majority of doctors, just when the restriction of second places was a contentious point.

According to a letter from Sándor Pintér, the government accepted the proposal that those in the medical service “in peacetime” can only be sentenced to 44 days a year under the Labor Code (1 + 1 year was included in the law as an option), but this is not valid during emergencies. .

The government also accepted the argument that in families where there is a child under the age of 16 and both parents are “doctors in employment”, only one of them could be assigned.

It was also decided that with the commercial contract, those who worked in primary care would also receive a “perceptible” salary increase, as they were outside the law.

According to Sándor Pintér, the government did not agree to significantly relax the conflict of interest rules or significantly delay the deadline for their introduction.

“This is because the proposals go against one of the principles that lead to correct the functioning of health care, namely its political position on the partial separation of public and private health care.”

Participants in the negotiations were concerned that the legal deadline for informing the person concerned about the intended content of the health service employment contract was too short, so the government decided that this information should only be provided after completion of the emergency.

Since, therefore, it is not possible to conclude new contracts within the legal deadline, that is, December 31, the government has changed the deadline. They receive a salary increase guaranteed by law regardless.

Sándor Pintér’s letter was published by the Hungarian Medical Chamber on its website and on its Facebook page, where the chamber’s president, Gyula Kincses, added in a post that “the negotiations appear to have been simple, if not simple” .

In first reading, he wrote that the rules on secondment would be amended as requested by the MOK, with an increase of “appreciable level” in primary care, the additional support of 71 billion in the regulation published this week.

most conflict of interest rules will remain (under them, will not be removed by 2023).

The last comment is interesting because in recent weeks, it has been discovered that the government is wasting everything with the introduction in 2023. Treasure estimates that the new employment contract will have a good chance of being signed by doctors around June 2021.

The execution decree has not yet been published in the Magyar Közlöny (Minister Gergely Gulyás said yesterday in the government information on the hvg.hu issue that it is still being worked on), so it is not known how long it will be they will postpone the deadlines mentioned by Pintér, such as the rules on second jobs. that, like those who are exempt from the second job restriction.

In this sense, the MOK stated that the possibility of occupying second places must be guaranteed:

bad examples need to be banned to avoid, not to make honest professional development work permission

Last week, based on the negotiations, the MOK even wrote that a 2-year delay in conflict of interest rules for second jobs is expected. The MOK has concluded that if it really takes two years, the detailed rules do not need to be defined now, because there is enough preparation time to develop workable and consensual rules based on actual experience.

At the same time, the MOK also asked that gynecologists not be discriminated against, “because that is the basis of corruption, the gratitude of money.” At the EMMI meeting it was said that the Government insists on this for reasons of “population policy – protection of the family”.

But what is a conflict of interest about?

The law not only stipulates that “a person in a medical service relationship”, more simply a doctor working in public offices, hospitals, can work in a secondary position only with the prior permission of a government designated body, but the doctor cannot provide the same patient with the same problem in his private practice and in public care.

There will be exceptions to this, in the justification of the bill, emergencies and obstetric and gynecological care have already appeared. However, the general practice will be that after the examination in private practice, the doctor cannot tell the patient to go to the hospital the next day, prescribe a large laboratory, a CT scan, or perhaps he will have surgery there – he explained to hvg.hu a health expert requested anonymity in early October after the bill was introduced. Similarly, the operation of a patient in a public hospital cannot be ordered for a private control order.

To hear countless examples of the latter, for example, a doctor told our reader after an intervention, that he can be admitted to the hospital in two weeks, but his private order is available at 3 pm the next day.

With the removal of the trick, waiting lists will not be shortened – there will be no more doctors – but it is a fact that everyone starts with the same possibilities. Although it has been suggested that the system could be circumvented by a private doctor sending his patient to a public hospital with his colleague, the expert said that this trick could be used by both the patient and the doctors.

As of June, patient data has been collated in the “cloud”, that is, the Electronic Health Services Area (EHIC) includes public and private services in addition to the name (or number) of the patient, but also it is known which physician provided them. One of the cheating doctors can be “caught” because after diagnosing a disease, he did not continue to treat the patient (the patient can even sue for the latter), and the receiving doctor may suspect a patient who appears without a history and then he is sent for a laboratory examination. expert.

The change can be integrated into a serious reform of the health system

While the detailed rules are unknown and it is unknown what the conflict was about in the negotiations, that is why Gyula Kincses wrote about it now, seeing the letter, the negotiations were successful, in any case the health expert Gabriella Lantos – party of József Pálinkás one of the founding members: after presenting the bill, he spoke on the hvg.hu podcast about the original version, medical barons can lose more, they have to make a very serious decision about how to proceed and did not understand why what gynecologists have a loophole.

Lantos also spoke about if doctors can no longer work in more places, smaller hospitals could lose because there will not be enough professionals. “These small hospitals, therefore, will not be closed by the government, but because of the shortage of doctors,” Lantos said at the time. According to Lantos, by limiting the number of second jobs, a quarter of a year after the law came into force, it will be clear for how many doctors there are enough doctors in Hungary.