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On Wednesday, the Norwegian Medical Association announced that 23 doctors in Narvik, Tromsø, Trondheim, Bergen and Stavanger will go on strike starting Monday, October 26.
The strike only applies to the emergency services and the doctors will continue to work as normal doctors.
The following week, the strike could intensify further.
Doctors want a limit to the number of hours a GP may be required to work in an emergency room. But KS, which organizes the municipalities, does not want to introduce that limit and believes that the workload of GPs should be seen as a whole.
According to the Norwegian Medical Association, doctors in smaller municipalities work an average of 37.7 hours on-call per week, either in the form of on-call, on-call at home or on call. This is in addition to a normal work week as a GP.
A quarter of doctors have more than 52.8 hours of emergency care a week. 1 in 10 doctors works 100 full hours of emergency care or more per week, the doctors say.
– Presentation without varnishing
Health and care manager Alf Lorentsen in Karlsøy emphasizes that his own municipality has a good collaboration with the four doctors who work in the municipal medical service. – They assume their social responsibility in the best way.
Photo: Karlsøy Municipality
Alf Lorentsen is head of health and care in Karlsøy, a small municipality in Troms and Finnmark with just over 2,000 inhabitants.
He believes that the Norwegian Medical Association is exaggerating a lot when it states that smaller municipalities require doctors to work up to 70 shift hours in addition to a normal work week.
– In working life in 2020, this sounds completely crazy. It is presented as if municipalities are making demands that are completely on the side of Norwegian working life.
Not so, believes the health director.
What does not emerge is that the doctors on duty in the smaller municipalities have shifts mainly in the form of home shifts or late shifts.
– Without a broader explanation of what the home guard and the rear guard are, it is obvious that everyone must think that KS and the municipalities make completely irrational demands on doctors, says the health director.
Your example is if an LIS doctor, formerly called a doctor on call, has a weekend shift. Then another fully competent doctor must have an emergency guard.
Compensation is the same whether you are present in the doctor’s office or sitting at home.
– The emergency guard consists of having a phone in his pocket. But it lasts 64 hours, and of course contributes to the high hours, he says and elaborates:
– If an on-call doctor in a typically smaller municipality like Karlsøy has an 8-hour day shift, a mid-week home shift, and a shift shift for the LIS doctor’s on-call shift this weekend, so the total is an 88 hour shift that week. That sounds inhuman.
But for 80 of these 88 hours, work effort can be limited to keeping a phone in your pocket, by idle emergency preparedness, he adds.
– Trivialize
Nils Kristian Klev, leader of the Association of General Practitioners, tells NRK that this conflict is exclusively about the workload of doctors and where work in the ER adds to an already full work week.
– The health manager at Karlsøy minimizes the fact of having a work shift, but it is additional to the regular shift and takes up the doctors’ free time, says Klev.
– The health director trivializes, says Nils Kristian Klev, leader of the Association of General Practitioners.
Photo: Thomas B Eckhoff / Norwegian Medical Association
Klev says that when doctors are on call, they must move in a few minutes in case of acute illness or accidents.
For example, doctors must be prepared for a babysitter, and there is a limit to what they can do while having such babysitters due to the requirement of an emergency call.
– If you work a 40-hour workweek, there are still 128 hours of the week to cover in the emergency plan. It goes without saying that how stressful this is depends on how many doctors there are sharing shifts, Klev says.
Klev says that under the special agreement, there should be at least four doctors sharing this in small municipalities, but that municipalities should strive for a six-part on-call scheme.
– If the municipalities had adhered to it, the burden would have been manageable. When the municipality has fewer doctors than this, the burden becomes large and anti-recruitment. This is full charge. The municipality cannot come from the fact that they have an employer responsibility, says Klev.
– It’s about economics
A KS report shows that a GP in 2018 earned an average of NOK 1.6 million.
The Norwegian Medical Association has emphasized that the strike is not about finances, but about working hours.
But Karlsøy’s health director thinks otherwise.
The entire ER system relies on the GPs going to the ER.
Photo: Øystein Antonsen / NRK
A doctor in Karlsøy waiting for an LIS doctor receives between 14 and 15,000 in compensation for being on hold this weekend.
Lorentsen says he noted that the Ombudsman proposed removing the on-call scheme for on-call doctors who do not meet the competence requirements in emergency medicine regulations.
– But this was probably not interesting for the Norwegian Medical Association because it is a completely unusual financially favorable plan that they want to maintain. Provides many hours of statistical observation and completely limited work effort.
Lille Karlsøy has doubled the remuneration for emergency services since 2018.
In 2018, the remuneration cost NOK 1.6 million. In 2020, the price is 3.5 million.
– It can’t go on like this. There is nothing in the municipal budgets that gives us a framework for this, and the state has not covered a penny to double the additional cost.
– There are many hours between Friday afternoon and Monday morning and the hourly wage regulated by the special agreement is just over NOK 200, responds Nils Kristian Klev at the Association of General Practitioners.
– It will mean the end of the emergency room
The medical association requires that physicians work no more than seven hours of emergency care per week, which corresponds to 28 hours of emergency care.
If the requirements of the Medical Association are met, it would have major consequences for Karlsøy, says the health director.
– It is impossible to implement. In practice, this would mean that the population of Karlsøy will not have an emergency room plan.
The health director fears that seven hours of emergency care a week will give municipalities and GPs full contractual freedom to find local solutions.
The health officer says he is fully aware of the outpatient regime which is based on the fact that doctors sometimes have to work long shifts. And that a tired doctor is not a good doctor.
