Work-to-Rule Strike: What Moscow Doctors Are Fighting
March 25, 2015
Moscow doctors have declared a work-to-rule strike. Disgruntled by personnel cuts and the introduction of time limits for seeing patients, they said they would now work strictly by the rules, without overtime. We found out how the strike has been going in the capital’s clinics.
“Our working day is not set,” explains Dmitry Polyakov, a neighborhood general practitioner at Diagnostic Center No. 5. “When forty-five people pass before your eyes in a single day, you feel awful. And there have been staff cuts, many specialists have left, and their patients are referred to us. People are unhappy, of course, and they take it out on us. By the end of the day it is often difficult even to focus one’s eyes, let alone concentrate. Salaries have fallen, incentives to work have decreased, but the workloads have grown.”
In addition to seeing patients in clinic, a neighborhood GP has many other duties, such as visiting ten to fifteen patients at home. Plus, there is paperwork: outpatient charts, registration stubs, and discharge sheets. Much of the paperwork has to be filled out during the doctor’s free time. And yet salaries have been rapidly shrinking. Whereas before they had been as much eighty and even one hundred thousand rubles per month, neighborhood GPs are now paid around forty thousand rubles a month [approx. 640 euros at current exchange rates].
“We have a very large flow of patients,” complains Yekaterina Chatskaya, an OG/GYN at City Clinic No. 180. “There is no one to see all the patients; the workload is colossal. It happens that you work nine and ten hours a day. I basically don’t see my husband and child, and I make only forty thousand rubles a month. If we were at least provided with stationery supplies. Yesterday, I was issued paper for my printer for the first time in five years. Usually, though, I have to buy supplies out of my own money. But the main disaster is the lack of time for examining patients properly. The Health Ministry allots ten to twelve minutes for each patient, but it is impossible to meet this standard.”
Elena Konte, a GP at the first branch of City Clinic No. 220, had hoped that the start of the work-to-rule strike would simplify things. If she didn’t have to work overtime, she would manage to go home on time, and fill out outpatient charts that had piled up from last week. But a nurse who was supposed to help with patients took ill; a conference was scheduled for the middle of the day; and a mysterious “inspector,” a doctor from an outpatient center, suddenly showed up as well.
“This never happened before. I am sure she came because of today’s strike,” says Elena. “She didn’t say anything about the strike, but she asked about how much we have to work and inquired about the UMIAS (Unified Medical Information Analysis System). I think she was horrified by how much unnecessary scribbling falls on us and how much running around the entire clinic we do searching for patients’ test results: after all, they’re not even recorded in the computer at our clinic. Of course, it’s uncomfortable working when you’re being observed all day. But at least they paid attention to us.”
Elena Konte managed to see all her patients that day, but she was unable to complete all the outpatient charts. The first day of the work-to-rule strike failed to solve the problems that have accrued over the past months for staff at the first branch of City Clinic No. 220.
“At first, there were six doctors working eight neighborhoods in our second general practice department,” says Elena. “Then, one of the neighborhood GPs was sent to retrain as a family doctor, and there were five of us left. In February, yet another doctor was transferred to a neighboring branch. But this is winter, the peak time for upper respiratory infections. And the workload is such that it is like we’re working two positions. The strain is very hard, both physically and mentally. Yesterday, I got to the clinic at 8 a.m., and went home at nine in the evening. But I will continue to participate in the strike. They have already promised to reduce consultation hours from five to four hours, and have added another position in reception.”
Downstairs, on the ground floor, two old women were vigorously discussing the news from the world of medicine.
“They all got laid off. Who is there to do the work now?”
“Exactly! And in a couple months, they say, there will be further layoffs. They have to go on strike.”
If the strike has gone unnoticed for both patients and physicians at this clinic, things are quite different at Diagnostic Center No. 5.
“Today, I managed to see everyone who came by appointment, and even finally filled out all my paperwork in normal handwriting and finished working with the outpatient charts that had piled up,” says neighborhood GP Irina Kutuzova. “Maybe the bigwigs won’t notice the strike at first, but when an emergency occurs, everyone will get it. Generally, it is hard to work in the present circumstances. You cannot examine a patient who has come by appointment longer than ten minutes, but some patients require much more time. And it often takes twenty minutes to fill out a sick leave form. I get forty to forty-five patients a day; it is a constant blitz. And there is another whole crowd of patients who come ‘just to ask a question.’ As a result, people get disgruntled: they literally kick open the door and voice their complaints. By the end of the day, it all becomes a blur, and I don’t have the strength to write out prescriptions. But today I had thirty-seven patients. Also a lot, of course, but better nevertheless.”
In the hallway, an elderly woman catches my hand. She is waiting in the queue for the next room.
“Young woman, you’re not a patient? Maybe you know whether they’ll see me today or not?” she asks hopefully.
Her name is Galina Bordo, and she has been waiting her turn for nearly two hours. A few weeks ago, she had a tumor removed, and now she must have regular checkups. The doctor’s visiting hours ended twenty minutes ago, but the last patient still has not come out.
“I heard they started a strike today. Good for them, it’s the right thing to do. Otherwise, in today’s environment, with the queues and unnecessary paperwork, they don’t cure anyone,” Bordo says.
According to the healthcare workers union Action (Deistvie), twenty employees at six clinics have been taking part in the work-to-rule strike by Moscow doctors. In the near future, twenty-two other health care providers may join them.
“Our goal is not to cause a collapse, but to show how and under what conditions doctors work,” explains Andrei Konoval, Action’s organizational secretary. “To demonstrate that under normal, unhurried service, the number of patients who can be seen in a day is reduced by one and a half to two times. This means that it is necessary to increase the number of doctors and medical facilities. Even if there were only one brave doctor willing to participate in the strike, we would still go through with it.”
Andrei Khripun, head of the city’s health department, has already dubbed the strike a “political provocation,” and claimed that it had failed, because “Moscow clinics are operating in normal mode.” Although that had been the point of the strike: to work according to the rules.
Today, a comrade and I went to a medical facility to hand out leaflets (the appeal by striking doctors to patients). Fortunately, people have been reacting quite positively to the doctors’ strike and have gladly agreed to support them. Many people took leaflets to hand out at home.
I called one of the strikers and asked whether she has felt pressure from management. She said she had, but since they are determined and have really enjoyed working according to the law, the strike could continue for quite a long time. But now they are able to spend exactly as much time as they need on a patient, and not what officials want them to spend.
What is interesting is that if women have taken something on, they’ll definitely see it through to the end, unlike most of us men. I think it would be better if officials started listening to what they’re saying and stopped destroying healthcare while it’s still not too late.
One shady type drove up in a car and asked for a couple of leaflets. Then he pulled away and photographed us. Apparently, he was a spy. Security behaved properly, and at first they even tried not to notice us. Later, though, they asked us not to make trouble for them and go outside. That was even more convenient for us, and we handed out more leaflets.
Tomorrow, we will go to the other strike sites and notify patients. I think it would be great if everyone who was going to a hospital or clinic would take several such leaflets along and hand them out there. So, friends, don’t stand on the sidelines so that you’ll regret it later. Make your contribution to the common cause. The text of the leaflet is below. Anyone can print it out.
On March 24, a “work according to instructions” action, which journalists often call an “Italian” strike, was launched at several Moscow clinics. Its gist is that doctors who have decided to draw the attention of authorities to the disgraceful state of medical care have started to work in complete accordance with the Labor Code and the standards of care.
We have worked in inhuman conditions for years. Our workday often lasts nine, ten, and even twelve hours. However, rather than increasing staff and creating normal working conditions, health officials have begun laying off physicians and reducing the time patients can be seen to mere minutes. But the workload and amount of paperwork have only grown. In our view, such excesses only serve as cover for bureaucrats pursuing a policy of commercializing healthcare: the longer the artificially generated queues in clinics are, the easier it will be to make patients pay.
From March 24, we have decided to hold consultations based on established standards. Moreover, if a patient’s condition requires more time than is laid down in the regulations, we are not going to speed up examinations, because haste poses a threat to the person’s life and health.
We ask for your understanding and support. We are in the same boat, on the same side of the barricade erected by “optimizing” officials. We will do everything we can to ensure that no problems with the provision of medical care arise. Eight days ago, we warned our chief physicians, as well the Moscow Department of Health and even the Russian Federal Prosecutor’s Office, of the need to ensure that patients whom we do not have time to examine during our shifts are seen.
If you are, nevertheless, unable to get an appointment through the negligence of management, we suggest you send a complaint to the Department of Health. (Believe us, it helps!) In the complaint, you should write that the physician you wanted to see had warned management of possible problems in connection with “work to rule,” but management failed to take the necessary organizational and personnel measures. You can do this on the site mosgorzdrav.ru in the section marked “For the public” > “Petitions from the public” > “Receipt of petitions from the public.”
We would be grateful if you would sign the online appeal in support of the issues we have raised. To do this, simply type in the address goo.gl/nxJ8C5.
Together we will make the system work for the benefit of patients, not bureaucrats.