As a doctor on duty, Ida Marie Ringerud experienced falling asleep while on duty. In her hand she still held a bag which was slowly filling with fluid from a patient. When this happened, Ringerud says that she had been continuously at work for almost 18 hours, and had not slept for 56 hours. Believes that “predation” is taking place. It is now almost ten years since Ringerud was ordered to bed by a caring senior doctor. But this summer something happened that woke her up. A young female doctor took her own life. And afterwards, her fiancé described the working conditions she had had at several Norwegian hospitals in a Facebook post. Ringerud knew the doctor from before. And the description of her friend’s working conditions resonated. – What is described there, what she was in, is what is normal for most doctors. DOCTOR’S CALL: Doctor Ida Marie Ringerud believes there is “predation” on doctors in all areas – throughout the country. The Facebook group #legermåleve is for doctors, and currently has over 4,000 members. Photo: Christian Ziegler Remme / news Ringerud felt the urge to act and thus she created the Facebook group #legermåleve. The stories started pouring in from doctors who support the petition. Both stories from young doctors, and experienced doctors who look back on the first time in working life. For one group stands out with particularly strong stories: The young doctors who are specializing. They point to a failure in the health system itself, says Ringerud. Further down in the text, you can read what the Ministry of Health and Social Care thinks about the matter. The LIS1 scheme LIS stands for “doctor in specialisation” and LIS1 is the first part of the specialist course for people with a medical official qualification. LIS1 corresponds to what was previously called shift service. The LIS1 positions are standardized at 1.5 years. One year in hospital service and half a year in the municipal health services. The LIS1 positions are advertised in the job portal of the Norwegian Directorate of Health by the health organizations in collaboration with the municipalities. There are two application rounds each year, in spring and autumn. All doctors who are going to specialize in Norway must complete LIS1 before further specialisation. Source: The Directorate of Health and the Great Medical Lexicon An echo of experiences Most of the stories come from doctors who themselves do not dare to come forward. And many contain phrases such as “others have it worse than me…”. Here you can read some examples from the doctors. Some messages have been sent to Ringerud, while others have come directly to news: According to Ringerud, the doctors are describing a “rat race”. And many point out that it is difficult to tell the employer. – What everyone has in common is that you are completely dependent on your job in order to complete your specialization and be able to continue your professional career as a doctor. If you become known as the one who speaks up, you won’t get a job, says Ringerud. Because there is a lot of competition for the so-called LIS1 positions. A doctor in specialization is a fully qualified doctor who immerses himself in a specialist field in order to become a specialist. According to an overview from the Norwegian Directorate of Health, in recent years hospitals have received an average of between 400 and 600 applications for each position as doctor in specialization level 1. Doctor and in training – at the same time Specializing in a subject area takes place at the same time as you also do normal management tasks, explains the manager in Yngre legers forening, Ingeborg Henriksen. – We always prioritize patient care first. It is right now and then, but if we deprioritise the parts that are supposed to provide good education to the LIS doctors, it will have consequences for patient care in the long term. Demanding assessments and decisions are part of everyday life for doctors. Despite a lot of knowledge, uncertainty is an essential part of the medical profession. – We have a very exciting and rewarding profession, and we get to meet patients at their most vulnerable. I believe that one of the most important things we do is to teach doctors to be safe in the face of uncertainty. It also creates an experience of mastery. It is important that what is so rewarding about our job is perceived as meaningful and not burdensome. WIN-WIN: – We know that investing in education results in safer doctors and fewer medical errors, and it should be a win-win for everyone, says Ingeborg Henriksen of the Young Doctors Association. Photo: Yngre legers forening / Sturlason President Anne-Karin Rime makes no secret of the fact that doctors have long working days and high workloads. – Over time, doctors have been assigned more and more tasks, but the resources to solve the tasks are not included. This is a continuous challenge, and the strong stories that have been shared show that there is still work to be done, she says. HIGH PRIORITY: The medical association organizes around 95 per cent of the doctors in the country. Anne-Karin Rime, president of the Medical Association clarifies that proper working time arrangements have a high priority in the Medical Association. Photo: news – Requires effort from the management State Secretary Truls Vasvik in the Ministry of Health and Care emphasizes that proper working time arrangements are a basic requirement that applies to everyone. He points out that the working time arrangements for doctors have been agreed between the Medical Association and the employers’ association Spekter. – We must create good frameworks, but at the same time it also requires effort from the management at the individual workplace, writes Vasvik in an e-mail to news. NOT AN EMPLOYER: Although the ministry is the owner of the hospitals, they have no employer role, writes State Secretary Truls Vasvik in the Ministry of Health and Care in an e-mail. Photo: news news has asked the regional health organizations for comments. Helse Nord points out that the responsibility for ensuring soundness lies with the individual hospital. – But we have launched several regional measures to help the hospitals with this work, says HR director Anita Mentzoni-Einarsen. She specifies that they take the feedback from the doctors seriously. Hilde Christiansen, director of staff, organization and technology at Helse Vest, also writes to news that they are concerned about the matter. – All employees in healthcare institutions must have proper work schedules, whether their working hours are regulated by the Working Environment Act or by collective agreements, which for doctors have provided wide exceptions from the Working Environment Act. Health South-East is also following up on the topic with the hospitals. In addition, Svein Tore Valsø, director of personnel and competence development, writes that they want to further develop the work with resource planning. – Helse Sør Øst has discussed the need for separate work in this area and dealt with a board case on this in November last year, writes Valsø. Helse Midt has not responded to the inquiry from news. The regional health organizations have come up with a joint statement on the issue: Joint statement from the regional health organizations “The role of doctor is developing rapidly and working time arrangements are developing perhaps faster than collective agreements. Many trends are coming at the same time, there are different generations of doctors with different needs and expectations. Both female and male doctors participate more actively and share tasks in family life than before. Activity in the hospitals has increased, while the number of doctors in the hospitals has never been higher than now. This is in line with the expectations of owners, users and society. Faster patient progression with short length of stay, investigation and treatment methods are constantly developing, faster access to outpatient clinics and day treatment, (which is often better for the patients), but it also requires faster treatment, analyzes and answers. What previously could wait until the next day or over the weekend must be investigated, answered and processed regardless of the day of the week and longer into the evenings than before. This is more treatment-intensive and requires more physician capacity and increased specialization. The health organizations have therefore increased their medical resources to keep up with this development and the medical group is also one of the fastest growing professional groups in the hospitals. The percentage growth of doctors in the hospitals in Helse Vest over the past 10 years shows that the professional group of doctors has increased by around 38%. In addition, the relationship between doctors who are on the LiS training courses and senior doctors has changed – more is required of rearguards and emergency arrangements. The senior doctors’ home care arrangements are under pressure with increasing activity throughout the day, despite better technology and aids to be able to solve tasks from the home care. The development is known both to managers, union representatives and not least to the doctors themselves. With this as a background, the regional health organizations (RHF) together with Spekter and the health organizations have worked on this issue over time. Together with the employees’ organization (the Medical Association), several parties have worked on how the future collective agreement regulating the working time arrangements for doctors should be formulated and regulated. Several parties have carried out and are now carrying out work on the topic of “future collective agreement/working time agreement for doctors”, where, among other things, an approach to the ordinary rules of the Working Environment Act has been discussed. Today’s collective agreement contains safeguarding provisions in section § 3.6.3 where, in very special cases, local exceptions can be made between the employer and union representatives. (…) This means that more is required from management (superior) and shop stewards locally to make assessments of the needs and safety of the schemes. The possibilities for compression/condensation of working time are present, and this requires thorough assessments. Regardless of the protection provision, the manager is always responsible for making arrangements for a fully responsible working environment. Therefore, a process description for the manager for how work plans are to be developed in line with clarified needs has also been included in the collective agreement, and the work is distributed evenly among the participants in the working time arrangement. In 2022, it was then also decided to work with the parties to provide further guidance for the soundness assessments, this is described in the protocol for the collective bargaining negotiations, this work has still not been completed, and was continued in this year’s negotiations.” Personal health in education At the same time as employers must recognize that the medical profession is demanding, the doctors themselves must also become better at taking care of their own health. Reidar Tyssen, specialist in psychiatry and professor at the Department of Behavioral Medicine, University of Oslo, believes so. – We see that work-related stress, such as the fear of making mistakes, time pressure and finding the balance between home and work, is worst in the very first years. FOLLOWS THE DOCTORS: Psychiatrist and professor at the Department of Behavioral Medicine (UiO), Reidar Tyssen, has been involved in studies that follow doctors over several years. As a psychiatrist, he has had many conversations with doctors. Photo: Ola Hana Therefore, Tyssen believes that taking care of yourself should have a permanent place in teacher education. – We have many stories about doctors who ignore the body’s own signals, and just go on and on until they suddenly hit the wall. Hospital doctors and stress level In 2021, the Norwegian Medical Association conducted a member survey on Norwegian hospital doctors’ working conditions. 45 percent of a total of 6,695 doctors stated that they experienced an unpleasant level of stress at work. 49 per cent of the 3,255 members of Yngre legers forening answered that they experienced an unpleasant level of stress. Women experienced the most stress with 52 percent. 52 percent of the workers answered that they managed to take a break and eat during the working day. Source: Member survey among hospital doctors spring 2021. The Norwegian Medical Association. Gets cheers Anne Fagerheim Skaug is today head of department at the medical department at Gjøvik hospital, where Ringerud describes falling asleep standing up after many hours on duty. She thinks the episode sounds extreme. – It is difficult to understand, but I have no reason to doubt that what she says is correct, says Fagerheim Skaug. In general, she believes that there has gradually become a clearer focus on the care of newly qualified doctors. – I think that what is special about LIS1 is that they spend so little time in each department. It is more difficult to become known and feel safe, and to dare to speak up. BIG TRANSITION: Head of department Anne Fagerheim Skaug says LIS1 doctors often come from a long course of study, and the transition to everyday life as a hospital doctor can be very big. It places higher demands on employers, Fagerheim believes. Photo: PRIVATE Ida Marie Ringerud is clear that over the years she has not been good enough to take care of herself. Ringerud boasts of good colleagues and she has experienced understanding from the management. But doctors are too conscientious and conscientious, she says. – It gets us through a medical study, but is also what sometimes becomes our path. Therefore, she has taken steps to take better care of herself. And she adds: – We have to take care of each other, even in situations where we may not even realize how tired we are. The story of the friend who died is a good picture of what work pressure does to doctors, believes Ida Marie Ringerud. Photo: Christian Ziegler Remme / news
ttn-69
Doctor Ida Marie Ringerud (42) from Gjøvik is at the forefront of the doctors’ rebellion #legermåleve – news Innlandet – Local news, TV and radio
