Why don't I believe in wellness reform?
Each next wellness minister enters the hotel with a colorful slide weapon and a grin full of reformist enthusiasm. And everyone ends up just the same: a painful collision with a wall.
I don't believe in any systemic revolutions for 1 very simple reason. We have not adequate doctors in Poland to let you to fight any war with them.
I'm not talking about all the doctors. The vast majority performs their profession from vocation, and the patient is more crucial to them than money. However, I am talking about a key group of specialists who decide how the strategy works. That's what I think of them.
In this game, only 1 page has been playing cards for years.
If doctors strike or massively pass on 3 months of leave free of charge, the hair will not fall. They have safe financial cushions and private offices that will feed them in all conditions.
For patients, however, this will end tragically - queues from the clinic and hospitals will rapidly decision to ceremony facilities. And power knows that.
My disbelief in systemic changes is based on 5 hard facts.
1. Dramatic first line HR deficit
In 2024 only 141 193 doctors worked straight with patients in Poland. Although over 166.5 1000 people surviving in the country have the right to practice the profession, more than 25 1000 of them do not treat Polish patients for various reasons – for example they work in the pharmaceutical manufacture or have retired.
To catch up with the average of the countries in the western part of the European Union, we are already short of about 20,000 medics. With specified a dramaticly tight staff situation, it is adequate to absolve a tiny part of them so that full infirmary wards begin to close like card houses.
2. Astronomical Cost of Doctor Education
Doctor production is 1 of the most costly public investments. Six years of medical studies cost about PLN 330 thousand. erstwhile we number this year's postgraduate internship, this amount easy exceeds half a million zlotys per man.
The state bears tremendous financial expenditure before the young doctor even starts to treat himself.
This is not a production tape in a mill that can be accelerated overnight by purchasing machines.
3. Educational partisan, or medicine without background
Mass beginning of medical courses at universities with no academic and medical traditions is simply a recipe for disaster. medicine is not simply theoretical discipline that can be taught in a average hall utilizing a projector. The recently created departments collide with 3 basic barriers:
- No pro-sectoral database, no labs. Anatomy students should learn from human body preparations, not just from tablets or plastic models.
No 1 has their own clinics. conventional medical universities have powerful clinical hospitals where uncommon medical cases happen and experienced staff work. However, these facilities are already overflowing.
New universities fix these shortcomings by signing contracts with local region hospitals. These institutions, although highly needed, frequently do not have high-specialist branches or doctors with technological degrees who would have the time and competence to conduct the teaching properly.
- "Flying Professors". The deficiency of its own staff forces universities to "import" lecturers from large academic centres. specified a prof. arrives erstwhile all 2 weeks, runs a weekend lecture marathon and returns to himself. In specified conditions, there is no mention of the master-teacher relation or the real mentoring care of the future doctor.
4. Importing doctors from abroad will not patch the hole
The explanation that staff shortages will rapidly be supplemented by doctors from the East, for example from Ukraine, is an illusion. In practice, a doctor from abroad can treat in Poland only to the degree that the Polish medical authority will let him.
The Chief Medical Board and the territory Medical Chambers are very strict in keeping with the procedures for nostrification of diplomas and language examinations. It is officially about patient safety, unofficially – about protecting your own marketplace from the influx of cheaper competition. The professional corp effectively blocks this power channel of the system.
5. The time you can't buy
From the first day in a medical college to the minute erstwhile a doctor obtains the title of specialist, he usually passes from 11 to 13 years: six years of study, 1 year of internship and 5 or six years of specialization.
Even if we triple our financial expenditure present and open up a medical department at all higher vocational school in the country, we will not see the results of this decision until the late 1930s. By then, the current strategy will be completely scattered.
Conclusions: chaos that pays off for everyone
The conclusion of this analysis is brutal: the current paralysis – not to call it more clear: a brothel – is for key players, or medical mafia, very convenient.
Experienced specialists are not disturbed at all. Why would he bother them? There is no competition, there is no hazard that individual will replace them with a cheaper labour force in public hospitals, plus The patients will come to their private offices anyway, paying all amount requested to miss a fewer years in the NFZ.
Their negotiating position towards the government is absolute. It is this environment – which is well aware of its uniqueness and impunity – that will effectively block any effort at a deeper improvement that would require any concessions.
History has been through this. I remember perfectly well the spectacular show of the power of the Green Mountain Agreement. It took a period of closed clinics and paralysis of primary wellness care to get the panicked government on its knees back to the negotiating table and sign the conditions dictated by doctors.
As long as the doctor in Poland is specified a deficit and luxury good, there will be no real reform. We will only witness another powdering of the corpse – of course at the expense of patients' wellness and money.
Unless the doctors are in trouble...
