Photo by Landspítali

Following a round of unsuccessful negotiations, doctors in Iceland commenced their first ever strike in late October. In the wake of the banking crisis, so as to share the burden, doctors not only accepted a 5% wage cut, but also ceased seeking pay raises with as much fervour as before. As a result, their wages now lag far behind other public sector professions and the consumer price index. Compensation in the Icelandic healthcare sector is no longer competitive with those in our neighbouring countries, both in terms of salaries and holiday allowances.

Now that the economy is purportedly in better shape, doctors are asking that their wages reflect the six years of unpaid academic study that their profession requires, and the amount of responsibility that the job entails. At present, doctors who specialize abroad also face a hefty wage cut upon returning to the island—experts have expressed serious concern that Iceland will soon face a shortage of medical specialists if their salaries don’t start reflecting what comparable positions in neighbouring countries yield.

The Icelandic Medical Association’s motion to strike received near unanimous member support, with 96% voting to engage in strike actions in an early October ballot. Since no agreement has been reached, plans are afoot to engage in further and harsher strike actions in 2015.

Primum non nocere

The strike sees departments scaling down their efforts (albeit with good notice), making research, surgeries and appointments grind down to a halt. However, those who need immediate medical attention do receive it, and there is a clear emphasis on not risking patients’ safety, as was apparent in the case of Sebastian Andrzej Golab. Vísir reports that Sebastian was stabbed through the heart on November 23, mid-strike, and suffered cardiac arrest upon arrival at the hospital. Following an emergency surgery, he has fortunately made a miraculous recovery.

All manner of non-essential operations and procedures, however, are being delayed. This leaves an estimated 540 people awaiting minor surgery; with a further 100 people awaiting specialised surgeries such as cornea transplants and coronary angioplasty; 800 individual tests, such as blood tests, X-rays and CAT scans; and an estimated 2,041 outpatient appointments.

Minister of Finance Bjarni Benediktsson has said that the doctors’ demands are unreasonable and will, if met, result in a slippery slope, where other professions will ask for similarly unattainable raises. While Minister of Health Kristján Þór is not on the negotiating team, he has expressed sympathy for the doctors’ cause. “Their wages have fallen behind in a very competitive market,” he says, “but I believe the strike will only be solved if both parties reach a compromise.”

Remarking on the strike, Prime Minister Sigmundur Davíð Gunnlaugsson echoed the position of Business Iceland (a service and lobby group for Icelandic businesses), calling for a national reconciliation on pay raises. Polls by Capacent-Gallup and MMR show that the generally populist PM has positioned himself on the wrong side of popular opinion in this regard, as both indicate that an overwhelming majority of the nation supports the doctors’ demands (finding majorities of 80% and 70%, respectively).

The voice on the ground

Dr. Íris Ösp Vésteinsdóttir, chair of the Icelandic Association Of Junior Doctors, says she was shocked when the strike went forward in October. “I had difficulties falling asleep the night before the strike commenced, because I was convinced I’d hear them announce on the news that a compromise had been reached,” she says. “But, the negotiators didn’t so much as call us with a new token offer.”

Íris says that the problem started in 2008, when doctors were asked to refrain from seeking pay raises, so as to keep the system going. Ever since, the base salary has remained low, but doctors have had the possibility of raising their wages by working overtime shifts on evenings and weekends. The younger generation of doctors, however, is not particularly interested in employing such measures to attain a fair salary, Íris remarks.

The hospitals continue running as usual during the strike, says Íris, with critical patients receiving the care they need. But, everything happens at a slower pace, with longer waiting periods.

A case in point would be that of 24-year-old football player Mist Edvardsdóttir. RÚV reports that Mist, who has stage three lymphoma, caught a serious infection while undergoing immunosuppressive treatment, but had to wait a full fifteen hours to be treated.

Íris fears what might happen if the strike isn’t soon resolved. “Since the economic crisis started, healthcare professionals have been driven hard for a long time, and now they are tired and want something in return.” If the healthcare system continues deteriorating as it has been, Íris believes Iceland will become less appealing to move back to for young people who have studied abroad, as well as educated medical professionals.

With 35% of Icelandic specialists slated to retire in the next ten years, and 20% in the next five, Íris foresees an imminent shortage. Already, Dr. Ólöf Birna Margrétardóttir, MD, and Dr. Jón Örvar Kristinsson, a gastroenterologist, have publicly handed in their resignation letters, and there are fears that more will soon follow if an agreement is not reached by the end of the year. “It stings even more when both the Prime Minister and Minister of Health have said they are worried about the situation, but the negotiators refuse to budge,” she says. “With Skype, Facetime and other modern technologies, living apart from your ones family and loved ones is less difficult than ever before, making the prospect of working in another country seem viable to many.”

The appeal of Iceland

Úlfur Thorodssen, a medical student in his final year, does not imagine he’ll return to the country after becoming a specialist with the situation the way it is right now. He will have to study overseas, which he estimates takes around five years, after which his international earning potential will outweigh anything Iceland has to offer. “After living somewhere for five years, you’ve made a life for yourself, and have higher wages than here, so why should anyone return home?” he asks.

Were the situation different, wages higher and more funds put towards the healthcare system as a whole, Úlfur says he would strongly consider moving back. “I know it won’t be as good as in other countries, but if the wages and holiday allowance were better, it would change the equation.”

For others, like Dr. Guðmundur Karl Snæbjörnsson, there is a compromise to be made between living at home and earning good wages. In the aftermath of the economic collapse, Guðmundur started an agency called Hvítir sloppar (“White Robes”), which solicits jobs in Sweden for Icelanders interested in working there for periods of time. He says that some take unpaid leave from their posts in Iceland to supplant their wages, whereas others will spend every other fortnight working in Sweden, returning to Iceland to rest and meet their families in between stints, thus earning enough to support themselves and their families.

“We recently advertised 300 available positions in Sweden, so there’s no shortage of work to be found,” he says, adding that his company employs junior doctors and specialists alike. He refuses, however, to discuss how many people are involved in the venture.

Guðmundur has full confidence in the current health minister, and has personally taken part in shaping the health policies of the Independence and Progressive parties (currently in government), but says there has been a long-standing lack of interest from parliament in dealing with medical matters. “Healthcare professionals, the ones that know the most about their work, have no say in how the healthcare system is run. This results in bad bureaucratic decisions that negatively affect the system.”

Despite the times being rough at the moment, some—like Dr. Inga Sif Ólafsdóttir, PhD—have returned to Iceland with their families in tow. Inga Sif spent ten and a half years abroad, specialising in internal and respiratory medicine, as well as receiving a PhD from the University of Uppsala, Sweden. During that time, she and her husband, an ophthalmic surgeon, had bought a house in Uppsala, where they enjoyed a good life with their three children. She says that they eventually decided to return home to Iceland because there was something calling them back. “Good memories, family and nature all factored heavily into our decision,” she says, “but we weren’t quite expecting what we encountered.”

Upon their return, the family’s wages shrank by more than half. In Iceland, Inga Sif receives only a small portion of the holiday allowance that doctors in Sweden are allotted.

What surprised Inga Sif more than the low wages, however, was how few healthcare professionals there were around, and at what pace they had to work. “You quite often come home feeling disappointed, because you don’t have time to complete as many tasks as you would like to,” she says, “and there is significant risk of people burning out.” Inga Sif is afraid that if the system doesn’t become more flexible, doctors will stop returning to Iceland from international studies, and that it will create a downward spiral that will be difficult to reverse.

In addition, she’s worried about how long the waiting periods are for routine operations like hip replacements, cataracts, and more. “There are doctors and facilities to perform the operations, but there’s no money to open the surgical theatres, which is a scary notion for patients,” she says. She feels the strike is only adding to the problem, adding to already long waiting lists.

Inga Sif calls for a certain attitudinal change in society, for politicians to look at the big picture, and realise that doctors are a vital segment of the healthcare system—if all the segments don’t work together, we can’t maintain the system we have grown accustomed to.

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This article is a part of our feature on the country’s healthcare system, Squeezing Blood From A Turnip: Iceland’s Universal Healthcare At Risk. You may be interested in also reading:

Down To The Bone: The Healthcare System, Post-Austerity

The current shape and financial situation of Iceland’s healthcare system, and how the previous and current Minister of Health views the situation.

Iceland’s University Hospital: The Director Speaks

University Hospital director Páll Matthíasson, on how his hospital has weathered the storm of austerity measures, how it compares to our neighbouring countries, and what the future looks like.