Translation of a June 27 ETtoday editorial by Dr. Chang Chao-hsuan (張肇烜). (link). Another editorial making the same argument, by Dr. Lin Che (林徹), was published by UDN on June 27 (link).



Flight attendants’ strike succeeded, so how about health care personnel?

Following the historic first-ever wildcat strike by Taiwan’s flight attendants, the strikers received promises from management that all seven of their demands would be satisfied, a milestone in labor history.

The Labor Standards Act stipulates that the maximum number of work hours in a month is 174. Not all industries follow it, however. One point of controversy in the flight attendants’ strike was Article 84-1 of this act: As the flight attendants’ maximum number of daily work hours was not capped at the standard 12, their monthly labor hours ran as high as 220.

Taiwan has another line of work that’s even more liver-bursting than being a flight attendant. It can’t even achieve the piteous standards of Article 84-1.

Based on the latest statistics of the DGBAS, amongst the 7.41 laborers in Taiwan, over 510,000 work over 200 hours a month. The most liver-bursting occupations include security guards, long-distance bus drivers, and medical personnel.

Under current labor standards, all laborers are pouring out their sweat and blood. And needless to say, in Taiwan some occupations call outside the protections of the Labor Standards Act. Following the 2014 inclusion of all nurses under the Labor Standards Act, virtually the last orphans left outside the law are employed doctors (S.tw: as opposed to doctors who are their own bosses).

There is no limit on work hours for medical students in training, doctors in residence, and employed doctors. Many young medical students don’t know what being “on call” really means until the moment they enter the white tower.

The time of being “on call” lasts from the moment one “clocks out” one day until the moment one “clocks in” again the next day. That is, after working during the daytime on day 1, doctors are “on call” overnight, handling patients’ and families’ situations and emergencies as needed until they go “back to work” in the daytime of day 2. The combination of regular work and “on call” hours adds up to a doctor being at work continuously for 34 hours or more. Most young doctors need to be “on call” every third or fourth day, and as many as ten times a month. That is, they spend the night at the hospital as many as ten nights a month. This has long led to overwork, and in recent years there have been cases of Taiwanese doctors dying from it.

What happens in Taiwan has also happened in the U.S. In 1984 at a New York hospital, a patient named Libby Zion died due to an incorrect decision by an overworked doctor. The ensuing controversy drew widespread attention from American society. In order to prevent such a tragedy from happening again, in 1989 New York state passed reform legislation restricting the number of hours a week a doctor can be at the hospital to 80, and limiting the number of consecutive work hours. This also ensured patients sufficient medical manpower for treatment. This legislation was extended to the whole country in 2003 and called the Libby Zion act.

In the U.S., controversy over overwork of doctors led to reform. As for Taiwan, the institution of the NHI in 1995 made medical treatment convenient and inexpensive—but the cost of this change has been borne by the base-level medical personnel, who have been overworked. In exchange for their sweat and blood, Taiwanese medical care has become cheap and comprehensive, and the NHI has become a source of pride for the nation’s politicians. Meanwhile, demand for medical services has constantly risen, but there has been no corresponding improvement in the rights and interests of medical personnel. While flight attendants are going on strike, employed doctors are going without basic protections.

Hence, an official once remarked that the Labor Standards Act doesn’t apply to doctors, and even if they work 200 hours a month that’s not illegal. This shows that Taiwan’s arrogant government officials are not willing to face up to their error and actively make reforms. The doctors’ inclusion in the Labor Standards Act has been blocked more than 20 years and still is unattainable.

There are strict work hour limits for pilots, flight attendants, and drivers, because their work influences not only their own health but those of their passengers. The overwork of medical personnel, which typically produces a high level of fatigue, necessarily reduces the quality of care for patients. Work hours for hospital doctors are currently regulated only by an evaluation system that sets maximum weekly hours at 88. However, statistics reveal that there are hospital surgeons working as many as 150 hours a week, close to the number of hours the average person works in an entire month. This is shocking!

Flight attendants have gone on strike: How about medical personnel?

Although nurses have already been incorporated into the Labor Standards Act, they are working as much as ever, having to arrive to work early every day to take over shifts, then handle a load of transfer paperwork when their shifts have ended. That is to say nothing of the longstanding nurse shortage that has produced abnormal and irregular rotating shifts. There are also great quantities of in-house training courses, “on call” hours, and so forth eating into off-work rest time.

Employed doctors are not even protected by the Labor Standards Act. They are orphaned by it. They don’t even have unions, so they can’t go on strike. Although European countries like Germany and the U.K. see medical personnel strikes for work rights and interests as normal, Taiwanese medical personnel have no way of doing this.

The strongest weapon that would be used against such a strike is nothing other than rhetoric about morality: “How could medical personnel go on strike? That would violate medical ethics!”

I cannot help but remember the time someone said to me “medical ethics are consumable goods,” and think that more and more doctors may choose to cast off the heavy shackles of medical ethics because they are asking themselves, “I just want some protection; why is that so difficult?”

