Use of unpaid doctors, unfair to them and risky for patients, must be ended

The Yomiuri ShimbunDespite being involved in examining and treating patients, some doctors are not being paid wages in keeping with the work they do. This inappropriate practice resulting in “unpaid doctors” must be rectified.

An Education, Culture, Sports, Science and Technology Ministry survey of 108 university hospitals across the nation has confirmed that 2,191 doctors were working without being paid. This equates to about 7 percent of the about 30,000 doctors, excluding university teaching personnel, working at these hospitals.

Some of the surveyed university hospitals said they were “still investigating the situation,” so it is possible the final number of unpaid doctors could increase further.

The ministry was quite right to demand the hospitals improve their labor management practices. Each university hospital should make efforts to pay doctors suitable wages.

Many of the unpaid doctors were university graduate students with medical licenses or residents who aim to become specialists. University hospitals said these doctors were not paid because they were providing treatment to improve their own skills or partly for research purposes.

Nevertheless, these doctors were doing the same job as regular working doctors, such as being included on the rotation of doctors examining and treating patients. It is obvious that, in reality, they were workers at these hospitals. There are strong suspicions this situation could infringe on the Labor Standards Law, which states the obligation to pay wages to workers.

A majority of the unpaid doctors worked part-time at other hospitals to make a living, resulting in their easily becoming overworked. If doctors provide treatment when they are exhausted, the possibility they could make a mistake increases, which could endanger patients.

Consider thorough measures

The fact that at least 6,000 doctors at university hospitals across Japan did not have employment contracts or did not have workers’ accident compensation insurance cannot be overlooked.

Without an employment contract, working hours and holidays are not properly controlled. Not having workers’ accident compensation insurance means that if an infection or other incident occurs in a hospital, it will not be recognized as a labor accident. University hospitals must swiftly correct this situation.

The practice of unpaid doctors at these hospitals has continued against the backdrop of the ikyoku training program system. The pyramid-shaped ikyoku framework has a professor at the top and graduate students and residents at the bottom.

Professors atop the ikyoku wield huge influence over whether students acquire doctorate degrees and over personnel decisions at affiliated hospitals that could become places of work for residents. Consequently, graduate students and others were probably unable demand improved conditions in some cases, even if they had received unfair treatment.

Some observers have pointed out that although the number of doctors who can be paid a salary at university hospitals is limited, the massive workload means that hospitals keep operating by using unpaid doctors.

It also is true that unpaid doctors at university hospitals are dispatched as part-time doctors to hospitals in regions lacking such medical staff, and they prop up the provision of medical treatment in these areas.

How can this distorted structure, in which doctor shortages are filled by using unpaid doctors, be corrected? It will be necessary to consider comprehensive measures to fix this problem.

(From The Yomiuri Shimbun, July 5, 2019)Speech


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