The complication of the latest health policy: the crisis in medical education

Foreseeing that the solutions you put forward to resolve problems in politics may lead to other problems is a distinct political virtue. Producing problems is in the nature of society, and politics exists first of all to diagnose these problems and then to treat them soundly. Sometimes the solution or course of treatment you apply has complications, and against these complications one must take preventive measures alongside the initial treatment.

That the terminology we use here for politics comes from the field of medicine is of course not because we see politics as equivalent to medical operations. Indeed, reducing politics to medicine carries its own danger, as with reducing it to engineering. In the end, you are not facing a patient on whom you carry out unilateral operations of scientific certainty; you are facing a society, in all its diversity, that can object to the politics you pursue and that may gain or lose from it. That the terminology here comes from medicine takes on a distinct meaning precisely because the field we are discussing is medicine.

Until just three years ago, we were speaking of how those working in Türkiye's health sector, doctors in particular, and especially doctors working under the Ministry of Health, were subjected to serious injustice through pay and personnel rights out of keeping with the hardship, importance, and characteristics of their profession. There really was such a problem at that time. We had said, through a "call for justice for physicians," that despite the many features that add hardship and value to their profession, beginning with the education they receive, doctors were far from what they deserved in terms of both pay and personnel rights.

This call for justice also alluded in part to the principle of "justice" that existed at the founding of the AK Party. Not only in order to establish justice among professions, but also because the strongest politics that has kept the AK Party in power all these years has been in the field of health, and because the burden of this fell especially on health workers. In one respect, the AK Party has had the opportunity to prove itself most in the field of health in its claims to serve the people. Of course, without ignoring other fields and thereby causing a different kind of injustice. Yet it was a reality everyone saw that policies in the field of health that could easily be described as a "revolution" were to a great extent loaded onto the shoulders of health workers.

Health workers should be given the value they deserve and shown respect, and this should have begun first of all with improvements in salaries and personnel rights.

After that, these things were done. But unfortunately this time the improvements were made without regard to certain personnel conditions within the health sector, sectoral differences, the consequences that might arise in relations between the private sector and the Ministry of Health, and especially the differences that arose between university hospitals and the Ministry of Health in revolving fund advantages, and so today our health sector has come to the brink of an entirely different crisis.

The "newborn and intensive care scandal" of recent months should have rung an alarm bell about what sectoral growth in private hospitals can lead to. This issue was a very serious warning that we have no ethical ground at all in the field of health. We must have a long discussion about it. Protecting human life, and health service, is a field that, unlike all other professions, must be much more closely connected with ethics, morality, and spirituality. A society in which the matter has been reduced entirely to a field of wild profit-making should not expect any other disaster.

This is very important and I could not pass without mentioning it, but the actual problem I want to address today is a complication caused by the treatment of a problem that had been identified in the health field earlier and for which treatment had been undertaken. I am speaking of a problem that directly affects medical school education.

A complication that the improvement of the situation of specialist doctors attached to the Ministry of Health can cause is its reflection on the faculty-member doctors at medical schools. The gap that has arisen between these two sectors today leads to the migration of professors from medical schools to the Ministry of Health, and at many medical schools not even an instructor to teach a course can be found.

I relay, in summary, what several medical school deans struggling to find faculty members have said:

"The salary of specialist doctors is now higher than the salary of a Dr. Faculty Member...

Because the salary gap is large, specialist physicians prefer to work as specialist doctors in state hospitals rather than as Dr. Faculty Members.

In addition, specialist physicians working as faculty members at any university can be assigned as specialist doctors wherever they wish. That is, working as a Dr. Faculty Member gives them the right to obtain a transfer wherever they want. Thus they are subject to positive discrimination.

Because the pay of specialist doctors is higher than the salary of a Dr. Faculty Member, and because specialist physicians who are Dr. Faculty Members can obtain transfers wherever they want, it is seen that even when specialists move to faculty membership, they obtain a transfer wherever they wish within 1-2 months and prefer to work as specialist doctors. This causes universities to suffer a shortage of faculty members.

Faculty members working at the Ministry of Health (MoH) generally receive higher revolving fund and supplementary payments. The performance system is more advantageous, and because patient volume is greater, income can be higher. Faculty members working especially at Training and Research Hospitals can earn substantial additional income because they provide both clinical service and education. By contrast, for those working at University Hospitals (medical schools), apart from their fixed salaries, revolving fund income is generally low. The distribution of revolving funds is very limited at some universities or may not be made at all. However, systems applied at some universities, such as private patient examination (where there is a private practice right), can offer additional income opportunities."

All of these advantages for doctors at the Ministry of Health arose from the policy pursued to improve their situation. Either the balance was overshot, or the effects on medical schools were not calculated, could not be calculated. The cost of this failure to calculate is that our medical education has been brought to the brink of a crisis today. Medical schools cannot find instructors to teach in many fields. Their existing professors are migrating to the Ministry of Health or to the private sector.

At a threshold where Türkiye is so ambitious about offering international service, in the field of medicine as well, new treatments are needed to remedy these side effects.