Another reminder that the Department of Health in our district is broke and salaries are next on the chopping block.
What Would You Do?
This is a quick little case study based on true and current events. Our DoH is broke. Penniless. Insolvent. And word via the grapevine is that salaries are either not going to be paid or are going to be drastically cut (no commuted overtime pay, no rural stipend) over the next few months as solutions are sought.
For context, this is not just an empty threat. As recently as 2012, doctors in the Eastern Cape went without pay for six months due to “administrative errors”. Of course, the overriding rumour was that funds had been dried up and the six month delay had nothing to do with the alleged systems’ error. And note, this was after months of threats of legal action for unpaid salaries, and with the blasé attitude that is applied whenever anything involving junior doctors’ rights is being discussed, because, of course, we don’t strike.
If this were any other job, employees would be entitled to strike action and could refuse to work until salaries were paid. (Seriously, though, who would ever be expected to work when their previous half a year of labour had gone unpaid??? I’m sure there’s a word for that, and it rhymes with bravery.) The waters are muddied, however, by the fact that as state doctors, we are public servants as well as employees. And we form part of “essential services”, so our right to strike action and labour law protection is extremely limited. It’s like being unemployed, but with all the requirements of employment and none of the legal backing to call a spade a spade.
This is scary.
My colleagues and I are interns. Legally, we can’t just work somewhere else to put food on the table like our seniors can. We are prohibited from undertaking locum tenens work as we are still “under supervision” and not yet licenced for independent practice outside of our designated facilities. It’s a really sticky situation, because I think that’s what the Eastern Cape doctors did (locuming) to survive while keeping their internship posts and providing care at their designated sites despite no guarantee of future (or back-dated) compensation.
A friend of mine (also an intern doctor) doesn’t understand why I’m so vexed.
“It’s simple. They don’t pay, we don’t work. Doctors aren’t gods, we have expenses just like everyone else. We can’t live on goodwill and gratitude,” she’s said, multiple times. “One month unpaid is enough charity work and essential servicing.”
I’m slightly torn. I don’t believe our oath strips us of our rights. We had an ethics class in which we were asked if we would help someone with a known haemorrhagic fever without the necessary protective gear. Most of us said hell nah. We explained it away in a utilitarian manner–if we die, that’s less care for the remaining patients, if we don’t we’re still at risk of putting our other patients, family and friends in danger through contact with us–but most of us later confessed that self-preservation was a major motivating factor. We want to help, but not always at the cost of life and limb. This salary situation is, of course, slightly less dramatic, but the principle still stands. How far does altruism go? How far can you be beaten down, ignored and hung out to dry before you declare that enough is enough?
I’m also curious how being financially independent would taint one’s response to going six months without pay. (Obviously this all doesn’t apply to interns as most of us are sitting in the negative net worth territory with truckloads of student and other debt, but more to senior doctors with years of income and hopefully some common sense behind them.) On the one hand I feel like it would put one in the position to say, “Screw this.” If you didn’t need the money, you probably wouldn’t take the abuse. You wouldn’t need to hold on and hope that the government would eventually get its act together. On the other hand, a more financially secure doctor might be in the best position to ‘gracefully’ handle such a situation. Of course it would still be frustrating and wrong, but if your livelihood didn’t depend on the check, you could be more compassionate about how patients who need these essential services will be the ones to suffer and might be willing to go the extra mile to bridge the labour gap left during a ‘soft-strike’.
This is all theoretical of course. People get crazy whenever money is involved, especially when their rights are being disregarded, but I think financial independence or at least security would make me more patient with the faulty process and more likely to avoid doing anything stupid to fill the income gap. There is, of course, a limit to this thinking. I wouldn’t want to be responsible for delaying the process of things being set right due to my supposed compassion. Things move quicker when groups act in unison, and sometimes a few people carrying on like it’s business as usual can make everyone else look unreasonable and selfish.
Those Eastern Cape doctors were willing to do the “right” thing after that first month of no pay, and the DoH exploited that for the next five months. They took their kindness for weakness and dragged their feet in doing right by their employees because they knew that, generally, people who gravitate towards the health care profession and work in rural hospitals, aren’t the kind of people to refuse to treat patients for mercenary reasons. There was no hasty resolution because there was no impending threat. Who would hurry to solve a problem that doesn’t really exist? Seeing the doctors sacrifice their needs and rights for the sake of patients didn’t soften their hearts, instead it made them less likely to correct an error that should never have been made to begin with.
Sometimes strike action works because it forces the higher ups to take employees and their issues seriously.
Sometimes strike action doesn’t work because people who need the service of those employees suffer.
I can’t help but wonder, however, if the doctors had striked from that very first missed paycheque, would there have been a speedier resolution? Did they shoot themselves in the foot for being too compassionate?