Across Europe, public hospitals appear to be on life support.
In Germany, Slovenia and Sweden, healthcare workers went on strike in 2024 to demand a pay rise and an improvement in their working conditions.
In Sweden, health workers went on strike for the first time in 16 years for 78 consecutive days.
After four months of collective bargaining, the Swedish Association of Health Professionals began a strike from April 11 to June 28.
“Negotiations reached an impasse“, Sineva Ribeiro, president of the Swedish Association of Health Professionals, a union with 11,400 members representing nurses, midwives and radiologists, tells Euronews.We had to go on strike. There had to be a conflict.“.
The union had also banned overtime.”In 2023, they [les membres du syndicat] worked three million hours of overtime“, explains Sineva Ribeiro. So we knew there was a shortage of nurses, midwives and radiologists.”
In the end, the Swedish Association of Health Professionals managed to secure a reduction in working hours for 10% of its members – those who work nights – and a wage increase of 3.05%.
Deteriorating working conditions are forcing some healthcare workers to leave Sweden to work in neighbouring countries.
“We have about 20,000 nurses working in Norway because they are better paid and they work fewer hours per week.“, believes the unionist.
13,000 qualified nurses are estimated to have left the profession, according to a report by the Swedish National Board of Health published in June. This would represent a cost of more than €60 million to taxpayers.
“The situation may be better [en Suède] than in other EU countries“admet Sineva Ribeiro.”But we still have a huge shortage of nurses who can care for the population. And we never know when the next pandemic might happen..”
“A time bomb”
Sweden is not an isolated case.
Hospitals in other European countries face similar challenges.
“There is an increase in demand, mainly due to four main factors: the aging of the population, the increase in multimorbidity and chronic diseases, the backlog accumulated during the COVID-19 pandemic in terms of waiting lists, and increased patient expectations.“, explains to Euronews Tomas Zapata, head of the unit on health workers and service delivery at the World Health Organization (WHO) in Europe.
It evokes a “labor crisis” in the health sector in Europe.
“We have more doctors and nurses than ever before. Over the last 10 years, there has been a 20% increase in the number of doctors across the region and a 10% increase in the number of nurses. However, the demand is growing at a faster rate. So that means we have this shortage, this gap between the demand and the availability of health care workers.“, he explains.
In a regional report published in September 2022, the World Health Organization (WHO) in Europe warns of a “ticking time bomb” threatening health systems in Europe and Central Asia.
According to the report, one of the main challenges is the ageing of the health and care workforce: 40% of doctors in 13 of the 44 countries surveyed are already aged 55 or over.
The report also highlights mental health issues among healthcare professionals.
In some countries, more than 80% of nurses reported some form of psychological distress caused by the COVID-19 pandemic. Nine out of 10 nurses were considering leaving their jobs, the report said.
All these challenges are pushing caregivers to strike across Europe to demand better working conditions.
Germany demands quality care
In January, thousands of doctors at German public university hospitals went on strike after collective bargaining with hospital directors failed.
Nearly 5,000 doctors took part in a “warning strike” organised by the Marburger Bund in the northern city of Hanover, according to the union.
They demanded a 12.5% pay increase and higher bonuses for night work, weekends and public holidays.
According to the Marburger Bund, around 7,000 doctors from 23 German hospitals took to the streets again in March after the fourth round of negotiations with the 16 federal states (Länder) that run public hospitals ended in failure.
“We cannot accept that academic medicine remains the last wheel on the wagon in terms of doctors’ salaries.“, said Andreas Botzlar, second president of the Marburger Bund, in a statement.
“The last round of negotiations left us with the impression that the states still do not understand what is happening: we demand fair conditions for first-class medicine. No more, no less.” he added.
Longest Doctors’ Strike in Slovenia
In Slovenia, public doctors and dentists began what has become the country’s longest doctors’ strike in January.
In particular, they withdrew their consent to overtime work in order to push the government to honour its commitments on health reform.
In 2023, the doctors and dentists’ union had indeed signed an agreement with the government to create a separate salary pillar in the public sector salary scale for health professionals, but it never materialized.
“Employees are leaving public institutions and good pediatricians are being penalized for their willingness to help the public sector“, said Damjan Polh, president of the Fides trade union, in a statement.Promises of reform remain unfulfilled, and health care laws are written by those who do not understand them at all..”
The Slovenian government has adopted a proposal to amend the Medical Services Act to establish a minimum working time requirement during a strike “in order to ensure the stable functioning of the health system.”
For its part, the Fides trade union is challenging the constitutionality and legality of such a measure before the Slovenian Constitutional Court, because it “would further limit the right to strike of doctors”.
In August, the union informed the Slovenian government of its intention to continue the strike to protect the medical profession.
Controversial reform in France
In France, a measure of another kind has provoked indignation among medical students: there will be 1,510 fewer intern positions at the start of the school year.
According to data published in the Official Gazette in July, only 7,474 positions will be opened this year, compared to 9,484 in 2023.
“We are all very afraid (…) The work in the hospital is very difficult. It is very demanding on the mental and physical level of the interns.“, Marie, who is finishing her sixth year of medical studies, tells Euronews.And there will be fewer of us for the start of the school year. Except that the workload is not decreasing. So that means that we will have to share the workload, knowing that there are fewer of us.”
According to the government, the number of positions was reduced because the number of candidates applying for the internship exam also decreased.
“Every year, there is an adaptation of the positions in relation to the number of interns who apply. Except that this time, there were many more repeats,” explains to Euronews Dr Agnès Ricard Hibon, spokesperson for the SAMU Urgences de France union.
However, some students claim that many of their classmates deliberately failed their exams and repeated the year because they did not want to be a “crash test” class. They were in fact the first to take the internship competition following the reform of the second cycle of health studies.
Specialties will suffer to varying degrees: general medicine and ophthalmology positions are expected to decline by 18%, while emergency medicine positions will be reduced by 15%.
“There are certain specialties like plastic surgery, which will be more impacted and others which are preserved like pediatrics or pediatric surgery, because there is a huge need“, the spokesperson.
Dr Agnès Ricard Hibon nevertheless qualifies the impact of the reduction in the number of interns on hospitals: “They are systematically supervised by seniors. They are not the ones who operate the services.“.
An online petition calling for the reopening of intern positions had received more than 58,000 signatures by September.
The authors, sixth-year medical students, claim to have had a hard time: the multiple reforms to their studies have negatively impacted their results and their mental health.
As a result, about 1,000 students reportedly chose to repeat their fourth and fifth years and another 400 students failed the competitive exam, the petition said, adding that some positions have also become more competitive.
“A student who wants to do a digestive surgery internship in Paris must now be ranked among the top 23% of his class, compared to 35% last year.“, the petition states.
As a result, many students will be forced to choose a major out of spite, they say.
Marie, a medical student, warns that some students are considering continuing their studies abroad rather than giving up on their ambitions.
She says she reads daily distress messages on social media, asking for advice on how to continue their studies in Switzerland or Belgium.
To compensate, France could import foreign doctors in the opposite direction. “Maybe there will be a few more positions open to foreign practitioners who want to come and train in France“, Dr Agnès Ricard Hibon told Euronews.
Some students, however, consider such a solution unfair, both for them and for foreign doctors. “Foreign doctors are also being taken advantage of because they are paid less than us, so they are also being exploited.“, Marie believes.
More generally, these debates take place in a context of denunciation of the working conditions of interns: exhaustion, overtime, competition, significant responsibilities and low salaries.
The Bucharest Declaration on Health and Care Workers, adopted by WHO representatives in Europe in 2023, provides some ideas for emerging from this crisis.
It calls for concrete policies to recruit and retain health workers, train them and optimise their performance.
The challenge is immense: poor working conditions for caregivers have a negative impact on the quality of care.
“When you mistreat a caregiver, you know you are mistreating 10 people you care for behind you.“, warns Marie.
