Salaries could be doubled in public hospitals

Seventeen of the 30 doctors on duty at the provincial public hospital in the city of Río Cuarto resigned in protest against low salaries. According to the news, the basis of the claim is that the basic monthly salary is only AR$ 75 thousand. The modality of the protest –the resignation– and the relatively low salary –being professionals with high responsibilities– generated a wide acceptance in the rest of the medical community and the population. 

This is not an isolated event. Low salaries are a cause of widespread unease among professionals in public hospitals throughout the country. As hospital administration is the responsibility of the provinces, the most natural and immediate reaction is to demand a greater share of the provincial budgets. What does the evidence say about this demand? Since there is no public information for all the provinces, an illustrative approximation can be made based on the province of Cordoba, where the conflict is currently manifesting itself, but it is extensible to all the provinces. 

In the public hospitals of Cordoba, there are approximately 4,600 doctors contracted for about 35 hours per week. Assuming they do 3 consultations per hour, each doctor could attend about 330 consultations per month. On the other hand, 1.5 million people live in the Province without medical coverage. Therefore:

• The total number of consultations that public hospitals in Cordoba could attend is approximately about 18 million per year.
• Assuming 6 medical consultations per year per person, to attend to the population without social security, 9 million consultations per year are needed.
• This implies that the potential supply in public hospitals doubles its population’s needs. 

These data, although approximate, suggest that the main shortcoming of public hospitals is not a lack of resources but of management. The fact that twice as many physicians are hired as are needed implies that the salaries of working doctors could be doubled if salaries were not paid to those who work little or not at all. In this sense, management failures generate unfair salaries because they do not allow for monetary recognition to reflect the very different levels of commitment of the doctors. Management failures are even more unfair to people who have to line up in the early hours of the morning for an appointment and, when they get it, often end up not receiving care on that day. That’s why emergency wards are overcrowded.

Management deficits are materialized fundamentally in the deficient identification of the people that hospitals have to attend to. This results in weak control of the tasks performed by the personnel. The lack of good records of the patients and the professional who attended to them are the two main sources of salary injustices. Working physicians are clearly underpaid. While physicians who do not go to work, or go only on some days, and when they do go see only a few patients, receive the same salary. The result is very low salaries for those who work, high salaries for those who work little, and extraordinarily high salaries for those who do not work at all.

Public hospitals need a structural change in their management model. At present, there is a strong administrative centralization in the provincial Ministry of Health and the tendency to appoint as hospital director a staff physician from the same hospital who is not a professional health administrator. Their main function is to process files to manage personnel and to purchase supplies and maintenance investments centrally from the Ministry of Health. The change of model should be based on the professionalization of management in order to decentralize it and set a patient identification system to monitor medical care. Under these conditions, with the current resources, physicians’ salaries could be improved. 

It is also essential to rethink the role of the national government. Historically, it runs about twenty national programs that consist of transferring small sums of money and supplies to provincial hospitals. The national Ministry should be transformed into a national outcome evaluation agency. Its function should be to measure health results and disseminate them to society. In this way, provincial authorities will be subject to control and pressure from their citizens to maintain professionalism in the management of public hospitals. Thus doctors could be paid much better.