The Samoa Medical Association has highlighted the ongoing problem of doctor shortage as the cause of excessive overtime, which has been the main topic of discussion between doctors and the Public Service Commission in recent weeks.
In Parliament on Thursday afternoon, the Minister of Health Hon Valasi Toogamaga Tafito Selesele highlighted the main issue as being the method of paying overtime hours to doctors and nurses under the Labour and Employment Relations Act. According to the Minister, paying overtime at the rate of a doctors’ hourly rate had led to overtime of up to $10,000 tala per fortnight.
“That is a total of $260,000 tala per year,” said Valasi. The Minister goes on to say that for a Junior Doctor earning $40,000 tala per year, that would result in an annual payout of $300,000 tala.
The Minister goes on to say that this is unacceptable, as it would mean a doctor earns more than the Head of State, the Prime Minister and Members of Cabinet.
The Health Minister asks rhetorically as part of his Parliamentary address, “Is this appropriate, when the country is complaining about the service? They wait for hours to be seen by a doctor.. women give birth before a doctor even turns up.. and some On-Call doctors give instructions over the phone and don’t even bother to come in..”
In response the President of the Samoa Medical Association (SMA) and senior surgeon Taulealeausumai Dr Titi Lamese told the media at a press conference last Friday that the Minister’s remarks were demoralising for Samoa’s doctors.
“We are deeply hurt by these remarks,” said the President, “our hard work over many years, has all been undone by the Minister.. it feels like we have been working for nothing.. to be told our work is useless..”
“His remarks are also very misleading to the nation listening in,” said Taulealeausumai.
According to the President, the excessive overtime payments exist because doctors are working around the clock night and day, to fill the serious problem of doctor shortage.
The President was joined at the press conference by Dr Monalisa Punivalu and Dr Folototo Leavai.
According to Dr Punivalu, all Senior Doctors and Registrars work from 8am to 4pm, and afterwards, they are forced onto an on-call schedule to cover the other 16 hours of the day.
Also the Head of Obstetrics and Gynaecology at the Tupua Tamasese Meaole Hospital, Dr Monalisa Punivalu said the On-Call strategy was developed by doctors as a solution to the shortage.
“The system provides for a Registrar level doctor to be the first on call, and if this needs to be elevated, there is a Consultant or a Senior Doctor scheduled to be the second on call“.
Dr Punivalu said that in order to provide quality and safe service, there must be a supervisor and adequate support for Junior Doctors at all times.
However, “Some departments just have one Consultant, and some have only two – and that means that a Consultant can literally be on standby 7 days a week.”
“So we work normal hours, and then we have to be on-call to cover the other 16 hours of the day, every day, all year round..”
According to Dr Punivalu, the shortage of doctors is exasperated because there is a severe shortage of Consultants and Senior doctors.
The Obstetics & Gynecology and the Surgical Units were highlighted as being the most affected by the shortage, “due to the fact that Consultants and Specialists are commonly needed to perform surgeries and respond to emergencies after hours..”
“Obstetrics and Maternity are high risk areas,” explains Dr Punivalu, “and the on-call system is there to protect the junior doctors.”
Dr Punivalu says the Surgical department is extremely busy, however, for a long time, it has had only one Consultant. “It now has two, but very recently.. and that is to cover the other 16 hours everyday of the week!”
Dr Folototo, who is currently acting Head of General Medicine, added that surgeons often have to help out and cover other areas outside of their specialty, especially for after hours and emergency surgeries.
“So if those doctors sign contracts as ENT surgeons, for example, the reality is that they’ll end up helping out and performing stomach surgeries,” said Dr Leavai, “it’s not like overseas where doctors only perform work relating to their specific specialties.”
SMA President Dr Titi Lamese added that the excessive overtime hours are therefore inevitable, and something that doctors do not ask for, nor prefer.
“People are pointing fingers at doctors and saying this is about money..
“We would love to work the same hours as all other Government Ministries. Come in at 8am, then go home at 4 or 5pm and have a good night’s sleep; but that is not the nature of our work as doctors..”
“Amuia isi Matagaluega a le Malo.”
The President says that if doctors’ overtime hours is costing the nation too much money, then they would be happy to work their normal 8-4 shift, and go home at the end of the day.
“But we know that will hurt the people of Samoa, and our decision to not go down that path is one that puts the nation first,” said Taulealeausumai.
He adds that the problem of doctor shortage falls squarely on the government. “That is the government’s problem to fix.”
The number of doctors currently working in Samoa’s public health service, is around 92. The World Health Organisation (WHO) recommendation is a minimum of one doctor per 1,000 people. For Samoa, that would mean 205 doctors are needed to service the current 205,557 population.
The Samoa Medical Association representatives said they are in total agreement that the health of the nation is getting worse.
“There is a marked increase in non-communicable and infectious diseases, and the realities of pandemics and outbreaks means the workload continues to increase exponentially,” said Dr Monalisa Punivalu.
On the proposed remuneration schedule and working conditions put forward by the Public Service Commission, members of the SMA say they are grateful to PSC for the many positive areas that have been offered.
“Overtime started at 30% and now we have reached an agreement for up to 60%” said Dr Folototo. “The talks have been very positive.”
SMA says good things have been raised by PSC and doctors look forward to implementing some of the new initiatives, such as proper alignment of medical professionals to the correct salary level.
“There are doctors working at the hospital who have been on the same salary for six even 10 years,” said the President, “they have since become qualified with Masters degrees, but remain on the same salary..”
Dr Titi Lamese says the proposal for a Responsibility Allowance remains an issue that needs more time to discuss, especially in light of senior consultants who have no choice but work overtime.
“If there are emergencies at night, we must perform surgery in the middle of the night, and that can go on for hours until early morning..”
“E ao lava o fai isi taotoga.”
The Samoa medical profession have called on the PSC to keep negotiations open, and continue to dialogue towards a solution that would benefit both sides, and limit the impact on the nation.