According to Khabar Online, it was the winter of last year that Siamak Behrvan, a first-year psychiatry resident, was pressured due to not providing a guarantor to fulfill his residency obligations and finally committed suicide. Most of the people who have completed the residency period believe that the difficult conditions of the residency period are sometimes beyond the tolerance of people and the person ends his life to end the problems of the residency period. Among the problems of the residency period are the excessive and unbearable pressure of the upper years on the lower years, insulting the upper years, irresponsibility of professors, long-term guards without rest, financial problems and of course, unprincipled commitment to provide service.
Unilateral commitment to serve during the residency period and its challenges
In a situation where there is no fair access to specialist doctors in the country and in some fields such as emergency medicine, anesthesiology, and pediatrics, the alarm of shortage of specialists has sounded in deprived areas, the Ministry of Health, contrary to the ruling of the Court of Administrative Justice, strange conditions for studying in the course Has established an assistant. In the circular of the Ministry of Health, this ministry has considered two types of collaterals for residency students, and the students are required to provide one of these collaterals in order to pass their course. First, a notarized commitment with two non-retired official employee guarantors with less than twenty years of experience, and the second is a notarized commitment with the deposit of property collateral.
According to the Farhikhtegan newspaper, the excuse of the Ministry of Health for taking these commitments is to require assistants and young doctors to provide services. If this incident basically causes young doctors who do not have high financial resources or do not have access to an official guarantor, to stop studying; Because the trouble of the assistantship period will endanger their whole personal and work life. Of course, this story is even contrary to the slogans and some decisions of the Ministry of Health in recent years, such as increasing capacities to compensate for the lack of doctors. On one side of the story, the Ministry of Health increases the capacity of the assistantship course, and on the other side of the story, contrary to the ruling of the Administrative Court of Justice, it still asks young assistants to provide a guarantor or heavy financial guarantee. The painful part of the story is that if the resident dies during the study period or during the plan, the guarantors have to pay the annual education fee and the education allowance of the person.
After all, if a person applies for studying in one of the specialties and after one year, for example, comes to the conclusion that he will not become a good neurologist or he will not be a comprehensive expert in the said specialty, still because of the obligation to return the annual fee and The scholarship cannot be withdrawn; Because he has to pay nearly 800 million tomans per year of education. The main and fundamental question in this case is whether this will have any results other than the classification of the assistantship course?
Consider a person with lower average economic conditions in the society, who has been able to be admitted to medicine with many difficulties. This person has a desire to study and serve the country in his field and is also applying for the assistantship exam. In the meantime, he has to spend his planning period in one of the deprived areas, and unfortunately, he gets into a car accident and loses his life. How should the family of such a person pay the high cost of this person’s education?
Administrative Court of Justice: Obtaining a commitment is an example of unfair discrimination
Following the complaint of one of the students of medical sciences regarding this directive of the Ministry of Health regarding the beginning of the residency period, the Court of Administrative Justice, recognizing the issue, entered into the issue and issued a decision about it. In October 1400, the Court of Administrative Justice announced: “In an extra-legal measure, the Ministry of Health has made the continuation of the education of those admitted to the specialized medical assistant exam subject to obtaining a notarized commitment to serve in deprived areas designated by the Ministry of Health, while this is contrary to Article 3 Note 1 is the service law for doctors and paramedics. In order to guarantee this demand, one of the following items has been requested as the main prerequisites for the start of the course. A. Notarized commitment along with introduction of two guarantors of non-retired employees with experience of less than twenty years, b. Notarized commitment with real estate deposit. Forcing a doctor accepted in the exam to introduce a non-retired official employee as a guarantor with less than twenty years of experience or to deposit a real estate bond in order to continue his education is a clear example of illegal discrimination; Because it prohibits people who do not have the financial ability to buy property and who do not have relatives of an official employee from continuing their education (which is a public right and citizenship). In addition, these unusual conditions are not required to start education or study in any field or training course, and no authority has the authority to force a person to give a guarantee despite their inner desire. Especially, according to paragraph 5 of the letter of commitment, the Ministry of Health obtains a notarial commitment and power of attorney from the doctor accepted in the entrance exam that in the event of the death of the doctor, on behalf of the doctor, he will reach an agreement with the Ministry to determine the amount of damages to the Ministry of Health and pay the amount of the damages. to demand from the guarantors, while demanding damages from the assistant and resident doctor of the hospital, who is responsible for the main workload of the hospital, especially during non-office hours, is a meaningless action.
Despite the decision of the Court of Administrative Justice and almost three years after the notification of this decision, the Ministry of Health still requires the commitment of service from the assistantship students with an official guarantor or bond. Apart from the fact that the decision of the Court of Administrative Justice explicitly mentions the discriminatory nature of this action, obtaining bail and making the conditions of study in the residency period more difficult, is against the general policies adopted by the Ministry of Health in the direction of access to doctors. That means, on the one hand, the Ministry of Health will increase the number of seats in the assistantship course, and even for some fields, after the completion of the general medicine course, they will receive assistantships directly. On the other side of the story, the conditions for obtaining a commitment to study in the assistantship course become so difficult that a person may be discouraged from continuing his education and completing the specialization course; First, it is possible that he does not have an official guarantor under the age of 20, secondly, he may not be able to provide a heavy financial guarantee, and thirdly, due to work commitments or even the difficult conditions of the residency period, there is a possibility of withdrawing from the internship. Therefore, a person doesn’t go towards continuing his education and getting a specialization out of fear of these possibilities, and of course, considering the circumstances, this decision is completely wise and logical.
Four years of education is equivalent to 3 billion repayments
Alireza Latifi, a doctor and trade union activist in the field of healthcare, believes that the residency requirement is a clear discrimination. He says: “In no field and at any level of education in this country, they do not ask anyone to commit to work twice as much as their education period, wherever the responsible institution says, the person will work. If he wants to cancel, he must return more than double the annual fee. Now, according to the formula presented, the annual repayment figure is nearly 800 million Tomans. Also, if the obligations announced by the responsible institution are not fulfilled by the resident, they will charge twice the money for four years of education from the resident. It means that a resident with current numbers has to pay 3 billion tomans. The interesting point here is that the text of this undertaking states that even the payment of this fine does not remove the obligation to implement the project from the shoulders of the resident. It means that if a person has the financial ability and cannot go to the plan, he still has to pay twice the cost of education and still has to pass the plan. In short, one has to pay and plan.”
As if the goal is not to train manpower
Latifi states: “We are not saying that you should not act according to the law, but all we are saying is that you should not act beyond the law. The thing is that we are not saying that the doctor should not fulfill his legal obligations, but we are saying that the doctor’s obligations should be reasonable like other fields of study. A letter of commitment is placed in front of the doctor and he is told to bring two guarantors with special conditions and a property guarantee. If, for any reason, the resident could not continue his education or intends to withdraw from his studies, they will immediately contact the guarantors of the resident to return the education fee. It means that the goal is not to train manpower and the only goal is to find free labor. During his residency, he worked for four years, saw patients and managed a hospital. Why should they still ask the resident to return his tuition fee? The annual tuition fee for residents is 312 million tomans. Is the cost of running the hospitals supposed to be collected from the resident? What is the basis of this number? A resident who provided services and suffered mental, psychological and family damage during this time… Why should such a fee be returned? The reason is that this letter of commitment is one-sided and the Ministry of Health only takes a commitment from the resident and does not give any commitment to the resident. “The Ministry of Health does not give any guarantee that if it forces the resident to work at the border zero point and pay his dues with a delay of one year, for example, he will pay a fine to the resident.”
Who pledges to the resident?
This young doctor continues: “The Ministry of Health does not make any commitment to the resident to increase the duration of the year or to pay on time. However, a design specialist is sent to the border zero point with 14 to 15 million tomans, and the travel expenses are even borne by the resident himself. If the resident is supposed to pay double the cost in case of withdrawal or failure to pass the plan, then who will be responsible for the injuries, limitations, psychological and financial damages and hardships of the resident? The commitment letter was created at the height of the health transformation plan. That is, when the incomes were higher and the payment for residency was relatively better. The life of the person was also improved during the plan period and the residents themselves were willing to go through the plan period. Now, however, when the Ministry of Health does not perform any of its duties towards the residents, the pressures have increased both during the planning and specialization period, and hope has been taken away from the residents, and the issue of commitment letters has become serious. That is, in recent years, there are people like Dr. Prastobakhshi who have written to all the relevant institutions, but in the end they have met the officials who implement the commitment letter and force the person who has seen mental and emotional problems to go through the plan.
Latifi also mentions that the problems of the commitment letter continue even after the death of the residents. That is, if a resident dies, he still has to pay the annual fee reimbursement to the Ministry of Health by the guarantors. In this regard, this doctor says: “We violate the principle of free education in this case. All our citations, in Article 7 of the amendment to the youth employment law, said that everyone should study for free in the country… In the meantime, I would like to add that residency is not an education in its full meaning, but rather an educational-skill and job course. . This means that the resident works and learns new skills. Instead of the resident getting services from the Ministry of Health, the resident himself should commit to doing the work. For example, the Ministry of Health only provides health insurance for the resident and the family is not insured, but from where does it get insurance? It is insured from the student insurance. That is, medical insurance is provided, and then after graduation, the medical insurance premium is deducted from the plan’s insurance salary. The Court of Administrative Justice has officially announced that the Ministry of Health! You do not have the right to take a guarantor and bond, but immediately after this, the minister writes that you should take a guarantor and bond. Abandonment, dismissal from service and non-implementation of the court’s orders are nothing. The justification is that the deprived area will be empty and if we do not get a commitment, no one will go to the project. If someone leaves, he leaves with dissatisfaction. What sin have the people of the deprived region committed that their hospitals should be filled with disgruntled forces?”
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منبع: www.khabaronline.ir
