The problems facing the medical community in Iran is in the news every now and then and sometimes even makes headlines. Issues like underemployment, low salaries and long working hours among others have often been the cause of complaints among those in the medical profession. However, the 70,000-strong general practitioners have been the most vociferous in that they consider themselves as the underdogs of the medical community.
To discuss their problems and give voice to their concerns, a gathering of representatives of the General Practitioners Society was convened in Tehran. Attending the meeting were high ranking health officials including Minister of Health Hassan Hashemi, president of the Medical Council Dr. Alireza Zali and the head of Iran Health Insurance Organization Anooshiravan Mohseni among others, the newspaper Iran reported.
Uppermost on the meeting’s agenda was the recent attacks directed at the medical community by the media - including state broadcasters - accusing them of financial corruption and misconduct. A program on IRIB channel one that claimed the salaries of doctors in Iran are 100 times higher than that of nurses, prompted the president of the Medical Council to write a letter denouncing such remarks which he condemned as tarnishing the image of doctors. Allegations have also been made that “surgeries can wipe out families’ financially due to the exorbitant costs and money is collected under the table by some specialists and surgeons.”
Media Hype
The health minister began his remarks by panning some media campaigns aimed at provoking confrontation between medical professionals and also promoting “despair” in society.
“There are forces trying to poison the relationship among various sectors of the medical community which is a betrayal of public health and puts people at risk,” Hashemi said. Mass media should not be used for judging others unfairly; this propaganda blitz will not work and the medical community should be careful not fall prey to these vicious attacks.”
However, he acknowledged that “the history of mistrust associated with general practitioners is still hounding them” but the government is trying to redress their grievances.
Network of Alliance
Hashemi said to strengthen solidarity among the medical fraternity, a network of doctors will be created. The network will be 12,500 strong and connect big cities and small towns. The plan will be first launched in the two provinces of Fars and Mazandaran with each province establishing a Comprehensive Health Center that will cover as many as 5 health bases. The plan is also aimed at boosting conditions in remote areas.
The minister highlighted the achievements of his office in tackling health challenges that the country faced when President Rouhani took office in 2013. Health insurance for 8 million people which was accomplished in one year, reduction in health care costs to make treatment more affordable for low-income families through introduction of medical tariffs and addressing the shortage of doctors in underdeveloped areas were some of the major breakthroughs of the ministry.
Easy Target
President of the Medical Council Alireza Zali, throwing his weight behind doctors said they had been “given the short shrift.” He said the existing rancor and animosity directed towards physicians is actually a sign of ‘’envy many feel about medical work.”
Instead of excoriating doctors, “why aren’t the names of those charged with corruption not revealed,” he asked. When a doctor in a small town fails to pay his or her taxes on time they immediately want them suspended from work, Zali noted. ‘’Our physicians are paid very low compared to British, American and Canadian doctors.’’
He criticized the media attack on general practitioners charging patients for seeing them the second time, saying that nowhere in the world “it is customary to see patients free of charge the second time.” He expressed concern over the low income of general practitioners, announcing plans to introduce higher tariffs for general medicine services in the near future. ‘’ Right now the highest income of a general practitioner is below $1660 a month,’’ he said.
Identity Crisis
President of the Society of General Practitioners (SGP), Abbas Kamyabi warned against what he called an ‘’identity crisis’’ among the general practitioners. “Since there is no definite status for GPs, the ongoing erosion of their designated role will prevent them from rendering their primary services and responsibilities,” he said. Their alienation is not fair and this may force them to either quit their jobs or immigrate.
Kamyabi hoped that by implementing the Family Doctor Plan their “misplaced identity” would be resurrected to some extent.
Fundamental change in general medicine education, rating the medical services and promotion of patient referral system were key issues urged by the president of the Iran Health Insurance Organization. Anooshiravan Mohseni called for the restructuring of health care system, but said the key “to accomplishing this reform is in the hands of general practitioners.”
“It’s true that health care funds have seen a big increase under the present administration, but since there has not been a fresh epidemiologic review of diseases, the existing budget will not be enough to tackle health problems and hence the need for a major restructuring,” Mohseni said.
Special Package
The chairman of the Majlis Social Committee however, had some “good news” for the audience. Abdolreza Azizi spoke about the special packages for doctors who are willing to work in remote and underdeveloped areas. He claimed that general practitioners in these areas can earn an income “four times the salaries of a member of Majlis” and “twice the salary of the health minister himself.” Azizi said the monthly salaries of village doctors had more than doubled in recent years and has now reached up to $4,300.
“The Majlis by allocating a $ 2.6 billion budget for healthcare has made efforts to eliminate medical corruption to a significant degree and increase employment opportunities in hospitals from 50% to 100%,” said Azizi.
He saw the ultimate solution to the plight of general practitioners in “observing the law” and said the parliament has been most cooperative with the government in this respect by allowing it generous access to national funds.
“The responsibility of the patient in an emergency falls on the physician while no ‘stress money’ is paid to these doctors which is not fair compared to a specialist who only receives hospitalized patients and patients that need counseling and is paid a regular salary too,” the lawmaker noted.
