Is "obligation" coming?

Medical studies: Is a “voluntary obligation” coming?

(Bild: Mathis Fotografie)

A "voluntary obligation" for medical students, for example via a quota for rural doctors, is possible, as medical law expert Karl Stöger (University of Vienna) now explains. He comes to this conclusion in an expert opinion commissioned by the Chamber of Labor (AK).

The starting point for the expert opinion was the demand by Federal Chancellor Karl Nehammer (ÖVP) last year to impose a kind of professional obligation on doctors for a certain period of time after their studies. Those who have completed a medical degree in Austria should "then also give back to society a little of what they have taken advantage of free of charge".

Last year, Stöger wrote an expert opinion for the Austrian Medical Association in which he came to the conclusion that a statutory obligation to work in public hospitals or health insurance practices, for example, would be inadmissible under constitutional and EU law.

Preferential access with subsequent obligation
The situation is different with a "voluntary obligation", according to Stöger in the AK report. A "voluntary obligation", which initially sounds like a contradiction in terms, would exist, for example, if, in return for preferential access to publicly funded studies, applicants undertake to work in an area of the public healthcare system for a certain period of time after graduation.

System already in place, restructuring required
Such a system already exists: according to the Universities Act, up to five percent of study places can be dedicated "for tasks in the public interest". The Austrian Armed Forces, for example, make use of this. Applicants for these places have preferential access in that they are not subject to the actual selection procedure for the best test results, but only have to achieve 75 percent of the number of points of all applicants.

According to Stöger, this system can be extended - but only within certain limits. For example, only as many places may be dedicated to a voluntary commitment as will later be needed in the public healthcare system. This quota should not be used as a substitute for better working conditions and pay for doctors in the public system, but only as a supplement.

In addition, sufficient "commitment-free" places must always be offered. In Germany, for example, a regulation has been made according to which a maximum of 20 percent of places (e.g. for rural doctors) may be dedicated to advance quotas. Conversely, 80 percent remain free of obligation.

And finally, details must be taken into account: For example, the commitment period must not be too long - in Germany it is around ten years after the end of training, in South Tyrol it is five years within a ten-year period. According to Stöger, starting work immediately after completing training is also less burdensome in terms of fundamental rights than postponing it.

Setting an appropriate penalty payment
When setting a penalty payment in the event of a breach of the obligation, limits must also be observed. On the one hand, it must be high enough to act as a deterrent. On the other hand, it should also not ruin the economic situation of those in breach of contract and should include hardship provisions and the possibility of repayment in installments. The average expected income of doctors could serve as an option for calculating the amount.

Options for obligated parties
The choice of the obligated persons regarding their subsequent area of deployment can also play a role in the assessment of admissibility under fundamental rights: The more freedom of choice they have with regard to their geographical location, choice of specialty or choice of practice/inpatient area, the better.

The AK calls for this leeway to be used. Those people who voluntarily commit themselves to the public health service should be given "preferential" access to medical studies. In addition, there should be a modern nationwide overall contract for doctors with flat-rate elements and thus a move away from the system of individual service remuneration. In addition, other healthcare professions should be included in the general contract to relieve the burden on doctors.

SPÖ leader Babler wants a two-stage voluntary obligation.

(Bild: APA/ERWIN SCHERIAU)

Babler in favor of a two-stage voluntary commitment
SPÖ leader Andreas Babler, on the other hand, advocated a two-stage voluntary commitment in return for preferential access: students would then commit to working as doctors in the public healthcare system once at the beginning of their studies and once towards the end of their studies - whereby the specific subjects in which there will be a need in the foreseeable future would be chosen the second time.