Representatives of Junior Doctors in European Countries met on the 30th and 31st of October 2009 hosted by the Irish Medical Organisation in Killarney for the Autumn Meeting of the Permanent Working Group of European Junior Doctors (PWG) to discuss the main issues in medical training producing the outcomes summarised in this document.
Copyright 2009 © The Permanent Working Group of European Junior Doctors (PWG)
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EU Directive on Patient’s Rights for Cross Border Healthcare
The PWG adopted its first position paper on the proposed directive on Patients’ Rights in Cross Border Health Care. A working group brainstormed the proposed directive from a European Junior Doctors’ perspective and presented a draft paper to the EU/EEA Subcommittee which, after minor alterations, was adopted by the plenary.
For PWG the most important issues were highlighted as follows:
- Post graduate training and CME/CPD;
- Medical migration and workforce planning;
- Terms and conditions of employment;
- Recognition of qualifications;
- Medical indemnity and insurance;
- Quality assurance.
Essentially PWG calls on the Europeam Parliement and the Commission to be aware of, and responsive to, the potential impact of the directive on these areas in particular. We will strongly lobby all EU institutions to pay special attention to Junior Doctors’ requirements for training and education as the dynamic of health care delivery changes within the EU over time.
Telemedicine and teleradiology
Telemedicine and teleradiology are becoming increasingly important in daily medical practice. This has profound implications in patient care and Postgraduate Medical Training (PGT). The European Health Services Directive will strongly regulate the field and already addresses various issues such as electronic substitutes for direct patient encounter, how patient records be made accessible remotely, legal pathways for this access and electronic certificates, amongst others. The main concerns towards PGT are the effect this technology may have on training, the learning needs of the Junior Doctors (JDs), the insufficient exposure to particular clinical situations, the possibility of an incomplete learning experience and legal responsibilities of JDs.
PWG adopted a Policy statement on this matter focusing primarily on the particular concerns and interests of the JDs. The PWG believes that it is essential to raise awareness on these topics and to efficiently lobby on them with other EMOs.
The European Working Time Directive
An honest and open discussion about the realities of the impact of EWTD on our member states was had. Over the past 12 months it has become very clear that the realities of the EWTD for different countries is very different. The range of implementation of the Directive ranges from some EU countries not having written the directive into national law, to other countries where very high levels of compliance with the directive has been achieved.
Even in those countries where high levels of compliance has been achieved, several key issues have been highlighted:
- Difficulty achieving the 48 hour average weekly limit, even when compliance with the 56 hour limit was high;
- Failure to accurately monitor working hours in some countries has led to innacurate estimates of weekly working hours and an apparent ‘on-paper’ compliance in a reality of non-compliance;
- The impact on training, particullarly in certain specialties where procedure based training is essential is causing concern for doctors, both Junior and Senior;
- We openly discussed the need for PWG to be confident that our position on EWTD is consistent with that of the plenary and the EU/EEA subcommittee will undertake to survey all delegations prior to the next meeting in order to ensure that PWG proceeds with a concensus position that accurately reflects the views of our delegations and the doctors they represent. This will be further discussed at the next EC meeting and SM 2010.
A very important issue about social responsibility also was raised. As leaders in Health Care in our respective countries we are at the thin end of the wedge when it comes to political issues affecting Health Care. As such we are well informed as to the social, economic and political fallout from EU legislation. Being in such a position comes with a responsibility to look at issues such as EWTD from a broader perspective than simply the individual impact on the ground. We need to be cognisant of the impact of the Directive on the health and safety of the medical workforce and especially on the health and safety of our patients. We cannot ignore the spirit of the EWTD which would see the dramatic reduction of working hours and the potentially massive positive impact that will have on patient safety and doctors’ wellbeing.
PWG supports the EWTD in its current format in full. It has been a long-held position and one shared with our colleagues in other EMO’s. As a progressive and dynamic organisation, PWG will continue to ensure that this position is the correct one from the perspective of Junior Doctors and as the EWTD undergoes further revision, PWG will lobby at the centre of the EU to influence the thinking and actions of the Commission and our MEPs.
European medical manpower
The PWG has decided to study the demography and manpower of the European Medical Doctors and presented its preliminary results during the joint European Medical Organisations' (EMOs). This project follows the PWG manpower study published in 1996, most likely becoming one of the most important studies in recent times steered by Junior Doctors and it is expected to have a significant impact in policy and decision making. CPME and FEMS have already given their support to this project and are expected to give out the questionnaire to their members.
The PWG initiated the discussion of other relevant topics that are expected to produce significant output in the next Spring Meeting (May 2010):
- Revision of the EU Directive 2005/36 on the Recognition of Professional Qualifications;
- Bologna Process;
- Gender imbalance in Medicine;
- Medico-legal issues in PGT;
PWG Brussels Office
For the PWG to accomplish its goals of representing the rights and interests of European JDs, it is necessary for the organisation to increase the lobby efficiency within the European Political institutions. The PWG Plenary supported the decision to contract the services of Marie-Christine Bonnamour to for a PWG Brussels Office, for a trial period of one year. The Office will provide the following services:
- A Brussels address;
- Follow-up of news, events and opportunities relevant to junior Doctors (funding included);
- Monitoring of relevant EU policies;
- Dissemination of relevant PWG documents;
- Capacity and know-how to assist on the PWG legal registration process.
The Association for Medical Education in Europe (AMEE) is a leading international association for medical education with members in 90 countries on five continents. AMEE has as its mission the facilitation of excellence in medical education across the continuum of undergraduate, postgraduate and continuing medical education.
PWG and AMEE signed a Memorandum of Understanding whose aim is to improve the quality of medical training throughout the continuum, but specifically with regard to postgraduate medical education.
MEDINE2 (Medical Education in Europe) is a network of 89 partners (Universities, EMO’s, medical education associations) compromised to promote mobility for medical students and physicians, tuning undergraduate medical training and developing research. It was awarded a European Commission Erasmus Grant of €600.000, during a 3 year period. The project started in October 1st 2009.
As a partner organisation the PWG will actively engage in the project.
PWG and the European Medical Students’ Association (EMSA) decided to embrace the development of joint projects. The main goal is to benefit from the expertise of the different organisations and improving the work done in defending the interests of medical students and junior doctors and promoting improvement of education standards. In the near future the focus will be on:
- Bologna Process 3rd cycle;
- Scientific Research during medical school and PGT;
- MEDINE 2;
- EU Directive on the recognition of professional qualifications (2005/36);
- Workshops (leadership training and coping with transition between medical student/JD);
- Networking between medical students and JDs at the national level.
The following colleagues were elected as PWG representatives to the respective UEMS Section/Board/MJC:
Indre Butiene (LT) - Paediatrics (vice-representative)
Carsten Mohrhardt (DE) - Orthopaedics
João Carlos Ribeiro (PT) - UEMS Section ORL
Elina Salmi (FI) -UEMS Section ORL (vice-representative)
NEWS IN THE PWG
The PWG strategy for the mandate 2009-2012 was discussed and supported by the Plenary. The document addresses the major challenges ahead of the newly elected Presidency – Internal matters, European influence, collaboration with other European Medical Organisations (EMOs), working and training conditions and health inequalities – devising the main actions address them in the following years.
Together the newly elected Chairpersons (see below), the PWG Executive Committee is now formed by the following members:
Bernardo Bollen Pinto (PT)
Andreas Botzlar (DE)
Sérgio Pereira Chacim (PT)
Treasurer Luís Monteiro (PT)
New Technologies Officer
Elections for the PWG Subcommittees Chairpersons
The following colleagues were elected as Chairpersons of the respective PWG Subcommittee:
Noora Ritamak (FI)- Medical Workforce
Carsten Mohrhardt (DE) - Postgraduate Medical Training
John Morris (IR) - EUEEA
Sérgio Chacim (PT) - Economy