Reykjavík Grapevine - 05.12.2014, Blaðsíða 20

20
The Reykjavík Grapevine
Issue 18 — 2014
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Quality - Experience - Dedication
With 35% of Icelandic specialists
slated to retire in the next ten years,
and 20% in the next five, Íris foresees
an imminent shortage. Already, Dr. Ólöf
Birna Margrétardóttir, MD, and Dr. Jón
Örvar Kristinsson, a gastroenterologist,
have publicly handed in their resigna-
tion letters, and there are fears that more
will soon follow if an agreement is not
reached by the end of the year. “It stings
even more when both the Prime Minis-
ter and Minister of Health have said they
are worried about the situation, but the
negotiators refuse to budge,” she says.
“With Skype, Facetime and other mod-
ern technologies, living apart from your
ones family and loved ones is less diffi-
cult than ever before, making the pros-
pect of working in another country seem
viable to many.”
The appeal of Iceland
Úlfur Thorodssen, a medical student in
his final year, does not imagine he’ll re-
turn to the country after becoming a spe-
cialist with the situa-
tion the way it is right
now. He will have to
study overseas, which
he estimates takes
around five years,
after which his inter-
national earning po-
tential will outweigh
anything Iceland has
to offer. “After living
somewhere for five
years, you’ve made a
life for yourself, and
have higher wages
than here, so why
should anyone return
home?” he asks.
Were the situa-
tion different, wages
higher and more funds put towards the
healthcare system as a whole, Úlfur says
he would strongly consider moving back.
“I know it won’t be as good as in other
countries, but if the wages and holiday
allowance were better, it would change
the equation.”
For others, like Dr. Guðmundur Karl
Snæbjörnsson, there is a compromise
to be made between living at home and
earning good wages. In the aftermath
of the economic collapse, Guðmundur
started an agency called Hvítir slop-
par (“White Robes”), which solicits jobs
in Sweden for Icelanders interested in
working there for periods of time. He
says that some take unpaid leave from
their posts in Iceland to supplant their
wages, whereas others will spend every
other fortnight working in Sweden, re-
turning to Iceland to rest and meet their
families in between stints, thus earning
enough to support themselves and their
families.
“We recently advertised 300 avail-
able positions in Sweden, so there’s no
shortage of work to be found,” he says,
adding that his company employs junior
doctors and specialists alike. He refuses,
however, to discuss how many people
are involved in the venture.
Guðmundur has full confidence in
the current health minister, and has
personally taken part in shaping the
health policies of the Independence
and Progressive parties (currently in
government), but says there has been a
long-standing lack of interest from par-
liament in dealing with medical matters.
“Healthcare professionals, the ones that
know the most about their work, have no
say in how the healthcare system is run.
This results in bad bureaucratic deci-
sions that negatively affect the system.”
Despite the times being rough at the
moment, some—like Dr. Inga Sif Ólafs-
dóttir, PhD—have returned to Iceland
with their families in tow. Inga Sif spent
ten and a half years abroad, specialis-
ing in internal and medicine respira-
tory medicine, as well as receiving a PhD
from the University of Uppsala, Sweden.
During that time, she and her husband,
an ophthalmic surgeon, had bought a
house in Uppsala,
where they enjoyed
a good life with their
three children. She
says that they eventu-
ally decided to return
home to Iceland be-
cause there was some-
thing calling them
back. “Good memo-
ries, family and nature
all factored heavily
into our decision,” she
says, “but we weren’t
quite expecting what
we encountered.”
Upon their return,
the family’s wages
shrank by more than
half. In Iceland, Inga
Sif receives only a small portion of the
holiday allowance that doctors in Swe-
den are allotted.
What surprised Inga Sif more than
the low wages, however, was how few
healthcare professionals there were
around, and at what pace they had to
work. “You quite often come home feel-
ing disappointed, because you don’t have
time to complete as many tasks as you
would like to,” she says, “and there is sig-
nificant risk of people burning out.” Inga
Sif is afraid that if the system doesn’t
become more flexible, doctors will stop
returning to Iceland from international
studies, and that it will create a down-
ward spiral that will be difficult to re-
verse.
Inga Sif calls for a certain attitudinal
change in society, for politicians to look
at the big picture, and realise that doc-
tors are a vital segment of the healthcare
system—if all the segments don’t work
together, we can’t maintain the system
we have grown accustomed to.
Throughout the whole debacle, one man
has consistently remained focused on the
big picture: LSH director Dr. Páll Mat-
thíasson, PhD. Educated as a psychia-
trist, Páll served as a senior physician
before becoming the Chief Psychiatry
Executive at LSH in 2009—and director
at the end of 2013. Despite the tremen-
dous pressure he faces with the ongoing
strike, Páll still finds time to sit down
with me in his office to discuss LSH and
the future of medicine in Iceland.
“Off the cliff”
Up until the second draft of the govern-
ment’s budget was announced, Páll was
looking at having to employ hefty cost-
saving exercises, which he likens to hav-
ing to put on a T-shirt that’s a size too
small. “Either you tear it by trying to do
too much at once, or you have to down-
size so you fit into it.”
This problem has been affecting the
director’s work since the 2008 collapse.
His predecessor, Björn Zoëga, retired
in protest a year ago, when the state yet
again failed to raise the hospital’s budget.
At the time, he remarked: “if the budget
is not changed, it will be very difficult to
run the hospital in a safe way. I will not
partake in driving the hospital off the
cliff.”
Páll celebrates the newly allocated
funds earmarked for medical equipment
renewal, the plans for a new state-of-the-
art hospital (more on that later), and the
extra one billion ISK that will make its
way to LSH’s operational budget. He says
that it's as if those in charge have finally
woken up from a bad dream and realised
how dire the situation had become. “We
were able to cut costs efficiently for about
two years, but we knew we’d need more
funds,” he says. “It’s a bit like holding
your breath. You can do it for half a min-
ute, but not five, so if we had gotten this
money in 2012, we’d have a lot less work
to catch up on.”
A quick billion
The current strike presents to him a two-
fold challenge; on the one hand, the lon-
ger it persists, the more of the operational
budget will be eaten up by procedures
that the strike places on hold, and on the
other it is demoralising for staff, and may
spur hospital employees to seek gainful
employment elsewhere. He stresses that
people have to be paid well enough to en-
joy their work.
At present, Páll has the task of allocat-
ing that one billion ISK, which he says is a
good start, though more funds are need-
ed. “Just replacing the old backup power
generators at the Fossvogur branch will
cost up to 200 million ISK,” he says, “and
our computer systems are in dire need of
upgrades. We suffered a crash not long
ago that resulted in the entire network
being down for two hours. That will also
cost around 200 million ISK.”
His work requires him to look even
further than that, though, and getting
the long-promised state-of-the-art hos-
pital built is one of his top priorities. The
building is slated for completion in 2020,
and Páll deems it to be paramount to
patient safety. He says that the facilities
at their Fossvogur branch haven’t been
properly cared for in decades, and as a
result black mould has festered, among
other things. Overcrowding is also an is-
sue, with up to six people at a time shar-
ing a room and toilet facilities.
“Building the new hospital also al-
lows us to centralise many of our servic-
es, such as our A&E departments, which
will cuts costs considerably,” he says. At
present, the hospital operates two op-
erational emergency departments along
with numerous specialised care depart-
ments spread over a large area, both of
which present risk factors for patients.
“We move 9,000 patients between de-
partments and buildings annually,” he
says. “Just the act of moving a critically ill
patient between floors presents a risk—
ferrying them across town is both costly
and hazardous, and will lengthen their
recovery time by about a day.”
Páll estimates that operating out of the
new hospital will save around 2.63 billion
ISK per year, once it’s completed.
Every little bit helps
Páll admits that the hospital staff has
managed to work wonders with very
little money, but that for any meaningful
change to happen, more funds need to
be funnelled into the healthcare sector.
Iceland’s health expenditure went from
being 10.05% of its GDP in 2003, down
to 8.81% in 2013, which is a development
that Páll wants to reverse. Only two other
Western countries have cut their health-
care expenditures proportionally more
than Iceland: Greece and Ireland.
In comparison to the other Nordic
nations, Iceland spends a lot less on its
healthcare system. A 2013 OECD report
shows that Norway spends 9.3% of its
GDP on health expenditures, Sweden
9.5%, and Denmark 10.9%—these coun-
tries also out-earn Iceland’s $54,000
GDP per capita, with $100,000, $58,000
and $59,000 respectively. “Each percent-
age of our GDP is worth 18 billion ISK,”
Páll says, “so if we were to match Ger-
many’s 11.3%, that would be an addition
of 40 billion ISK or so.”
The McKinsey & Company consul-
tancy group compared the cost of proce-
dures at LSH and Karolinska University
Hospital in Stockholm, Sweden, which
is a facility three times as big as its Ice-
landic counterpart. Carrying out a single
unit of procedure, such as curing pneu-
monia, was found to cost 50% less in Ice-
land than in Sweden. This efficiency is
to be celebrated in Páll’s opinion, but the
hospital needs to be run in a sustainable
manner where people feel good about
their work and don’t risk burning out. “If
you routinely have to call in one or two
people to cover a shift, you’ll cut costs by
just creating more positions and giving
your staff a bit of breathing room.”
Until the funds increase and the
strike is resolved, he’ll keep doing what
he does, and try to make LSH the best
hospital it can be with the resources at
hand.
“Since the economic
crisis started, health-
care professionals have
been driven hard for
a long time, and now
they are tired and want
something in return.”
Continues from P.19 Enter
The Director
Páll Matthíasson runs this ship...