EXTENDED SUMMARY

The transformation in health services in Turkey, which started to be shaped by neoliberal policies in the 1980s, took flesh and bones with the Health Transformation Programme. In this process, many transformations have also emerged in terms of doctors’ labour. In addition to examining the legal and administrative regulations on doctors’ labor and the transformation of health legislation with the relevant literature, a descriptive analysis of semi-structured in-depth interviews with representatives of the Doctors’ and Other Health Workers’ Public Health and Social Services Union (Hekim-Sen), Health and Social Service Workers’ Union (Tabip-Sen), Doctors’ Union Health and Social Services Workers’ Union (Hekim Birliği), and Health and Social Service Workers’ Union (SES), General Health and Social Workers’ Union (Genel Sağlık-İş), the Turkish Medical Association (TTB), the Family Medicine Employees’ Union (AHE-SEN) and Forum Sağlık 2023 was conducted to reveal the trajectory of the transformation in physician labor. The interviews lasted between 45 and 82 minutes, five of which were recorded with the permission of the participants. Türk Sağlık-Sen and Sağlık-Sen were repeatedly contacted for interviews, but no appointment could be scheduled. In the light of semi-structured in-depth interviews, the main problem areas regarding physicians’ labour are examined. The main problems are the erosion in the social and professional positions of doctors, the decline in their basic income, violence in health care and the emigration of doctors as a result of these developments.

While doctors were traditionally members of a sanctified service field with high professional prestige, high income and a high level of control over their profession, they have become proletarianised in parallel with the transformation in health services. Simultaneously, many health professions began to struggle for professionalisation. This situation, fuelled by the dynamics of marketisation, has led to intense conflicts and divisions within the healthcare team.

The removal of doctors from alternative means of livelihood outside the wage system, the de-skilling and devaluation of doctors’ labor, and the commodification of the conditions of reproduction of labor have led to the proletarianization of doctors. With the introduction of performance-based remuneration in the health transformation process, basic wages have decreased and doctors have tried to increase their wage income by working harder and performing a higher number of procedures. This situation not only alienated physicians, who started to earn wages in return for piecework production, from service production processes, but also fragmented holistic medical practices.

Another effect was the transformation of the relationship doctors and patients. The doctor-patient relationship, which had a paternalistic spirit, has turned into a market relationship. “Patients’ rights”, an important tool to protect patients, have begun to function as a means of supervising healthcare professionals and intervening in their decisions. As patients frequently resorted to the complaint mechanism, their wishes began to play an increasing role in the decisions of doctors. As patients, who assumed the role of consumers, began to hold healthcare professionals responsible for all failures in healthcare services, verbal and physical violence against healthcare professionals increased. For example, waiting in line for an examination, not prescribing the requested medication, refusing to prescribe a prescription without seeing the patient in person, or restrictions on patient relatives’ access to intensive care units are the main causes of violence against healthcare professionals.

These sharp transformations have created individual and collective struggle tendencies among doctors. Although occupational unionisation in the public sector is legally banned, doctors’ unions have been established and many doctors’ demonstrations have been organised. While some some resigned from public health institutions, others started to emigrate. This situation is concerning both in terms of the loss of Turkey’s skilled labor force and the decline in the number of qualified doctors who play an important role in health service delivery. There is also a high level of migration among medical students. Medical students have stopped attending lectures for the Medical Specialization Examination and started to attend German courses. The migration of doctors is an indicator of physicians’ dissatisfaction with the health environment in Turkey. The main reasons for migration are the perception of doctors’ labor as cheap labor, the decrease in their purchasing power every year, the devaluation of physicians, the length of working hours and violence in health. It was also stated that the discourse of the political power that devalues physicians is also an important driving force in the migration of doctors.