Between December 2 and 6, 2024, family physicians in Türkiye went on strike, suspending services during the previous work week. The display was supported by the Turkish Medical Association (TTB) against the Regulation on Amendments to Family Physicians Agreement and Regulation, which in its official announcement stated, “We are warning the Ministry of Health. Our actions will continue until the ‘Torture Regulation’ is withdrawn.’” The strike was a continuation of the 3-day work suspension held earlier on November 5-7 as the outcome of the first protest was determined to be insufficient and incapable of fulfilling the physicians’ demands which include canceling the performance-based system, regulating salaries, and reducing workload.
The Family Physicians Agreement and Regulation
The Regulation on Amendments to The Family Physicians Agreement and Regulation entered into force on 30 October 2024, upon publication in the Official Gazette. On November 1, Minister of Health Prof. Dr. Kemal Memişoğlu announced the regulation change by saying, “We have made a new start to the value-based approach in health through family medicine.” He added, “The new regulation does not interfere with the diagnosis and treatment of family physicians, nor does it eliminate their freedom to prescribe medication. The main purpose here is to encourage rational drug practices.” Despite this positive description, doctors and professional organizations deemed the regulation outrageous. Far from being the new beginning it was promised to be, the adjustment merely established a health system built on incentives.
The changes the amendments propose include reducing the maximum number of patients physicians are responsible for from 4000 to 3500, making performance-based incentive payments, making deductions from physicians’ salaries for payments made for individuals who have not applied to Family Health Center (ASM) in the last 6 months, allowing physicians who prescribe medicine below the provincial average to benefit from incentive payments, and allowing the ministry to terminate family doctors’ contracts unilaterally. The regulation also brings forward misleading information like the fact that physicians will not be able to prescribe certain medications like antibiotics and painkillers. Moreover, due to some amendments containing expectations that were somewhat unrelated to the field, hard to measure according to scientific criteria, and susceptible to causing grievances, Sağlık-Sen, the Health and Social Service Workers Union filed a lawsuit with the Council of States for the annulment of some articles on November 4th.
The Doctors’ Demands
These adjustments pose many problems for physicians and the public health sector as they unjustly decrease doctors’ salaries, prevent the prescription of proper doses, push many administrative positions on them, and reduce accessible healthcare while penalizing physicians who do not fully comply with the amendments.
The press release made by the TTB to explain the strike listed five main demands. First, for equipment and public health centers providing primary healthcare services to be provided by the general public. Second, to expand the scope of sufficient healthcare by increasing the number of ASMs. Third, to assign an adequate number of nurses, midwives, and technicians according to the population structure, support vaccination development and preventative medical practices, regulate the wages of midwives according to their professional responsibilities, and increase the maximum salary of family health workers in ASMs. Fourth, to give physicians, midwives, nurses, and health technicians paid leave and salary a salary that allows them to live on a humane degree. Finally, to take effective and deterrent measures violence in the health sector, ensuring the safety of health professionals.
Over the course of the week, the physicians gathered in front of ASMs, provincial and district health offices, and city centers. They made public statements, distributed leaflets proclaiming their demands, and organized meetings while members of the TTB Central Council attended events in their respective provinces. President of the Central Council Dr. Alpay Azat stressed that their actions were not only to defend their professional honor but to advocate for the public’s right to healthcare. He added that they would continue to organize various demonstrations until a satisfactory result was obtained.
The physicians’ demands for secure employment, provision of health infrastructure, and adequate staff reflect the deep-rooted, global issue of accessible healthcare. Regulating health standards according to the interests of stakeholders other than the general public gets in the way of universal, quality medical support. Hence, health workers’ struggle is not just a professional battle. It is a contumacy against social inequality.
Edited by: Melisa Altıntaş, Yağmur Ece Nisanoğlu