24-hour shifts or pay cuts: the price of being a doctor and getting pregnant

BarcelonaJan is already six months old, and his mother, Vanesa Gallego, returned to work a week ago. She's a doctor at a primary care center (CAP) in the public health system in a rural area; her regular schedule is Monday through Friday, followed by on-call duty on weekends. Before becoming pregnant with Jan, she had suffered six miscarriages and took sick leave in the fourth month of pregnancy; she didn't want to take any chances. From then until she gave birth, she estimates she's lost about €6,000 in salary, as the Catalan Institute of Health (ICS) has only paid her for the days she would have worked during the week and has stopped paying her on-call duty, a large part of her salary. Although she has filed a complaint, she doesn't expect to recover that money.

"It's unacceptable that a woman who stops working shifts because it's absolutely necessary to protect the life of the baby—since working 24 hours straight is ridiculous—loses a significant portion of her salary," says Elvira Bisbe, president of the Barcelona Medical Association (COMB). This pushes many professionals, like Gallego, to take sick leave, but in these cases, shifts are only paid when the person stops working due to an occupational illness. That is, if it's due to a common illness, they don't get paid. This is where they should file a complaint, but even after taking the situation to court, they have no guarantee of being paid for the overtime shifts they've stopped working. "They put many obstacles in your way, and you have to deal with administrative silence; it's very complicated," Gallego complains.

The Doctors of Catalonia union demands the right of pregnant doctors to stop working shifts due to the risk they pose to their health. According to its deputy secretary general, David Arribas, these are "stressful and tiring" days that are associated with "premature birth, miscarriage, and low-birth-weight babies." In addition to not paying them, Arribas criticizes the ICS for taking a long time to respond to doctors who request a break from on-call duty and says it only accepts them for high-risk pregnancies. All of this pushes these professionals to take time off. "The situation is perverse: we need these professionals, and pregnancy is not an illness. If they stop on-call duty, they can continue working," says Bisbe.

Accrediting the risk

According to the third ICS agreement, which regulates the conditions of public health professionals and is endorsed by Doctors of Catalonia, pregnant women are exempt from on-call duty when there is a contraindication for health reasons. However, they require a report certifying this impossibility from the Prevention Service and a favorable resolution from the ICS's HR department. The union and the institution met last week because there are pending requests to be resolved, and the ICS's HR director, Xavier Saballs, admits they must expedite their response. He expects them to be resolved in the "coming weeks."

Saballs maintains that the ICS guarantees the safety of all pregnant women, following the recommendations of the Spanish Society of Gynecology and Obstetrics and adapting the workplace when necessary, and asserts that there has been an improvement compared to the previous agreement. Now, professionals who take maternity leave are paid the average of the on-call shifts they've worked in the last 12 months, whereas previously, only the last six months were counted, when pregnant women work fewer overtime shifts.

The ICS (National Institute of Statistics and Census) reminds us that healthcare services must be guaranteed 24 hours a day, 365 days a year. "We've already limited on-call shifts to people over 50; if we now eliminate them for pregnant women, there will be people who will end up working many more. We're trying to implement conciliation policies and we reached a consensus with the third agreement," says Saballs.

Exceptions

However, there are other centers in Catalonia with their own collective bargaining agreements in which pregnant women are exempt from on-call duty and, furthermore, are paid for it. This is the case of Hospital del Mar, which pays for a maximum of three on-call shifts per month once the doctors stop working them. Berta Areny, a professional at the Barcelona hospital, stopped working unscheduled shifts at week 16 of pregnancy, but continued to be paid until she was granted sick leave due to occupational risk at week 34. "I did my normal work, from Monday to Friday, but I didn't do on-call duty. I'm a young person, I felt well, and I wasn't at risk. I wasn't at risk."

The Medical Association has proposed standardizing the rights these doctors have when they become pregnant at other centers. In fact, Obispo was at the negotiating table for the Hospital del Mar collective bargaining agreement when this improvement was achieved. "It's more than reasonable and, above all, necessary." "We can't punish them by charging less," the president concludes.