Sarah Maesen is in her final year of medical school at KU Leuven and is an activist with Comac. Over the past academic year, she has undertaken various work placements, including one with Medicine for the People in Lommel. We spoke to her about medical training, working conditions in the sector, the impact of increased commercialisation on the healthcare system, and the importance of activism. Testimonial.
How did the last academic year go for you?
During our final year of study, we are required to undertake work placements throughout the year, apart from 20 days’ leave. An internship can involve up to 60, or even 72, hours a week. On top of that, we have to write our dissertation, carry out various tasks and, from time to time, attend lectures. All of this adds up to a very heavy workload. There’s very little time left for friends, family and social commitments – or even for cooking. What’s more, you have to perform at your best at all times because the placements are marked, and the marks you get determine whether or not you’ll be able to specialise. So it’s a very intense year. I’ve done placements in various places, from Brussels to Sint-Truiden. My last placement was in Lommel, with Médecins du Monde.
«There’s very little time left for friends, family and social commitments, or even for cooking.”
Sarah Maesen
Are there any students who want to bring about change in this situation?
Recently, a group has been formed, Arts en Mens (Medicine and Humanity), which has a growing membership and campaigns for improved working conditions during clinical placements in medical training. In a very short space of time, we have collected a thousand signatures online, and many students are backing our campaign.
The newspaper, *De Standaard*, recently published our opinion piece and our request was discussed in Parliament. We have also received numerous messages containing personal accounts. I can therefore see that things are moving forward. The students believe that, as doctors, they should not have to put their private lives on the back burner. Maintaining a private life does not prevent you from being a good – or even a better – doctor.
and is an activist at Comac
In recent years, there seems to be increasing discussion about the working conditions of trainee doctors.
Yes, interns, but also assistants. The two are often confused in the world of politics. The assistants have finished their studies but have to work very hard for a very low wage. Both trainees and assistants are now striving to show that this system should not be normalised.
This is because this system means that doctors, later in their careers, often find it difficult to set limits on their workload, which leads to a high number of cases of burnout, depression and addiction.
In your view, what are the main differences between your placement at Médecine pour le Peuple (MPLP), a local health centre, and your other placements, where the performance-based healthcare system is in place?
There are so many, really. First of all, MPLP rang me to ask if I’d be up for a full-time work placement. For them, full-time means 38 hours. I thought that was crazy. 38 hours is really very little. They also asked me if I’d like to do some additional training during my placement. That’s a huge difference compared to my other placements, where I constantly had to prove I could do everything. At MPLP, I was supported and treated as someone who is still learning. That was really cool!
During my work placement, I also had the chance to work on prevention projects, which I really enjoy doing. I took part in a campaign to encourage women to have more cervical smears carried out by their GP. Prevention programmes emphasise the importance of staying healthy rather than treating medical problems after they have arisen. Under a flat-rate system, patients do not have to pay after their appointment; everything is settled through their health insurance fund, which means that more time for prevention and health education. The patient comes first.
In fee-for-service medicine, for example, a lot of unnecessary tests are carried out because it is in doctors’ interests to see more patients and carry out more tests. As the flat-rate system allows more time for a consultation and the patient does not have to pay straight away, there is more time for dialogue and for building a relationship of trust.
“In a flat-rate system, the patient comes first.”
Sarah Maesen
Do you notice any difference between working in a public hospital and a private hospital?
In Belgium, privatisation isn’t really an issue in the major hospitals. There are certainly some smaller private hospitals, but I don’t know much about them. What I’ve noticed is that, The fact is that the profit motive is becoming increasingly prevalent in hospitals. All healthcare workers must record the services they provide to ensure they are paid. There is a great deal of administrative oversight. Furthermore, a great many unnecessary tests and scans are carried out simply to generate additional revenue. Healthcare staff are understaffed and underpaid. This is a political issue.
“The profit motive is becoming increasingly prevalent in hospitals.”
Sarah Maesen
It is not only assistants and trainees who face poor working conditions. Nurses and other healthcare staff are also calling for better working conditions. Can we talk of solidarity amongst the various members of the healthcare workforce?
As students, we feel it is very important to show solidarity with everyone working in the care sector. Therefore, We do not want nurses to have even more work placed on their shoulders to ease the burden on trainees and assistants. We are calling for more resources and better working conditions for everyone. Healthcare is a sector in which many people play a vital role. This includes, for example, those who clean the operating theatres. We are all indispensable!
Thank you, Sarah!
