Doctors and nurses employed in public healthcare services all around Finland describe the practice of hiring in staff from temp agencies as being out of control.
A survey by the Ministry of Social Affairs and Health in October and November sought the views of the 21 wellbeing services counties that provide healthcare services as background data for a study on hospital organisational reform.
Yle's MOT editorial team obtained the survey through a public access request for information.
The survey was answered by directors and chief medical officers in the country's regional wellbeing counties. It asked, among other things, whether there was unfair competition in terms of staff availability. Only experts in four of the 21 regions said they saw no problems with the use of staffing agency personnel.
The questionnaire's cover note stressed that the responses should not be interpreted as the official position of the wellbeing counties, but asked for information on the experiences of experts involved.
The Ministry of Social Affairs and Health's network on the use of temporary agency work recently suggested that temporary personnel should only be used as a last resort, and should be subject to a price cap.
Stockpiling doctors
Mikko Pietilä, Hospital Director for the Wellbeing Services County of Southwest Finland, was one of the respondents to the ministry survey. He said that doctors with public service positions are being recruited by temp agencies on social media for up to double or triple their present salaries to do the same jobs.
What makes this particularly contentious is that the agencies do not necessarily have contracts with the healthcare sector, despite what is implied. Even so, doctors are being recruited to create a "stockpile".
"Since there is a shortage of doctors, someone is trying to buy them up quickly and sell them back at a higher price," Pietilä told Yle.
The same thing has happened elsewhere.
"Staffing companies are screwing everyone – both the employees and the wellbeing counties," says the head of hospital recruitment in one region in an interview given on condition of anonymity.
According to the interviewee, the first thing the temp agencies do is to identify which specialty has the biggest shortage of doctors in an area. Then they start recruiting them from "anywhere", even from another work site in the same wellbeing county.
Temp agencies have also started to offer medical students for jobs in public sector services. They have to be supervised by a licensed doctor employed by the wellbeing county.
According to Pietilä, the situation appears to be a vicious circle. He fears unchecked privatisation in the form of a mass exodus of doctors from the public sector.
"We may soon have to pay whatever it takes to get staff," Pietilä said.
Dictating terms
It's a seller's market.
Last year, expenditure on temporary staff ate up five percent of personnel costs in wellbeing counties. That works out to around 600-700 euros million a year.
The public sector is increasingly turning to temporary staff in order to fulfil legally mandated healthcare standards. The legal guarantee to health services requires that emergency care must be available immediately, non-urgent care, such as access to a healthcare centre, within two weeks, and specialist care within six months.
The amount spent on temp agency workers rose by a third in a year.
The monthly salary of an in-house doctor can, at worst, pay for only a week's work by an agency-supplied physician. According to Yle's information, the hourly rate is currently as high as 250 euros.
Despite the high prices, the wellbeing counties are not getting what they need, said Marina Kinnunen, Director of the Wellbeing Services County of Ostrobothnia.
"Temp agencies and the doctors dictate many of the terms," according to Kinnunen.
The situation is particularly difficult in psychiatry. Often, the doctors from temp agencies only work certain hours and certain days. Some may only want to work every other week.
This means that flexibility, continuity of care, and development of services are left to the full-time doctors. The law also says that, for example, the decision to provide involuntary care can only be taken by a full-time member of staff.
One chief physician interviewed by Yle referred to the temp agencies as "a pack of hyenas". The doctor said that vulnerable psychiatric patients need a long-term relationship with a doctor, which is not possible to establish with doctors who fill in.
"It is very difficult to get people into permanent posts because everyone sees that the workload is excessive. In psychiatry, the race is already lost," said Kinnunen.
Nurses' costs spiralling out of control
In the past, nurses and nursing assistants were only occasionally hired in from temp agencies. Now they have become commonplace in many wellbeing counties.
The root cause of the upswing is a shortage of nurses.
The biggest increase in payments to temp agencies has been in services for the elderly. Early last year, Yle reported on a nursing assistant working with the elderly who earns more than 4,000 euros a month working through a small staffing company. In the public sector, the salary of a nursing assistant is half as much.
According to the latest Labour Force Survey by the Ministry of Economic Affairs and Employment, there are 5,600 vacancies for nursing assistants across the country, and the same number of nurses are needed.
The survey shows that filling posts and finding summer replacements has become difficult in some places. For example, the Wellbeing Services County of Vantaa and Kerava faced a tough situation last autumn.
"We had to hire temp agency-supplied nurses and close some hospital facilities temporarily because with understaffing is not possible to run a 24-hour operation," Kati Liukko, director of the region's health services, told Yle in an email.
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