WILLEMSTAD - The National Decree on Top Incomes (LNT) is prompting a push from the Curaçao Medical Center (CMC), leading medical specialists to either reopen their own practices or seek employment at institutions such as Advent Hospital.
Vito Koeijers, Vice Chairman of the Association of National Medical Professionals Employed in Curaçao, explains this development.
This is certainly an option he is considering. By doing so, he directly denies the social media rumors suggesting that he stated he would quit. Koeijers further elaborates: "The court's ruling on the LNT, which states that medical specialists employed by the CMC are also subject to it, has created a lot of uncertainty among specialists. The employment contracts with the CMC include a notice period of three to six months, and I do not know what my work will look like in three to six months. If specialists, upon whom my work as a plastic surgeon depends, resign from their positions, then I cannot continue either. Therefore, I am not scheduling any new patients for September onwards."
Koeijers mentions that, as a 'yu di Kòrsou' (a native of Curaçao), he could start his own practice. However, it remains uncertain whether he will receive cooperation from the Social Insurance Bank (SVB) to treat patients. "Other younger colleagues may choose to seek employment a few kilometers away, for example in Aruba or elsewhere in the Kingdom where the LNT does not apply to medical specialists."
And this is how he expresses his viewpoint: "If the Curaçao Medical Center (CMC) is considered a government-affiliated entity, subject to civil service rules, then we as specialists should also carry out our work from 9:00 a.m. to 5:00 p.m. It is not taken into account that our current income includes everything: the mandatory training for the five-year re-registration in the specialist register, certain function-related allowances for, for example, the medical head of a department or group of specialists, and a so-called inconvenience allowance for demanding services that can last up to 12 hours a day and work at inconvenient times (emergency cases at night).
As a civil servant working 40 hours, I cannot add all those extra hours on top. In that case, it will be necessary to find specialists who are willing to do so. This means that additional doctors will be needed."
He continues: "Now that I suddenly find myself an employee of a government-affiliated institution, it is theoretically possible for a minister to interfere with my work. This compromises the autonomy of our profession. All these uncertainties may lead specialists to choose to leave or not come (for example, young graduates)."
In a post on the Facebook page of the Minister of Health, Environment, and Nature (GMN), Javier Silvania (MFK), he responds by stating: "If specialists decide to leave the CMC, I will look for replacements in the region to ensure the continuity of care."
"It smells like blackmail."
If medical specialists walk away from the Curaçao Medical Center (CMC) and establish themselves independently again to put pressure on the Social Insurance Bank (SVB) by creating a situation where there are no specialists left in the hospital, it smells like blackmail. That is the opinion of lawyer Richard Pols, who deals with many hospital cases. This would likely lead to further legal proceedings.
"I also don't understand why this action is being taken because there is a maximum compensation of 501,000 (130 percent) guilders possible. However, it requires sitting down with the minister to negotiate. Moreover, in other countries such as Aruba and the Netherlands, there is also a limitation for specialists in employment. The case was initiated by the CMC because the hospital believed the ceiling was 295,000 guilders. Now that it turns out the ceiling is much higher, the CMC still insists on its position. Engaging in lawsuits only leads to further escalation."
Pols explains that a medical specialist can be invited by the SVB to participate in the implementation of social insurance. In the past, private specialists could submit unlimited claims, resulting in large turnovers. Partly for this reason, a policy was initiated to hire specialists as employees in the CMC, thereby limiting costs for the community. As a result, the SVB now deals with the CMC legally rather than with individual specialists. The CMC receives the salary for each individual specialist in employment, including employer's contributions such as pensions, taxes, and premiums. These salaries are paid separately and in addition to the CMC's budget.
"A specialist is still allowed to establish themselves independently outside the hospital but can only treat private patients. A specialist who resigns and becomes independent is no longer participating in the social insurance system. Whether the specialists will achieve their goal of earning more than 501,000 or end up shooting themselves in the foot remains to be seen," Pols concludes.