Estonian healthcare workers strike for higher wages and reduced workloads, 2012

Estonia, a small country in northern Europe had a population of about 1.325 million people in 2012. When Estonia joined the European Union in 2004, healthcare workers began leaving Estonia for other countries with better pay and working conditions, such as Finland, where physician salaries were as much as four times greater. The ageing and shrinking healthcare force had become increasingly overburdened with the country’s healthcare demands. In 2012, a quarter of Estonia’s 4000 specialized doctors were above pension age, and the Estonian Medical Association stated that more than one third of physicians were considering working abroad. Doctors in major hospitals in the cities of Tallinn and Tartu were being paid for 32 hour weeks despite the fact that many worked well over 40 hours.

The Estonian Medical Association union, in partnership with Estonian Healthcare Workers Vocational Union, had sought higher wages through Estonia’s social ministry in arbitration proceedings during the spring of 2012, but the government had been unwilling to compromise. Following meetings between the two unions in early September, Andres Kork, president of Estonian Medical Association, stated that their only option left was to strike.

The two unions joined forces in September and outlined a plan for a strike to begin on 1 October, demanding 40 percent wage increases for nurses and a 20 percent increase for doctors. Before the strike began, unions adjusted their demands to include a 23 percent raise for caretakers, 17.5 percent for nurses, and 11 percent for doctors, a reduction of doctor and nurse workloads in inpatient and outpatient care centers, and paid working hours for medical interns.

In an email statement sent out two weeks prior to the planned strike date, organizers, including Andres Kork and Healthcare Workers Vocational union president Livi Luik, stated that they designed the strike to stop the exodus of healthcare professionals from Estonia and the collapse of the country’s healthcare system by ensuring better working conditions and dignified wages for all healthcare workers. The strike did not halt care in emergency rooms, intensive care units, and maternity wards, or treatment for cancer patients, pregnant women, and small children.

Estonian Prime Minister Andrus Ansip responded with outrage and publically rebuked healthcare workers for making unrealistic demands and refused to participate in negotiations with the two unions.

On 28 September, the Hospitals Association proposed a 6.6 percent pay increase for all workers in the healthcare sector. Hanno Pevkur, Estonia’s Social Affairs Minister and head of Estonian Health Insurance Fund (EHIF) stated that if the unions accepted the hospitals’ offer, he would push through the proposal during the next EHIF meeting. Healthcare workers rejected the offer and continued with the planned strike action.

The Estonian Education Workers Association and Estonian Rescue Workers trade union supported the healthcare strike, though they did not participate. The Estonian Medical Association had supported teachers during the education strike earlier that year.

On 1 October, workers in Estonia’s four largest hospitals in the capital city of Tallin and Tartu began to strike in outpatient care centers. Members of the Estonian Nurses Union wore green badges reading “dignified wages.” Many doctors who remained in their positions took turns striking during their office hours, effectively creating a slowdown strike in hospitals. On 8 October, the strike expanded to inpatient care centers within those hospitals, and healthcare professionals at Parnu, Viljamdi, Narva, and Kuressaare hospital outpatient care medical systems joined the strike. The strike did not include family doctors, but many supported the action by shortening their reception hours.

Green posters reading “STREIK” in large white letters appeared outside of medical centers and in offices of doctors participating in the strike. The posters read “soovime muutusi tervishhoilus” (we want to change healthcare) beneath the image of a healthcare professional exiting in a modified version of the European exit sign. Doctors, nurses, and caretakers wore buttons with the image to express their support and participation in the strike.

On 8 October, the government offered a 15 percent pay increase for caregivers, 10 percent for nurses, and 6 percent for doctors to take place gradually over two years and promised that physician workloads in outpatient and inpatient care would not be increased in the following year. The doctors’ and healthcare workers’ unions rejected this offer, claiming that it was too low to achieve their desired goals.

On 18 October, the two unions met with the EHIF and Hospitals union, but did not reach an agreement. Union leaders stated that EHIF head Hanno Pevkur was not able to make any real promises to the unions and talked about proposed wage increases in exceedingly vague terms. Union leaders asserted that the healthcare system needed to be reorganized immediately and that the country could not depend on economic growth to solve the problem.

The healthcare strike caused widespread distress among the public. Wait periods for appointments had grown to several months, longer if operations were needed. In the wake of the strike, participating surgeons had canceled most surgeries. Public opinion grew increasingly negative toward the government, which remained unresponsive to the strike, despite the fact that healthcare professionals were denying patients their right to medical care. By late October, healthcare professionals at all major hospitals in Estonia had joined the strike.

On 25 October, the two striking unions reached a preliminary agreement with the Hospitals Union and EHIF. Medical interns would be paid by the work week starting 1 January 2013. Beginning on 1 March 2013, caretakers, nurses, and doctors would receive their respective 23, 17.5, and 11 percent raises funded by the state budget and EHIF. In addition, hospitals would pay resident doctors for 40 hour work weeks. Hanno Pevkur presided over the signing.

Andres Kork announced on Friday 26 October that the strike had ended. Care centers resumed their normal reception hours and healthcare workers returned to their regular work schedules. The unions signed the finalized agreement in late November 2012.