Die Schwierigkeiten des Spitalsbetriebs nach dem neuen Ärztearbeitszeitgesetz
Von Dr. Wolfgang Mor, Facharzt für Kinder- und Jugendheilkunde im St. Anna Kinderspital
Das St.Anna-Kinderspital ist zwei Aufgaben verpflichtet: Der Betreuung der Wiener Kinder, die wegen eines offensichtlichen gesundheitlichen Problems die Ambulanz zu jeder Tages- oder Nachtzeit aufsuchen – und der Versorgung von Kindern mit Krebserkrankungen aus dem gesamten Osten Österreichs. Diese beiden Aufgaben sind oft schwer unter einen Hut zu bringen, bedeuten sie doch, die gesamte Nacht hindurch Kinder zu versorgen, die gerade eine akute Erkrankung entwickeln – und parallel dazu intensive Therapien an schwerstkranken Patienten zu leiten.
In diesem Sinne waren wir es als Ärzte des Spitals gewohnt, trotz aller nächtlichen Dienstverpflichtungen täglich anwesend zu sein, um die kontinuierliche Betreuung der uns anvertrauten kleinen Patienten optimal sicher zu stellen, auch wenn dies zu in anderen Berufsgruppen ungeahnt hohen Dienstzeiten geführt hat. Mit 1. Jänner 2015 trat nun das Ende Oktober 2014 beschlossene neue Krankenanstaltenarbeitszeitgesetz in Kraft. Es versucht, mit Übergangsfristen eine zehn Jahre alte EU-Richtlinie abzubilden, wegen derer Nichtbeachtung der österreichische Staat bereits mit einer EU-Beugestrafe bedroht war.
Das neue Arbeitszeitgesetz bringt einige Veränderungen mit sich, positive wie negative: Ärzte bekommen nun nach 25-Stunden-Dienst eine Ruhezeit von 23 Stunden vorgeschrieben. Eine Ruhezeit, die jedem anderen Arbeitnehmer schon längst zugestanden wäre. Dies bedeutet aber Verluste in der Betreuungsqualität, weil nicht mehr ein- und derselbe Arzt täglich für seine Patienten da sein kann. Die Kontinuität in der Behandlung, wie wir sie bisher bieten konnten, ist nun nicht mehr möglich.
Wir haben aufgrund des neuen Arbeitszeitgesetzes einen relativen Fachärzte-Mangel. Wenn Fachärzte nach Hause gehen, weil sie jetzt müssen, dann fehlen sie an irgendeiner Stelle im Spitalsbetrieb. Das Spital hat zwar früh reagiert und bereits seit Herbst neues ärztliches Personal eingestellt, aber ausschließlich junge Assistenzärzte bekommen, und leider keine Fachärzte, die dienstbedingt fehlen. Das ist aber nicht die Schuld der Spitalsverwaltung, sondern die Realität, weil es eben keine unbeschäftigten Fachärzte gab, die auf das neue Gesetz gewartet hätten.
Erschwerend kommt hinzu, dass wir uns mit hohem organisatorischem und administrativem Aufwand herumschlagen müssen. Für diese Aufgaben gäbe es auf jeden Fall besser geeignetes Personal. Unsere ausländischen Kollegen wundern sich, dass da ständig ein Doktor sitzt und tippt. Aber in Österreich ist so etwas möglich. Bis zu 50 Prozent unserer Arbeitszeit müssen wir also andere Dinge erledigen, als die, die wir in sechs Jahren Studium und zehn Jahren Ausbildung gelernt haben.
In Zukunft wird es Änderungen geben müssen, denn viele Kollegen gehen in den nächsten zehn Jahren in den verdienten Ruhestand – und nur wenige junge Kollegen fangen nach der Universitätsausbildung in Österreich zu arbeiten an. Wir gehen europaweit durch die geburtenschwächeren Jahrgänge einem Ärztemangel entgegen. Junge Universitätsabsolventen können sich europaweit die Ausbildungsplätze aussuchen – und entscheiden sich immer häufiger zu einer Tätigkeit im westlichen Ausland – da dort die Arbeitsbedingungen wesentlich besser sind. Zuletzt haben sich fast 60 Prozent der in Wien ausgebildeten Mediziner für eine Arbeitstätigkeit außerhalb Österreichs entschieden! Diese Realität haben unsere Politiker aber noch nicht verstanden.
Ich möchte an dieser Stelle betonen, dass es hier vorrangig nicht ums Gehalt geht. Uns geht es vielmehr darum, bei der Reduktion der wöchentlichen Arbeitszeit eine ausreichende Personalkapazität zu haben, um weiterhin eine qualitative Patientenbetreuung bieten zu können. Es wird in Zukunft wohl nicht weniger Krankheitsfälle und somit weiterhin viele Patienten geben, aber gleichzeitig weniger Ärzte. Was hier genau auf uns zukommt, können wir noch nicht abschätzen. Trotzdem wollen wir uns bemühen, allen unseren kleinen Patienten gerecht zu werden. Dies kann aber auch durch die neue Situation zu vermehrten Wartezeiten führen. Deshalb haben wir schon in den vergangenen Jahren das Manchester Triage System in der Notfallambulanz eingeführt, um schwer kranke Kinder nach objektiven Kriterien bevorzugt versorgen zu können.
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