Interview with RSU Rector on the role of hospitals in training medical practitioners

We offer you an interview with RSU rector Prof. Jānis Gardovskis (pictured) that was recently written by journalist Māra Libeka of the Latvijas Avīze newspaper and the editor of www.Veselam.lv Linda Rozenbaha, titled “Chasing after surrendered positions”.

“If a hospital bears the name of a university, the law or another legal instrument should lay out the scope and functions of such hospitals”, Prof. Jānis Gardovskis, the rector of RSU, wants to attain clarity and wider opportunities at hospitals bearing the name of RSU: Pauls Stradiņš Clinical University Hospital (PSKUS), Riga East University Hospital (RAKUS) and Children’s Clinical University Hospital (BKUS). What training opportunities should be provided by a hospital to prospective medical practitioners and what are the issues to be incorporated into the currently developed legal regulation on university hospitals?

Māra Libeka: At present RSU is closely linked to PSKUS. However, the operational form of the hospital is a limited liability company. Your colleagues have elaborated and presented to the Parliament a draft law on university clinics, targeted at introduction of changes in the management form and functions of such hospitals – turning them into university clinics. Do you think that systematisation of the legal framework should go as a priority and networking should come thereafter?

Jānis Gardovskis: Although we are neither the submitters of the new draft law, nor the drafters thereof, nevertheless I strongly believe that the stakeholders should act together.

M.L.: You are not involved in this?

We are not the developers of the project – the project was written by the hospital.

M.L.: Thus, you believe that your teaching staff should be involved and the legislative proposals should be drafted jointly, am I right?

I am of the opinion that in case it has been resolved to develop a legal framework for this matter, it should cover systematisation of the work of university hospitals in all areas. In my opinion, a university hospital should fulfil three functions, where high-level diagnostics and treatment should come first…

M.L.: …and not “all types of” intestinal and gallbladder surgery?

We cannot exclude it. While we will be sitting on our hands, waiting for complex cases, our fingers will grow numb and we will no longer be able to do anything. These surgical operations are vitally important for the study process – students have to watch and participate. Acute surgery occupies a major share – acute patients comprise around 50 % of all surgical operations.

M.L.: Thus, tertiary care should outpace the less problematic cases......

University hospitals should focus on severe, rare cases. Nevertheless, at this point we have to draw attention to the costs aspect - in complex cases, when patients have to stay at the inpatient facility for a month or even longer, we receive the same remuneration as for much easier cases. The financial aspect is essential. However, if we get back to the functions of a university clinic, apart from the already mentioned treatment function, the function of educating young specialists which is listed as second, is equally important, followed by the research function accordingly.

Cooperation between universities and university clinics should be more fundamental. At present the only contracts we have with Riga hospitals are short-term, e.g. a year long, tenancy and student training contracts. Due to the temporary nature of such contracts, we can paint walls and place furniture; however in case we desire something more, e.g. invest in technologies, undergo reconstruction, we need special long-term contracts extending to 20 years.

RSU has this experience. We have a long-term tenancy agreement with PSKUS for a building where, thanks to the EU funding attracted, we have opened the Institute of Oncology – it would not happen otherwise since the EU does not support short-term projects.

Since October last year, when RSU became a shareholder of SIA “Daugavpils reģionālā slimnīca” we have been engaged in new experiences. We have a small shareholding and a contract setting out our areas of responsibility: education and research. In case there is a clear layout of functions and we have the status of a co-owner, we can make investments; establish a training base within the hospital without opposing the legislative requirements which prohibit investments in foreign property.

Linda Rozenbaha: Why should a 100% state-owned hospital give any shareholding, irrespective of the amount, to any derived public person?

A shareholding is not a mandatory requirement. Liability may be regulated by respective statutory requirements of the prospective law or another legislative instrument. For example, a university may act as a member of the board of directors or supervisory board, depending on the organisational form and there are multiple solutions apart from surrendering or sale. Considering the poor funding of hospitals, we do not take a huge interest in becoming co-owners, since the status makes us co-responsible for the negative closing balance at the end of the year. We are not really keen on becoming the ones “patching the holes”.

There is a diversity of solutions. For example, Tartu University Hospital has three owners: the university, the state and the municipality, each holding a similar share. Kaunas University Hospital has two owners: the Ministry of Health and the Lithuanian University of Health Sciences. Such examples can be found not only in our neighbouring countries but also elsewhere in Europe.

L.R.: If you had more powers and authority at the hospital – what would you do? How would it affect us – people, patients?

It is not about powers and authority but instead about the operating principles of university hospitals and their cooperation. It is empirically proven that the presence of academic and research activity is a fundamental driving force, it makes general practitioners read and upgrade, since students and residents ask a lot of questions to be answered. Moreover, it is also beneficial for patients, as university hospitals not only have the latest technologies but also better educated staff, used to dealing with complex cases.

Thus patients have to take into account that the ambience in university hospitals is more bustling – although patients may like or dislike the presence of students and residents, it is vital for ensuring professional succession.

If we talk about succession and generational change, what is a huge issue in the periphery, a well-functioning university hospital is a major contribution. If we take, for example, Germany, medical practitioners start to climb the career ladder by arriving at a university hospital - it is a kind of entrance level. It would be excellent if university hospitals in Latvia would operate as a kind of trampoline for well-prepared specialists finding stable workplaces, particularly in regions.