Not only overcoming depression, PPDS needs to improve working hours and welfare

Improving the education of specialist doctors needs to be taken seriously. Apart from depression, there are also working hours and welfare.

KOMPAS/KRISTIAN OKA PRASETYADI

The resident doctors who are also students of Sam Ratulangi University (Unsrat) were in the auditorium of the Faculty of Medicine at Unsrat, Manado, North Sulawesi, on Tuesday (25/8/2020).

JAKARTA, KOMPAS — The results of mental health screening of specialist doctors' educational program participants who show symptoms of depression need to be followed up. This is necessary so that students receive good treatment so they can provide quality service and prioritize patient safety.

On the other hand, this problem also requires improvements in the implementation of specialist medical education programs (PPDS) in terms of working hours, welfare and workload.

The Ministry of Health's data recorded that 22.4 percent of prospective specialist doctors or PPDS students were detected to have depressive symptoms. About 3 percent of respondents even confess to feeling better ending their lives or wanting to harm themselves in any way.

This is based on the results of mental health screening for PPDS students at 28 vertical hospitals on March 21, 22, and 24, 2024. Screening was conducted on 12,121 PPDS participants using the Patient Health Questionnaire-9 questionnaire.

Also read: Depression, 3.3 Percent of Prospective Specialist Doctors Want to End Their Lives or Injure Theirself

The Chairman of the Indonesian Doctors Association (IDI) Adib Khumaidi, during a media gathering "Screening for PPDS in Several Vertical Hospitals of the Central Government", in Jakarta, Friday (19/4/2024), explained that the most common trigger for depression among PPDS participants is work hours.

Until now there has been no ideal time that has been officially set by the government regarding the working hours limits for residents.

According to Adib, if complaints of depression in PPDS participants are not seriously addressed, this could have an impact on patient safety management. Referring to a number of studies, 41-76 percent of PPDS students experience burnout (physical and mental fatigue) and 7-56 percent experience depression.

The Chairman of the Junior Doctors Network Indonesia, Tommy Dharmawan, said that the issue of depression among specialist doctor candidates needs to be addressed properly. Specialist doctor candidates undergo an internship process to ensure that they can achieve the competencies set by the college and study program.

Requires high flying hours

According to Tommy, regarding the finding of depression among specialist doctor candidates, this can be used as an evaluation material for improvement. Working hours, for example, need to be set in a humane manner. Generally, around the world, the maximum working hours are 80 hours per week.

"Because PPDS is an internship to achieve competency, if it has not been achieved there can be additional time," he said.

Regarding the working hours of PPDS participants, Tommy further elaborated that based on internal feedback and surveys, it is indeed still a problem. If the working hours exceed the average, prospective doctors can become tired, which can trigger depression.

"To achieve the competence of a specialist doctor, just like a pilot, a high flying time is needed. However, this working time must be humane. From literature, the meeting point of working hours so that prospective specialist doctors can master competencies is 80 hours per week," he said.

The well-being of aspiring specialist doctors can also become a trigger for depression. They work but do not receive any salary. Meanwhile, they have expenses for education, living, and supporting their families. According to the Doctor Education Law, the residents should be paid, but the reality is that they are not paid in Indonesia.

Tommy explained that when he took part in a scholarship or fellowship program in Singapore, the salary for prospective specialist doctors reached 2,650 Singapore dollars. In Malaysia, prospective specialist doctors are also paid around IDR 15 million.

"The amount for Indonesia is certainly adjusted to local wisdom for financing. The issue of doctor welfare in Indonesia is saddening, especially for general practitioners. So, besides the issue of depression, there is a problem of doctor welfare," he said.

“If you don't have money, how will you meet your living needs? This weak position can lead to bullying among juniors. This needs attention. "The salary for PPDS participants is because they work as a service," explained Tommy.

Also read: Prevent Depression and Bullying, Prospective Specialist Doctors Need to Contract with Teaching Hospitals

KOMPAS/STEPHANUS ARANDITIO

One of the patients at Fatmawati Central General Hospital in Jakarta, Erixs Gendala (28), consulted with orthopedic specialist Dr. Phedy on Friday (10/3/2023). The patient from Jakarta was diagnosed with herniated nucleus pulposus or a pinched nerve in 2020 and eventually recovered in September 2022.

In some educational hospitals, there is administrative work that residents must do, such as recording the number of operations or social security health insurance service databases. This administrative burden should be eliminated for aspiring specialist doctors.

Meanwhile, Vice Chairman of the Central Management of the Indonesian Association of Psychiatrists (PDSKJI), Agung Frijanto, stated that the screening results are an initial stage.

In order for the results to be valid and comprehensive, diagnostic enforcement is necessary, namely psychiatric or psychological interviews, for respondents who show high symptoms of depression. "The necessary steps should be taken as outlined in the regulations of the Ministry of Health, from screening and interviews to supporting examinations," he said.

According to Agung, many PPDS participants and medical students have mental health issues. However, with periodic screening and examination, mental health conditions can improve. Like other physical disorders, depression or anxiety can be managed and can recover.

"This is important as a preventive measure during the education phase. The aim is to ensure that, when they become specialist doctors, they can maintain the quality and safety of their patients with a better mental condition," he explained.