Employment Law Needs to Better Accommodate Doctor-Hospital Working Relationships

The existing employment and health legal system is considered to have not yet adequately accommodated the working relationship between doctors and hospitals. This normative vacuum has the potential to create uncertainty regarding the legal status of doctors, weak protection of employment rights, and ambiguity in the division of legal responsibility in the provision of health services. These findings form the core of Iskandar Zulkarnain’s dissertation, which he successfully defended in an Open Session of the Doctoral Programme at the Faculty of Law, University of Lampung, on Thursday (9/7). The dissertation is titled ‘The Legal Relationship between Doctors and Hospitals in the Perspective of Professional Autonomy and Employment Status’. In accordance with the research limitations, the focus is on full-time specialist doctors who hold only one Practice Licence (SIP) at one private hospital, without another SIP elsewhere, and who are not civil servants. Iskandar concluded that the current regulations have not been able to address the characteristics of the medical profession, which differ from general working relationships. ‘On one hand, doctors work within the hospital’s organisational system. They use hospital facilities, are subject to service standards, work schedules, governance, and service quality targets. Yet on the other hand, doctors retain professional autonomy in making medical decisions that legally and ethically cannot be intervened in by hospital management,’ Iskandar explained in his dissertation, according to a press statement in Jakarta on Saturday (11/7). According to Iskandar, this dual character cannot be fully accommodated by the employment relationship regime, which has so far only recognised Fixed-Term Employment Agreements (PKWT), Permanent Employment Agreements (PKWTT), and partnership relationships based on cooperation agreements. ‘As a result, various problems arise, ranging from the unclear status of doctors as workers or partners, protection of normative employment rights, legal liability when medical disputes occur, to legal protection for hospitals as health service institutions,’ he added. Based on normative, empirical, and comparative research, Iskandar proposes a Hybrid Sui Generis Working Relationship Model, a new legal model that recognises doctors as having an employment relationship with the hospital without eliminating their professional independence. Through this model, doctors still receive protection as workers for the normative rights inherent in the employment relationship, such as legal certainty, employment social security, occupational safety and health protection, and industrial relations dispute resolution mechanisms. At the same time, the state continues to recognise the professional autonomy of doctors and provides space for professional practice and health service cooperation in accordance with statutory provisions. ‘This model concept is considered a meeting point between the interests of hospitals as health service providers, doctors as professionals, and the public as service recipients,’ Iskandar stressed. Responding to the dissertation, the National Coordinator of GeberBUMN, Ahmad Ismail, opined that the research findings hold significant importance for national legal references. He stated that this dissertation not only identifies a legal vacuum but also offers a new regulatory model that is more adaptive to the character of the medical profession. ‘The Hybrid Sui Generis Model deserves consideration as a reference in the drafting or refinement of regulations in the health and employment sectors,’ said Ais. According to him, the debate over the status of doctors has so far always been placed at two opposing poles: worker or partner. In fact, health service practice shows that this relationship has special characteristics requiring specific regulation. ‘The Hybrid Sui Generis approach also has the potential to be applied to other professions with similar characteristics, namely working within an organisation but still exercising independent professional authority based on ethical and competency standards,’ Ais revealed. Iskandar’s dissertation was examined by nine academics and legal experts from both internal and external elements of the University of Lampung. The board of examiners declared Iskandar Zulkarnain to have passed with a distinction and entitled to hold the title of Doctor of Law. Amid the increasing complexity of hospital governance and the demands for medical personnel protection, this academic finding is expected to serve as a foundation for the government, the House of Representatives (DPR), professional organisations, hospital associations, and stakeholders in building a working relationship system that provides legal certainty, protection for medical personnel, and ultimately improves the quality of national health services.