Health services sued 270 doctors for not completing compulsory stay in the public system

Healthcare services in Chile have filed lawsuits against 270 doctors for failing to complete their mandatory public service period, known as the Periodo Asistencial Obligatorio (PAO). The legal actions, initiated since 2010, aim to recover over $37.7 billion in fines for professionals who did not fulfill their obligation to work in the public health system after receiving state-funded specializations. However, according to records from the judiciary, only approximately 2.8% of the funds, around $1.05 billion, have been successfully recovered so far. The PAO requires medical specialists who received government funding for their training to serve in the public health system for twice the duration of their specialization, typically six years. This policy is designed to ensure that the state's investment in education is repaid through public service. Those who fail to comply face financial penalties and a six-year ban from holding any position within the public administration. Despite these measures, enforcement has proven challenging. In one notable case, a dermatologist who completed a $86 million specialization funded by the Magallanes Health Service in 2018 left his post at the Hospital Clínico de Magallanes in July 2023 after just three years and one month of service. He cited poor working conditions, including patient aggression toward staff, as reasons for his resignation. His departure led to a critical shortage of dermatologists at the facility, reducing its capacity to treat patients by half. By November 2023, the waiting list for dermatology services had exceeded 471 patients. This incident highlights broader issues with the implementation of the PAO. While some professionals have returned to public service despite outstanding obligations, others have found ways to circumvent the rules. At least 45 doctors have resumed work in the public sector while still under penalty, and six have provided services through private medical companies even though they remain in debt and within the six-year restriction period. The legal framework surrounding the PAO has evolved over time. Since August 2018, the penalty of administrative disqualification applies exclusively to cases of non-compliance by individuals, rather than situations involving academic dismissal or institutional violations. In such instances, the requirement is limited to reimbursing the program costs with a 50% surcharge. According to reports from CIPER, which reviewed all ongoing and concluded legal cases across the country’s 29 health services, 270 doctors have faced judicial action since 2010. Of these, 125 abandoned the PAO, 50 resigned during their fellowship, 93 were dismissed due to academic performance, and two were penalized for other forms of non-compliance. The low recovery rate underscores the difficulty in enforcing this policy effectively. While the legal mechanisms are in place, practical challenges persist, including the ability of some professionals to continue working in the public sector despite being in default, and the lack of consistent enforcement across different regions and institutions. These factors contribute to the persistent gap between the intended outcomes of the PAO and its actual implementation.