醫師職業工會

In Taiwan, physicians are highly respected by society. However, behind the prestigious image lies a reality of overwork, stress, occupational injuries and illnesses, and unequal labor contracts. In 2011, the death of a medical intern due to overwork highlighted the severity of excessive working hours in the profession. In response to physician-led advocacy, the Ministry of Health and Welfare later issued the working hour guideline for resident physicians, limiting consecutive working hours to 28 and capping total work hours over four weeks to 320. Nevertheless, these limits still far exceed those set by the Labor Standards Act. Research has shown that such working hours significantly increase the risk of coronary artery disease and stroke. Employed physicians typically sign fixed-term one-year contracts with medical institutions. These contracts often include unreasonable provisions, such as excessive penalty fees for early termination and overly restrictive non-complete clauses. If a doctor terminates the contract early, they may be required to pay a penalty equivalent to nearly 800 hours of wages. Signing such “indentured contracts” leaves physicians with little room to negotiate or challenge their working conditions. As most physicians are not covered by the Labor Standards Act, when they encounter occupational accidents like the aforementioned death from overwork, the affected physicians or their families are forced to engage in protracted legal battles without guaranteed compensation. The Taipei Doctors Union was founded in September 2017. Within just a year and a half, it challenged hospitals’ long-standing practice of collecting "guarantee deposits” from physicians, successfully fought for marriage and maternity leave for doctors in Taipei City Hospital, and has continued to monitor the government's promise to extend Labor Standards Act protections to more physicians. In 2019, the government expanded the Act’s coverage to include non-military, non-public service resident physicians, but this group accounts for less than 10% of all doctors nationwide. In response, the union has advocated for legislative reforms to amend the Medical Care Act to include standards for employment contracts and labor conditions for all employed physicians, addressing the current legal cap. The healthcare industry also faces systemic pressures: the volume-based reimbursement system under National Health Insurance keeps service volumes consistently high; the post-pandemic labor shortage is severe; and demographic shifts such as declining birth rates, along with the lure of the aesthetic medicine industry, make it increasingly difficult for hospitals to retain clinical staff. Nursing shortages have led to ward closures and emergency department overcrowding. Through lobbying and advocacy, the union seeks to secure representation for healthcare workers in policy-making processes and calls for more equitable resource allocation that truly supports frontline healthcare workers. Physicians understand that the proper functioning of the healthcare system relies on interprofessional collaboration, yet decision-making within medical institutions often lacks bottom-up participation mechanisms. The union successfully supported the establishment of a company-level unionization at National Taiwan University Hospital the year after its founding and has since expanded to its branch hospitals. In the past year, it also helped establish a union at National Cheng Kung University Hospital. Through collective bargaining, the union aims to redress power imbalances in labor relations so that healthcare workers no longer need to express dissatisfaction through resignation alone. Inequities are not limited to employer-employee relations – they also exist within the hierarchical structure of healthcare institutions, such as between patients and healthcare providers or between senior and junior physicians. Senior doctors often monopolize key positions and resources within hospitals and professional associations. Under an entrenched apprenticeship system, junior doctors are reluctant to risk their careers by challenging authority. Since the rise of the #MeToo movement in Taiwan, gender equality issues in hospitals have come to the fore. Both doctors and patients have suffered from abuses of power. In response to gender discrimination and inequality in marriage and childbirth policies, the union has promoted academic research and supported anonymous disclosures by junior physicians, These efforts have led to the removal of powerholders with histories of sexual harassment and pushed regulatory agencies to fulfill their policy commitments. The union also engages in negotiations with hospitals to amend internal regulations, challenging the deeply rooted culture of complicity in the medical field. At of now, the Taipei Doctors Union has approximately 400 members, including around 80 medical students, and continues to strive for a fairer and more equitable labor environment in healthcare.