More services are being affected across the Slovenian healthcare system after doctors who are members of the Fides trade union stepped up their strike activities on 22 January.

While cancellations of non-urgent procedures continue, some doctors have also started to work to rule, strictly observing all provisions on working hours, rest and lunch breaks.

Under the law, doctors must provide a minimum of care even during strike, including for urgent conditions, to patients over 65 or under 18, pregnant women and cancer patients.

While activities differ depending on the health institution, since the industrial action started on 15 January striking doctors at many hospitals have worked beyond the legal minimum, and even then hospitals reported that the action had led to many cancellations of non-urgent appointments.

Community health centres have experienced disruption in online and phone communication with patients, and there have been reports of patients not being issued sick notes, which they need to excuse their absence from work.

Only "bare minimum" of services

Now, doctors say these activities were not intense enough. Milenko Stanković, a vice-president of the Fides trade union who works at UKC Ljubljana, said only the bare legal minimum of services would be performed at the hospital.

Fides members will also strictly adhere to the collective agreement, including by taking one hour out of their workday for preparations and half an hour for lunch, which they typically do not do now.

"We will not continue after completing our out-of-hours duty, we'll go home in the morning. And we'll strictly adhere to local standards," he said.

Doctors at the general hospitals in Ptuj, Celje, Nova Gorica and Murska Sobota have similar plans.

Borislav Vrbanec, a Fides representative at the Murska Sobota General Hospital, said some doctors were thinking of withdrawing consent for overtime work, in which case doctors would work a maximum of 48 hours per week.

In Nova Gorica doctors are considering that as well but have not yet taken action.

Fides representatives warned that if doctors opted massively to withdraw their consent this would lead to the collapse of the system.

Doctors unhappy with talks

While the strike continues, negotiations with the government have been continuing, but doctors do not see any progress and the government angered them by leaking some of the details of their demands, unofficially including a 30% rise in pay as an allowance until a deal on pay reform is reached.

The government has been insisting on tackling their pay demands as part of a comprehensive reform for the whole public sector.

"The staff, Fides members and non-members alike, are very disappointed at the government's last moves and with the way patients are being treated," said Jure Klanjšček, the Fides spokesman at the Nova Gorica General Hospital.

With cancellations mounting, there appears to be growing discontent and some commentators have started to blame not just the government but also doctors for the patients' woes.

Stanković, when asked whether doctors plan to back down given that patients are starting to feel the pinch, said that this could not be blamed on doctors.

While higher pay for senior doctors - demanded after junior doctors' wages rose more substantially last year - have been at the forefront of demands, Fides also wants a reformed system of promotions, elimination of pay disparities, and the implementation of an agreement reached with the government early last year to set up a separate pay tier for healthcare within the public sector.

This was highlighted by the Slovenian Medical Association in a statement of support for Fides. The group said past agreements needed to be honoured by both sides.

"Doctors are only the providers of health services, we are not responsible for the current situation in the healthcare sector," they said.

Slovenian doctors have staged strikes several times before; the longest one went on for 27 days in 2016.