I. Current status of unpaid doctors
　The term "unpaid doctor" refers to a young doctor at a university hospital who provides medical treatment under the name of practical training or research, and is not paid in full or in large part for the salary to be received. Their working environment has become a major problem. This time, I describe an example of a university hospital as one of the unpaid doctors. However, there are very few universities where this current situation applies, and I work together with the National Medical Union and the Japan Labor Lawyer Corps to collaborate with colleagues from 82 universities nationwide, and I would like to sincerely work on unpaid doctors.

At our hospital, the main source of their livelihood was a part-time worker at two to three frames a week introduced by the university, and the university has incorporated general medical care (ward services, outpatient services, examinations, etc.) into its routine work, and provided only a few tens of thousands of yen per month, regardless of their busy schedule. There are three major problems with this.

Studies are hampered by the compulsory practice of graduate students engaged in research.
Salary commensurate with actual work is not paid.
Work comparable to full-time work is treated as part-time work, and benefits centered on insurance are not obtained.
　Nowadays, the mass media has taken up the issue of unpaid doctors, and the hospital is now paying hourly wages for treatment. However, even if the hourly wage is abruptly lowered without explaining the details of the wage, or even if a full-time job is carried out, the payment from university hospitals remains at the center of the livelihood, at around 100,000 yen, and it is far from going beyond the definition of unpaid doctors mentioned above. There are also numerous problems, such as unpaid medical treatment fees paid to unpaid doctors who had been paid only a few tens of thousands of yen in the previous month, and full-time employment unless they work on the ward throughout the year.

　Against this backdrop, the outbreak of COVID-19 has further highlighted the problem of unpaid doctors. It is said that when you are in a difficult position, you can see the good and bad aspects of the organization, but Chapter II describes the actions taken by university hospitals and the government.

II. Enforcement of Corona Countermeasures and the Current Status of Non-Guarantee
Ⅱ-1 An inappropriate work system that relies on a sense of duty and mission as a doctor
　The outbreak of COVID-19 has become a major problem in Japan, and it is only recently that a national emergency declaration will be issued on April 17.

Universities and hospitals are also heavily affected by this. At the initial hospital, specialized departments such as the Department of Infectious Diseases, the Department of Respiratory Medicine, and the Department of Emergency Medicine were providing COVID-19 treatment, but as the number of patients increased, work became enormous, and young and mid-career physicians outside their specialty began to focus on the ward as a whole. Included among these are so-called "unpaid" graduate students, who account for about one-third of the doctoral responders.

As mentioned earlier, graduate students are essentially engaged in research that they want to carry out, but the current situation is such that they are greatly hampered by their core business and are forced to provide medical treatment that poses a risk of infection. In normal societies, there may be protests about breaches of contract or even strikes.

However, at our university, no one complains about the practice as a whole, and one week after the hospital proposes a policy, the practice has begun. Why? Graduate students are still doctors, and each student understands this emergency. It is no exaggeration to say that this medical service is built on the responsibility and sense of mission of unpaid doctors.

I would like to see the reality of university hospitals, which continue to have inappropriate labor systems, taken seriously by the people of Japan and the teachers who are leaders in charge of medical care.

II-2 Insufficient assurance
　At the expense of their own research, many unpaid physicians who are willing and unilaterally compelled to risk infection and fight on the front lines of COVID-19 have heard their voices of anxiety. Specifically, it includes the working environment and salaries during the COVID-19 treatment period, follow-up after the treatment period, and management in the event of infection. There is a possibility that this will be changed in the future, but at this point in time, the following items are shown below.

During the treatment period, only COVID-19 treatment is provided, and the patient is basically not allowed to return home and is forced to stay at a nearby hotel, although it is the cost of the hospital.
Having a part-time job normally performed, the patient was discontinued. During this period, the hospital will pay a portion of the byte cost that is originally paid.
There are many places where COVID-19 treatment does not provide additional hazard benefits, and there are no occupational accidents.
　Although the above-mentioned medical care system is in place, there are many voices of anxiety after the treatment period. If appropriate infection-control measures are in place for follow-up after the current treatment period, it is recommended that patients be treated normally without PCR or waiting at home for washout. The rationale is based on the absence of infection cases from medical personnel handling cruise ships and the absence of infection cases from healthcare personnel carrying out infection control, although only a few cases have been investigated. However, due to the insufficient evidence to prevent infection and the shortage of supplies, there are voices calling for cautious measures, such as PCR, in all cases, because of the high responsibility of healthcare providers for transferring infection to patients. In addition, in the event of infection, some universities do not suffer an occupational accident, and even at some universities, 60-80% of the salary of tens of thousands of yen, which is almost none, is paid. However, as mentioned above, there are also voices calling for whether the income of part-time workers who are unable to work outside is guaranteed in the same way as during the medical treatment period, as is the case with 6-80% of unpaid doctors.

　The current outbreak of COVID-19 is a so-called disaster, and it is usually an indication of accident insurance. Is the above-mentioned response worthy of "accident insurance"? It is understandable that there is no choice but to start treatment under urgent conditions, and it is difficult to reach a conclusion that is completely acceptable between the university side and the unpaid physician side due to the severe current situation. However, assurances in this situation are very important and we would like to find a compromise with each other in the future.

II-3. The danger of not only being a graduate student but also being unable to live in daily life
Due to the COVID-19 epidemic and the declaration of a state of emergency, many graduate students are forced to suspend their research due to the suspension of logistics and restrictions on the use of laboratories. Some of them have called for the repayment of part of their school fees, even if research is unavoidable, from the viewpoint that the environment for research is not in place.

　More than that, the greatest concern of unpaid doctors is that many of them are being asked to suspend part-time jobs introduced by universities in order to declare a state of emergency. As mentioned earlier, part-time workers are the main source of livelihood for unpaid doctors and are a vital issue. If everything is actually refused, the salary of the unpaid doctor will be lost only from the university, and it will become impoverished. In my opinion, universities should be responsible for part-time jobs introduced by universities, but at this point only a temporary guarantee for COVID-19 work in universities is referred to. Specifically, it is necessary to confirm the status of the guarantee of unpaid doctors from the university side to the party requesting the discontinuation. If it is actually difficult to guarantee from the other party, the university will be obliged to secure a part of the salary (about 60-80%) that should be paid by part-time workers or to provide a different part-time worker to unpaid doctors.

Furthermore, it is desirable to develop a social environment in which universities can protect graduate students independently. I sincerely hope that the term "unpaid doctor" will disappear in the future.