Pay attention to this detail in the employment contract!

Doctors in Turkey have experienced great disappointment in recent years. Doctors working in the public sector seek solutions in private hospitals or abroad for reasons such as health violence and harsh working conditions. Those who go to private hospitals, after a while, go looking for that abroad.

A change was made in 2015 concerning the social status of doctors practicing in private clinics or university foundations. This development, which aims to meet the expectations of private hospitals, which has become widespread in recent years, has revealed a great risk of loss of rights for doctors.

According to Law No. 5510 on Social Insurance and General Health Insurance, self-employed persons such as architects, engineers, lawyers who are owners or partners of companies or who act independently on their own account are subject to 4/1-b (BAĞ-KUR). In this context, doctors who have a private clinic, a practice or a hospital partner have been practicing in 4/1-b for a long time. Doctors practicing in private hospitals dependent on the employer were subject to 4/1-a status. Indeed, architects, engineers and lawyers working for an employer remain subject to the 4/1-a (SSK) status.

With the addition of Additional Article 10 to Law No. 5510 in 2015, a controversial provision was introduced for doctors and dentists. The provision in question is as follows:

“In the case of physicians associated with the company or exercising their profession independently, and persons who are experts in accordance with the legislation of specialization in medicine, persons under private law and/or health establishments and organizations belonging to foundation universities, unless otherwise provided in their contracts, the first paragraph of section 4 of this Act (b) shall be deemed to be insured within the scope of the paragraph. However, the rights relating to the periods worked as an insured within the framework of a) of the first paragraph of article 4 before the date of publication of this article are reserved.

This means: Unless it is clearly stipulated in the contract signed by doctors and dentists practicing in private hospitals and university foundations that the contract is governed by the Labor Code and that they will work under the status 4/ 1-a, they are automatically considered within the scope of 4/1-b. It should be emphasized that such exceptional regulation in the law only exists for doctors.


Being subject to 4/1-b not only entails many loss of rights for physicians, but also entails additional obligations.

RETIREMENT CONDITIONS ARE DIFFICULT: First, those subject to 4/1-a can retire with fewer bonus days, while those subject to 4/1-b can retire with more bonus days. This difference varies according to the start date of the insurance. Those with 4/1-a who started work between September 8, 1999 and April 30, 2008 retire with 7,000 days, and those with 4/1-b retire with 9,000 days. 4/1-a who started work after April 30, 2008 can retire when they have completed 7200 days, and those with 4/1-b 9000 days. For those who started working before September 8, 1999, the difference is even greater.

PENSIONS ARE LOWER: Due to the method of calculating the pension, the pensions of insured 4/1-a are higher. Also, because the bonus is paid on the entire earnings of 4/1-a holders, their salaries are higher. Since 4/1-bs pay their own premiums, they typically pay premiums on low earnings, resulting in low pensions.

NO RIGHTS TO ANNUAL LEAVE: Those who are employed under the 4/1-b status cannot benefit from the provisions of the labor code which protect the employee. Labor law grants certain rights and guarantees to employees. Those who are not subject to 4/1-a and therefore to the Labor Code cannot benefit from their rights to paid annual leave. However, they can go on free leave.

CANNOT BENEFIT FROM A SENIORITY ALLOWANCE: Employees subject to labor law can receive a 30-day retirement indemnity each year, while doctors subject to 4/1-b are not entitled to a severance indemnity.

CANNOT RECEIVE EMPLOYMENT INSURANCE: The working hours of employees subject to labor law, the working conditions and the procedures for terminating the employment contract are governed by law. In the event of unjustified dismissal of employees in an establishment of thirty or more employees, the provisions of job security are applied. Employees with status 4/1-b cannot benefit from job security.

THEY ARE VULNERABLE AGAINST MOBBING: Employees subject to labor law can assert their rights by contacting the Ministry of Labor and Social Security when faced with mobbing practices. Employees with 4/1-b status are considered natural persons acting on their own account, so they are deprived of legal protection against mobbing.

THEY WILL BE subject to tax subject to their self-employment income

The exceptional regulation established in Law No. 5510 for doctors was also transferred to Law No. 193 on income tax with Law No. 7394, which entered into force last week. Accordingly, in accordance with additional article 10 of Law No. 5510, the income of doctors working in the 4/1-b status will be considered income from self-employment. They will keep a book for the taxation of their income and will complete a declaration each year.

In the justification of the said regulations, in order to eliminate doubts as to whether the income of doctors working under private contract in private hospitals and foundation universities should be taxed as wages or as income from self-employment, the doctors who have signed contracts with one or more private health institutions should be accepted as self-employed and their income should be self-employed.

Normally, it is possible to work with more than one employer at the same time in the 4/1-a status by entering into a service contract. There are no obstacles in terms of social security or tax legislation. Premiums for employees working for more than one employer are paid separately by the employers and reflected in the pension. Physicians, on the other hand, will be considered self-employed regardless of the number of employers/hospitals they work with.

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