Radiation Leave and Employment Status of Physicians Who Invoice: 2026 Private Hospital Guide

Why are 24 July 2025 and 1 June 2026 different legal thresholds?

Article 12 of Law No. 1219, as amended by Law No. 7557, requires physicians, dentists and specialists working in private health institutions and foundation universities to work as insured persons under 4/a. Article 28 of the Law brought all the provisions into force on the date of publication. Transitional Article 16 provided that, for work permits already granted, a new application had to be made by 1 June 2026, failing which the permit would be cancelled.

This distinction is not merely terminological. If one says that "the 4/a obligation began on 1 June 2026", the legal character of the period from 24 July 2025 to 31 May 2026 may be wrongly framed. On the other hand, the entry into force of the Law on 24 July 2025 did not automatically cancel the existing work permits on the same day; the Law provided a separate adjustment timetable for those permits.

The current Private Hospitals Regulation, Article 15(2), also expressly states that health personnel will work under contract in the staff of a private hospital, insured under 4/a, with a staff work certificate issued through EKİP. Thus the statutory insurance rule and the staff/work certificate regime of the private hospital have been set up in the same direction. Private Hospitals Regulation, Art. 15

The practical consequences of this change are as follows:

• For a physician who is a regular member of the hospital's staff and organization, the "invoice from the company only" model is incompatible with the 4/a rule in force from 24 July 2025 and with the adjustment timetable completed on 1 June 2026.
• The physician's closing of his or her company or tax registration is not a statutory precondition for 4/a employment. What matters is that the work in the hospital is notified under the status required by the regulations.
• Earlier invoicing periods are not erased automatically. The nature of the past relationship is examined under the law of that period and the actual conditions of work.
• After 1 June 2026, a "hybrid" model of "low or minimal payroll plus the balance paid by invoice to the physician's company" requires special scrutiny as to the premium-based earnings (PEK), actual pay, tax and labour claims.
• A physician who, under the statutory conditions, treats his or her own patient in another private health institution, the patient having paid the fee and no claim having been made to SGK, is in a different position from a staff physician working within the health institution's own patient and work organization. The conditions of the exception must be made concrete by reference to Article 12 of Law No. 1219 and the legislation on health institutions.

Does the physician's 4/b status or the issuing of invoices conclusively establish that he or she is not an employee?

No. Social security, tax and individual labour law do not answer the same question:

Article 10 Additional Article, added to Law No. 5510 in 2015, had allowed physicians who were company partners or self-employed to be treated as 4/b where they provided services under contract to private health providers, unless the contract provided otherwise. Law No. 7394 classified, from 15 April 2022, income within this scope as self-employed earnings for the purposes of Article 66 of the Income Tax Law (GVK). These provisions were important in their own periods; however, the subsequent and express 4/a rule added to Article 12 of Law No. 1219 by Law No. 7557 entered into force on 24 July 2025, and a time limit to 1 June 2026 was granted for adapting existing work permits to the new model.

Classification under the tax legislation is not absolutely binding on the labour court when it characterises the factual relationship under the Labour Act. The reverse is also true: a finding of employment does not mean the automatic annulment of all invoices issued in the past or the automatic correction of all tax consequences. Tax and accounting corrections are assessed separately.

Is determining employment status the same as a sham?

Not exactly.

Requalification of the contract means determining whether, regardless of the heading used by the parties, the actual performances contain the elements of a service contract under Article 393 of the Code of Obligations (TBK). If the physician works personally, is dependent on the hospital's organization and receives remuneration in return, a "service procurement" label may be changed and an employment contract may result.

Simulation (muvazaa), under Article 19 of the TBK, means that the apparent transaction and the genuine and common intention of the parties differ. If it is alleged that a company was set up for the physician only in order to avoid the payroll burden or to conceal rights, the intention to create an appearance and the concealed relationship must be shown by evidence. Not every incorrect contract label is automatically classic simulation.

This distinction affects litigation strategy. Rather than saying only that "the heading of the contract is wrong", a claimant who relies on actual work must, if he or she alleges simulation, also show why the apparent company relationship does not reflect the real working arrangement.

The 2026 academic study by Cansunar and Subaşı argues that where a model is established under the appearance of a service procurement in a private hospital, explaining it by the classic concept of simulation may be dogmatically inadequate, and that where mandatory labour law provisions have been circumvented, an assessment of evasion of law (kanuna karşı hile) may be more accurate. This doctrinal view does not produce an automatic result in a concrete file. The court should not treat genuine independent activity as evasion of law; however, in a file where personal and dependent labour has been placed merely inside an invoice shell, it must examine whether the consequences of mandatory labour law have been avoided. Cansunar and Subaşı, 2026

How is it determined whether an invoicing physician is an employee?

There is no single criterion. The court considers the following indicators together:

A physician's professional autonomy in medical decisions does not prevent him or her from being an employee. A doctor's making diagnostic and treatment decisions under scientific rules is one matter; working hours, patient flow, leave, on-call duties and dependence on the employer in the institutional organization are different matters.

How are the four models of practice distinguished?

Does lawful outsourcing of radiology services differ from invoicing by a physician's company?

Yes. Article 6(11)–(13) of the Private Hospitals Regulation permits, for radiology and medical laboratory tests not carried out within the hospital, a specific model of inter-institutional service procurement. The service may be obtained:

• on site from another health institution holding a licence or activity permit, or
• on site from a contractor holding a medical device sales authorisation.

The service-procurement documents are submitted to the Provincial Directorate of Health; the hospital receiving the service and the institution or body providing it are jointly responsible for the implementation and results; test requests and results are processed through the electronic system and integrated into the hospital's system. Private Hospitals Regulation, Art. 6(11)–(13)

This regulation does not give a general permission for the hospital to require a physician working within its own staff and daily organisation to invoice his or her own company each month for personal labour. The essential differences between the two models are as follows:

Practical warning: The proposition "radiology services may be procured externally at the hospital" is not the same as the result "every radiologist within the hospital may be engaged through a company invoice". In a litigation file, the parties to the service procurement, the licences and permits, the staff list, ownership of the equipment, patient flow and electronic-system integration must be obtained together.

Does transition to 4/a reset past seniority and labour rights?

As a rule, no. Terminating the invoicing or service-procurement contract and reporting under 4/a the following day does not of itself erase the past actual relationship, if the physician continues in the same hospital, in the same work, patient group, equipment and management without interruption. The legal consequence is drawn not from the change of contract on paper but from whether there was a real interruption and termination in the employment relationship.

The following distinctions are particularly important:

• Closure of a service-procurement contract does not necessarily show that the real employment relationship has ended.
• Writing in the new contract that "the start date of employment is 1 June 2026" does not by itself change the start of seniority, if it is proved that the earlier period was an employment relationship.
• Imposing a new probationary period on an employee who continues without interruption is separately examined in light of the nature of the earlier actual relationship and the continuation of the same work.
• A fixed-term employment contract does not become valid merely because the parties write it as such in the heading; the objective condition in Article 11 of the Labour Act must be made concrete.
• A reduction of pay, or a substantial change of place or working hours, requires written acceptance and scrutiny of working conditions under Article 22 of the Labour Act and the contractual terms.
• Protocols stating "I have no rights from the past", "my seniority has been reset" or "I have received all my claims" are not treated as valid without examination under Article 420 of the TBK, the mandatory rules of labour law and the concrete payment.

A press note of the Istanbul Chamber of Physicians' Legal Office dated 21 May 2026 also states that, in the transition to 4/a, it is not necessary to sign a release or waiver protocol concerning past work; where the employment relationship continues, it may be arranged only that the former service-procurement contract has closed and that employment continues under the new employment contract. That text is not binding case law; it is a current professional-body legal opinion. Information note

Provisions of a 4/a transition contract that require particular scrutiny

Does the company's remaining open mean that 4/a insurance ends?

The company or the tax registration for a private practice remaining open does not by itself prevent the 4/a notification being made for dependent work at the hospital. The physician's genuine independent activity outside the hospital may continue. The overlap of insurance under Article 53 of Law No. 5510, the type of partnership, the scope of the 4/a notification, pension status and any social security support premium should be examined separately.

However, if the company has no other genuine activity, keeping it open merely as an "old payment channel" may give rise to obligations in respect of books, returns, chamber membership, municipality, workplace and tax. The 2026 information notes of the Ankara and Muğla Chambers of Physicians state that the company remaining open does not prevent entry under 4/a, but that maintaining an inactive company may create tax and municipal risk. These are not binding judicial decisions; they are professional-body assessments for practice. The decision whether to close, liquidate or keep the company for another activity should be taken after examining labour law, tax law and company law together.

What risks arise under a hybrid payroll and invoice model?

Paying a small part of the remuneration through the payroll and the remaining regular performance or progress payment to the physician's company is not merely a "payment technique". Depending on the concrete model, it may affect the following consequences:

• actual monthly and daily pay,
• premium-based earnings (PEK) for SGK and entitlement to pension and unemployment benefits,
• severance and notice pay,
• annual leave and the pay for radiation leave,
• overtime, weekly rest and public and general holidays,
• VAT, income or corporation tax and expense documents,
• whether the employer's costs have been unlawfully deducted from the physician's progress payment.

If the hospital has, by unilaterally reducing the total previous progress payment, placed on the physician the employer's premium or institutional costs arising from the transition to 4/a, a reduction in pay and a change of working conditions may arise. On the other hand, not every invoice amount can be treated as pay; VAT and the company's genuine expenses must be separated.

How should the judgments of the Court of Cassation E.2021/12186 and E.2024/8203 be read?

These two decisions are not two independent precedents; they are the reversal and the post-reversal affirmance stages of the same dispute. Without knowing the chain of decisions, it would be misleading to draw a broad principle from the 2024 affirmance alone:

In the concrete case, a radiology specialist entered into both a "full-time staff doctor contract" and a "doctor service-procurement contract"; the fixed pay was paid through the payroll and the progress payment through the company set up by the physician. Labour claims and radiation leave were examined in the same file. 2022 reversal decision — 2024 affirmance decision

The correct result of the chain is this: payment of a progress payment through a company was not seen, in that file, as an obstacle to assessing the employment contract, actual pay and radiation claims. However, the decisions do not establish a categorical principle such as "every physician who invoices is an employee", "every invoice amount is pay" or "all social benefits are added to the radiation calculation". The employment relationship, the pay components and the radiation work must each be proved in every file.

Why is the Court of Cassation decision E.2021/6818, K.2021/11272 separately important?

The decision of the 9th Civil Chamber of the Court of Cassation dated 01.07.2021, E.2021/6818, K.2021/11272, examined the calculation of overtime for an internal medicine specialist who received a progress payment in a private hospital according to his performance and the medical procedures he carried out. The Chamber stated that, since the progress payment increases as the working time increases, the non-increased part of the overtime was paid within the progress payment; accordingly, only the fifty per cent increase part, and not the full one hundred and fifty per cent, should be calculated. Accessible full text

The limit of this decision is clear: it does not concern radiation leave, whether the invoicing relationship is a sham, or the 2025 amendment to Article 12 of Law No. 1219. In this guide it is used only for the proposition that, for physicians with a performance or progress-payment system, the same labour should not be paid in full a second time in the overtime calculation, and that an expert report must be framed consistently with the payment model.

Which judicial decisions resolve which question, and which do not?

This table has been prepared not to "increase the number of precedents", but to limit the legal weight that each decision carries. The fact that a decision concerns the same profession does not mean that it resolves all the problems in the file.

Does an invoicing physician who is an employee automatically acquire the right to radiation leave?

No. Establishing employment status is only the first gate. For health leave, the following four conditions are examined in addition:

1. Is the work connected with the provision of health services within the scope of the Regulation?
2. Is the device or substance used an ionising radiation source or a radionuclide?
3. Is the place of work a controlled area under the legislation?
4. For how long did the physician actually work in that area?

X-ray, computed tomography, mammography, angiography/fluoroscopy, PET/CT, SPECT and radiotherapy may all be connected with ionising radiation. MRI works with magnetic fields and radio waves; ultrasound works with sound waves. A physician who reports only MRI or ultrasound is not automatically granted health leave because of the name of his or her department. If the same physician also works with CT, mammography or interventional fluoroscopy, those periods are calculated separately.

The dosimeter result is important but is not by itself the criterion that confers or extinguishes the right. It must be examined together with the device, the classification of the area and the records of actual work.

Do teleradiology and remote reporting give rise to radiation leave?

The status of employee and entitlement to radiation leave must be separated from remote reporting. Where a physician writes reports from home or from a centre outside a controlled area, linked to the hospital's programme, time, pay and organisational dependence may be present in relation to employment status; however, where there is no actual work with ionising radiation in a controlled area, reporting hours alone do not count towards the health-leave calculation.

Remote reporting of MRI and ultrasound images does not by itself give rise to radiation leave, because those devices are not ionising. However, where the same radiologist also takes part on certain days in CT, mammography, fluoroscopy or interventional procedures, those activities must be separated by date and time.

For which period and how many days of radiation leave?

Under the current EK-2, 1–50 hours corresponds to one day, 51–100 hours to two days, each additional 50 hours to one further day, and 1451–1500 hours to 30 days of health leave. Zero actual work does not create a day's leave under the first band's form of wording in the table. Leave must be used within the following year, in one piece and not divided; it cannot be carried over to another year and cannot be used consecutively across the change of year. Periods spent on childbirth, death, marriage and annual leave are not counted in the calculation of actual work. Current Regulation

The joint panel of the 12th and 10th Chambers of the Council of State, in its decision E.2023/3008, K.2025/2739 dated 27.05.2025, rejected the claim for annulment concerning the EK-2 calculation, the non-transferability rule and the exclusion of certain periods not worked. The decision indicated that a route of appeal was open; at the last check date of this publication, it could not be confirmed from open sources whether the decision had become final or what the outcome of the appeal was. The decision should therefore be used as a strong and current first-instance Council of State decision, and must not be presented as a "finally settled leading judgment". Accessible text of the decision

Is leave not used after 2023 converted into money on termination?

The decisions of the 9th Civil Chamber of the Court of Cassation under the former Regulation accept that radiation leave cannot be converted into money while the employment relationship continues, and that on termination it becomes a monetary claim based on final pay. Decisions E.2020/5049, K.2021/5141 and E.2020/5953, K.2021/3837 form the basis of this approach. Full text of E.2020/5049

The current Regulation, however, expressly provides that leave cannot be carried over to another year. Where the employer has never allowed the leave, a settled Court of Cassation case law under the 2023 regime, which definitively resolves the effect of that rule on the monetary claim on termination, has not yet been confirmed. Two approaches are possible:

• Interpretation in favour of the employee: An employer cannot benefit from its own breach; it cannot escape liability by not allowing the mandatory protective right and saying that "the leave burned". By analogy with annual leave, a monetary equivalent may be claimed on termination.
• Opposing view: Health leave, unlike annual leave, serves only to reduce exposure at the time; because of the non-transferability rule and the current hours system, converting past leave into money requires a clear separate legal basis.

Miraç Şamil Pekşen's academic study of 2025 argues that radiation leave not used at the end of the employment contract must be converted into a monetary claim on the basis of final pay. This is an important doctrinal view; it is not a Court of Cassation decision. Academic study

In a file concerning the period after 2023, the legal sources must therefore be presented in three layers:

This dispute must not be hidden in the petition. It should be discussed openly, by reference to the period, written requests for leave, the employer's duty of planning, and the breach of the protective purpose. The employee should request a record of actual hours for the calendar year; where leave has not been scheduled in the following year, should request in writing the leave to which he or she is entitled under EK-2, and should keep the reply. It should be clearly justified that the rule of non-transferability must not be turned, to the employer's advantage, into a mechanism for losing rights where the power and duty to plan leave belong to the employer.

How is the physician's real pay determined?

In its decision E.2021/12186, K.2022/528, the Court of Cassation 9th Civil Chamber agreed that the pay of the radiology specialist was fixed as "guaranteed pay plus premium/progress payment". The Chamber requested that the average of the variable premiums for one year counting backwards from the date of termination be found and added to the guaranteed pay to determine the final basic pay. The same decision also stated that the radiation claim would be calculated on the basis of final pay. Accessible text of the decision

That principle does not mean that every item on the invoice is pay:

Even the amount excluding VAT that the company invoices to the hospital is not directly a "net salary". If the company has other activities, staff, real expenses, tax and commercial risk, these must be separated. Conversely, where the company is merely the payment channel for the physician's personal labour, invoices are issued regularly each month and the consideration consists of guaranteed pay plus performance, the economic reality must be taken into account in determining pay.

A sound calculation considers together payrolls, invoices, bank movements, company ledgers, progress-payment tables, hospital automation and market comparisons. Tax and SGK experts and labour-law calculation experts may need to examine the same data for different legal purposes.

Illustrative calculation example

Suppose that, in the 12 months before termination, the radiology specialist's gross guaranteed pay on the payroll was TRY 70,000 per month, and that the average variable progress payment paid to his company for personal medical services, excluding VAT and after separating the company's genuine operating costs, which may be argued to be pay, was TRY 110,000 per month. If the court accepts both components as basic pay, the monthly gross basic pay is TRY 180,000 and the daily gross pay is TRY 6,000. For 28 unused days proved from the earlier period, the illustrative gross amount is TRY 168,000.

This example is not a guaranteed result or a ready calculation. In particular, the VAT in the company invoice, staff costs, equipment costs, independent commercial earnings and the physician's personal labour must be separated; an equation of "invoice = pay" cannot be established without that separation.

Are radiation leave claims, overtime and the FHSZ the same right?

No.

• Radiation or health leave is a right to rest that reduces exposure to radiation.
• Work exceeding the weekly limit of 35 hours under Article 1 of Additional Article 1 of Law No. 3153 gives rise to a separate claim for overtime pay, if the conditions are met.
• The increase for actual years of service under Article 40 of Law No. 5510 is a social-security and pension right; the 4/a or 4/c status and the actual working days declared are important.
• For incomplete SGK notification, a determination of service or a dispute as to premium-based earnings is pursued separately.

The same automation records may be evidence for all these claims; however, the legal basis and the method of calculation are different. The rejection of one does not automatically remove the others.

What other rights may arise if employee status is accepted?

For reinstatement, the identity of the employer must be determined with particular care. The company that prepares the payroll, the hospital's licence holder, the operating company and the intermediary structure that invoices the physician may not be the same legal person. Because mediation and the one-month action period are short, the termination letter, the SGK termination notice, the contract and the actual management must be assessed together.

May an SGK service determination also be needed?

Yes. Where the physician was declared under 4/b in the past through the company but in fact worked under an employment contract, the determination of 4/a service and of the actual premium-based earnings may arise. For a claim for determination of service under Article 86(9) of Law No. 5510, the five-year preclusive period running from the end of the year in which the service was rendered is, as a rule, critical. However, the application of the period may vary according to case law where the work is evident from documents given to the Institution, from employer records or from facts of which the Institution had prior knowledge.

The five-year statute of limitations in a labour claim and the five-year preclusive period for determination of service with SGK are not the same. The former is a plea of debt; the latter is a special period relating to the determination of social-insurance service. It should not be assumed that the period for determination of service is automatically preserved merely because a mediation application has been made.

Is the action brought by the physician or by the physician's company, and against whom?

The fact that the company issued the invoice does not mean that all claims belong to the company. The owner of the claim and the defendant must be determined separately for each claim:

Where the licence holder of the hospital, the company that operates the hospital in fact, the company that signs the contract with the physician and the company that pays are different entities, the "real employer", joint employership, organic link, transfer of undertaking or the principal employer–subcontractor relationship must be examined through concrete facts. Mere membership of the same group of companies does not automatically create joint and several liability; it must be shown that personnel management, payment, instructions, patients and the integrity of the organisation are unified.

If the physician's company has already started a commercial action or enforcement proceedings for unpaid invoices, a later claim for the same amount as "pay" may raise objections of set-off, res judicata, lis pendens and contradictory conduct. For this reason, before litigation the invoice claim and the personal labour claim must be matched month by month; the amount collected, the VAT layer and the residual labour claim must be shown separately.

How are the parties determined in mediation?

In an application for mediation as a condition precedent to litigation, all possible real employers against whom a labour claim will be directed should, so far as possible, be stated with their full trade name and their Central Registration System (MERSİS) and tax details. A brand or hospital name alone may not be sufficient. The commercial claim of the physician's company and the physician's personal labour claim should not be confusingly combined in the same application form. The party to the application, the claimant and the type of claim must also be clearly understood from the final minutes.

How is the competent court determined?

Where the physician alleges that the actual relationship was an employment contract and claims seniority pay, wages, overtime or radiation leave, it is argued that the dispute should be heard by the labour court. The court examines employment status as a preliminary question.

Where a genuine company claims the fee for services under its own commercial contract, and the physician's personal labour rights are not asserted, the commercial court or the general civil court may be relevant. Whether the physician or the company brings the action, whether the claimed outcome is a company receivable or a labour receivable, and the commercial status of the parties are important.

The SGK service determination is also heard in the labour court, but the parties and special procedure are different. A dispute about a tax assessment or about a work-permit decision may fall within the field of administrative or tax litigation. A single heading of "physician-company action" should not be used to pile all claims into one action.

Pre-litigation mediation and the post-31 July 2026 type of action

Under Article 3 of Law No. 7036, mediation as a condition precedent applies to claims for employer–employee receivables and compensation. In the application, rather than simply writing "labour receivables", the claim must be named specifically:

"Assessment, as a factual basis, that dependent work within the organisation of a private health institution is an employment contract; collection of radiation or health-leave pay not used for periods of actual work in a controlled area with ionising radiation, the actual pay difference, premiums and progress payments, overtime and other labour receivables arising from the conditions."

Under Law No. 7589 of 31 July 2026, Article 107 of the Code of Civil Procedure (HMK) was repealed and a new fourth paragraph was added to Article 109 of the HMK. Under the new system, where part of a receivable has been sued, the claim may be increased once in the same action until the end of the inquiry; for the increased part, limitation is deemed interrupted on the date of the action. For actions brought before 31 July 2026 for indeterminate receivables, the former Article 107 continues to apply. Law No. 7589, Arts. 19, 20 and transitional Art. 1/10

The new rule does not mean that an arbitrarily low amount may be stated. The value of the claim must be honestly calculated from the available data; it must be explained that the invoices, premium and hour records are in the defendant's possession; and the fact that the right to increase is single is to be borne in mind.

How are limitation and interest assessed?

The former case law of the 9th Civil Chamber of the Court of Cassation accepts that the radiation claim is due upon termination and that limitation begins on termination. The five-year limitation for labour receivables introduced by Law No. 7036 and its transitional provisions are applied separately according to the date of termination and the date the receivable arose.

As regards interest, the decision of the 9th Civil Chamber of the Court of Cassation, E.2016/2547, K.2019/12571, did not treat the radiation claim as pay in the broad sense and applied statutory interest. Full text of the decision

However, by Law No. 7589 of 31 July 2026, Article 1 of Law No. 3095 was amended. Where the rate has not been fixed by contract, statutory interest is now linked to eighty per cent of the short-term loan rediscount rate of the Central Bank of the Republic of Türkiye (TCMB) at the previous 31 December; if the rate at 30 June differs by at least five percentage points, the new rate is linked to eighty per cent of the new rate for the second half. In the concrete file, the start of interest, default, the type of interest claimed and the effect of the change on earlier receivables must each be calculated separately. It is not correct to write a fixed percentage as if it applied for years.

The content of the notice of default, the clarity of the claim type in the demand, the date of service and the period given are important for default. Neither the date of the mediation application nor the date of the action produces the same result in every file; it must be investigated whether a valid default occurred earlier.

Which evidence proves labour status and radiation leave?

Who bears the burden of proof for which fact?

The burden of proof and the location of a document are not the same thing. The physician must make the primary fact concrete; however, failure to gain access to the HBYS, PACS, RIS and device records held under the hospital's exclusive control must not automatically operate against him or her. Articles 219–220 of the HMK, preservation of evidence and official correspondence to institutions should be used to correct this imbalance.

In its decision E.2021/12186, the Court of Cassation stated that where the employer says that "leave was used" on days when there was actual work in the hospital's automation system, those days must not be deducted from radiation leave. The same decision also asked that a mere presentation of ultrasound records might not be sufficient, and requested that other examinations and the automation system be examined on site.

Mobile and operating-theatre devices: special proof

Mobile fluoroscopy, C-arm X-ray or operating-theatre equipment may not always appear, user by user, in the fixed PACS system. In such files, the operating-theatre case register, the raw logs of the device console, the anaesthesia form, the surgical team's report, the on-call schedule and the turnstile record should be requested together. The absence of images in the physician's name in the PACS does not by itself prove that the mobile device was not used.

Safe extraction of digital evidence under the KVKK

An employee must not download an unlimited amount of patient files or health data onto a personal device. In a screenshot required for the case, the patient's name, Turkish identity number, contact and clinical details should be masked, leaving visible only the type of procedure, date and time, device and user identity. It is preferable that the court request the original logs directly from the hospital, with patient data masked. The need to collect evidence does not give general permission for the unlawful transfer of health data.

What steps may be taken to keep evidence from being lost?

• A notice to the hospital requiring the preservation of records may be sent by notary, KEP or another provable corporate channel.
• Where the conditions of Article 400 of the HMK are met, preservation of evidence before the action may be requested.
• Within the action, under Articles 219 and 220 of the HMK, the production of specific documents in the employer's possession may be requested.
• Licence and permit records linked to the SGK, the Provincial Directorate of Health, the NDK and staff work certificates of the Ministry of Health should be obtained from the relevant authorities.

An example request to the court:

"The databases of the HBYS, PACS, RIS and device console used within the defendant employer are under the defendant's control. We request that the user logs, DICOM processing times, approval and reporting records and access-control audit trail data for the claimant's period [start–end] be submitted with patient personal data masked, and that a firm deadline be set for the defendant under Article 219 of the HMK; and that refusal to produce be assessed within the framework of Article 220 of the HMK."

Article 220 of the HMK does not require, in every case of failure to produce, the automatic acceptance of all the worker's claims. The court assesses in the concrete case whether the document exists, whether it is in the opposing party's possession and the conditions of refusal.

How is the technical integrity of digital records protected?

A single screenshot, even if it shows the date and time, the user and the context of the transaction, is not always sufficient. Particularly where the sharing of user accounts, the authority to correct data later or the period of log retention is in dispute, the following should be requested together:

• the original export file taken from the system and the report generation parameters,
• user identity, login and logout time and IP or terminal information,
• the DICOM header, accession number, device/modality identity and the time of the procedure,
• the audit trail and the administrative account that created, changed or deleted the record,
• a hash value taken on the date the file was delivered and a delivery record,
• the database time zone, daylight-saving and server clock synchronisation information,
• the hospital's log-retention and backup policy and any possible automatic deletion period.

In court or expert examination, reliance should not be placed only on printed screen output; where necessary, the duties of the IT manager, the radiology or nuclear-medicine expert and the labour-law calculation expert should be separated, and an on-site examination of the system should be carried out. Asking about the hospital's record-retention policy does not mean that there is a single fixed period in the legislation for each system; the request must be framed according to the concrete type of data.

Example text for a record-preservation notice

"It is requested that the user logs, audit trail records, backups and the related access and change history of the HBYS, PACS, RIS, Medula, EKİP, turnstile, shift/on-call, DICOM and device-console systems for the period [start–end] — relevant to the claimant's employment status, pay, work in a controlled area and the dispute over health leave — not be deleted, overwritten or destroyed outside the ordinary retention policy, and that they be kept, with patient personal data protected, until the dispute is concluded."

This notice alone is not an interim injunction or a decision for preservation of evidence; it informs the addressee of the risk of data loss and may matter in the later dispute over production.

What are the hospital's likely defences and the risks in the file?

Which errors should be checked in an expert report?

The expert should not make the legal characterisation in place of the court; however, the facts accepted for the calculation and the alternative scenarios must be clearly shown. When objecting to a report, the parties should not limit themselves to saying "we do not accept the report"; they should make concrete, in tabular form, the incorrect period, device, hour, pay component and set-off item.

Pre-litigation document checklist

• [ ] All work, service and consultancy contracts of the physician and any additional protocols
• [ ] Correspondence showing by whom and how the physician was told to set up a company
• [ ] Company incorporation, partnership, staff, expense and tax records
• [ ] Payrolls, SGK service statements and premium-based earnings
• [ ] All invoices, self-employment receipts and bank movements
• [ ] Tables of guaranteed pay, turnover and performance calculations
• [ ] Staff work certificate and Provincial Directorate of Health permits
• [ ] Shift, on-call, call, leave, turnstile and card records
• [ ] HBYS, PACS, RIS, Medula and device-console logs
• [ ] Dosimeter results, controlled-area plans and device licences
• [ ] Hospital website, corporate e-mail and staff directory records
• [ ] Written requests for radiation leave and employer replies
• [ ] Notice of termination, notice letter and mediation final minutes
• [ ] Examples of digital records with personal data masked

Hospital compliance checklist after 24 July 2025 and 1 June 2026

• [ ] Have the current 4/a entries and work permits of all in-house physicians been completed?
• [ ] Is a company invoice paid outside the payroll for the same personal medical service?
• [ ] Are guaranteed pay and all performance payments shown correctly in the payroll and PEK system?
• [ ] Can the genuine external physician be distinguished from the in-house employee by patient flow and contract?
• [ ] Are actual hours in the controlled area recorded per user?
• [ ] Is the EK-2 calculation made at year-end and is leave planned as one piece in the following year?
• [ ] Have automation permissions and actual assignments been closed off on leave days?
• [ ] Are PACS, RIS and HBYS audit logs stored in a form that cannot be altered?
• [ ] Have the physician contracts been reviewed together by teams on Law No. 1219 Art. 12, Law No. 5510, tax and labour law?
• [ ] If radiology or laboratory services are procured externally, are the provider's licence, activity permit, medical-device authority and documents submitted to the Directorate complete?
• [ ] Do transition contracts contain provisions that reset past seniority, include a general release, or impose the employer's cost on the physician?
• [ ] Are payroll-plus-invoice payments for the same personal medical service, and the consistency of VAT, PEK and pay, reviewed?
• [ ] Are remote reporting and actual work in a controlled area recorded under separate user and time codes?
• [ ] Can log retention, back-up, changes of authority and data-destruction procedures be audited in the event of a dispute?

Legal opinion of the author

Legal opinion of Att. Umut Güneş: In these disputes the reliable method is not to choose between two opposing slogans such as "invoice means pay" or "a company owner cannot be an employee". The examination has three stages. At the first stage it is established whether the physician's labour participates personally, continuously and dependently in the hospital's organisation, and in whom the genuine enterprise risk lies. At the second stage, for radiation leave, the device, the ionising source, the controlled area and the actual working time by date and hour are separately proved. At the third stage, the VAT and the genuine company expenses in the invoice are separated, and the guaranteed and regular variable pay corresponding to personal labour is determined. When these three tests are applied together, a consistent legal outcome can be established across status, leave and calculation.

This assessment is the substance of the legal opinion, re-examined against current legislation and verifiable decisions. It is an opinion of the author, to be applied to concrete evidence; it is not a binding court decision. The experience of Güneş & Güneş Law Firm since 1999 indicates that, in determining the outcome, the actual organisation and the joint reading of digital records are more decisive than the heading of the contract.

How does Güneş & Güneş Law Firm work on these files?

A file concerning a physician invoicing through a company is not solely a calculation of an employment-receivable. Güneş & Güneş Law Firm, depending on the scope of the concrete matter, combines in a single file map the working status, the leave under Law No. 1219, the 4/a–4/b notifications, company contracts, radiation-leave periods, actual pay, digital evidence and the determination of competent jurisdiction.

The work that can be provided includes analysis of contracts and simulation, a status table for past periods, protection of hospital automation data, the correct framing of mediation claims, separation of the labour and SGK processes, audit of the expert report for pay, hours and leave, and, where necessary, coordination with tax and accounting specialists.

Güneş & Güneş Law Firm has operated from Antalya since 18 March 1999 and provides legal services in national and internationally connected files with more than 27 years of professional experience. Each file is evaluated with its own contract, working period, device and evidence; no outcome is guaranteed.

Frequently asked questions

Can a radiology specialist who invoices a private hospital claim radiation leave?

Yes, if the actual relationship is an employment contract and the physician actually worked with an ionising radiation source in a controlled area during the relevant period. The invoice alone does not determine employment status, and the radiology title alone does not determine the conditions of health leave.

Can work continue through a company after 1 June 2026?

For physicians working within the hospital, Article 12 of Law No. 1219 requires 4/a status. External treatment of a private-practice patient under the statutory conditions and models such as owner or partner of the health institution are examined separately. The "hybrid" payroll-invoice practice carries a high legal risk.

Does the company remaining open prevent 4/a entry?

Not by itself. The physician may have other commercial or professional activity; the hospital work must be correctly notified under 4/a.

If the hospital contract says "there is no radiation leave", is the clause valid?

Where the relationship is an employment contract, a clause that in advance removes the mandatory protective right is not accepted as valid. Where the relationship is a genuine independent service, the employment status and the scope of the Regulation's personal application are discussed first.

Is the VAT-inclusive total of the invoice pay?

No. VAT is not pay. Even the amount excluding VAT cannot be automatically treated as net pay without examining all the company's activities and expenses.

Is performance premium counted in the radiation-leave calculation?

Under Decision E.2021/12186, a regular premium or progress payment that is the consideration for personal labour may be averaged within the variable basic pay. Each social benefit or company income is not added automatically.

Does it matter that the hospital website shows "consultant physician" even though the public list does not?

The title used in promotion is not decisive on its own; however, together with the personnel card, corporate e-mail, work schedule and patient flow, it may support inclusion in the organisation.

If the leave form was signed, does the case end?

No. If automation, turnstile or report records prove actual work on the date shown as leave, the document is assessed together with the other evidence.

Does a doctor who resigned voluntarily have the right to claim radiation leave?

Under the former case law of the Court of Cassation, the form of termination is not decisive for the conversion of unused leave into money. The reason for termination is separately important for severance and other rights. The uncertainty of case law on the monetary fate of leave after 2023 remains.

If the labour case is won, are the past invoices automatically cancelled?

No. Labour law, SGK and tax consequences are corrected before different authorities and under different rules. A court decision is an important item of evidence, but accounting and tax procedures are carried out separately.

Is mediation enough for an SGK service determination?

No. Service determination is subject to special party and time rules. The possibility of a five-year preclusive period must be examined immediately.

Did the 4/a rule come into force on 1 June 2026?

No. Law No. 7557 was published and came into force on 24 July 2025. 1 June 2026 is the last date for a new application for work permits granted earlier. The two dates have different legal functions.

Does the ability to outsource radiology services make it lawful for the physician to invoice the company?

Not automatically. The service procurement under the Private Hospitals Regulation is an inter-institutional model subject to the conditions of a health institution holding a licence or activity permit, or an authorised contractor, documents submitted to the Directorate, electronic integration and joint responsibility. The personal labour of the physician within the hospital's organisation is assessed separately.

Must the transition to 4/a be accompanied by a protocol resetting seniority?

No. The legislation does not require a release or a reset of seniority protocol where employment continues. The legal effect of any document signed, in relation to TBK Article 420, actual continuity and actual payment, is examined separately.

Does a new probationary period in the new employment contract erase past work?

Not by itself. Where the physician continues in the same hospital doing the same work without interruption, a new heading or probation clause does not automatically change the nature of the earlier actual relationship.

Does a radiologist who reports CT remotely from home become entitled to radiation leave?

Reporting only from home or outside a controlled area is not actual work in a controlled area with an ionising radiation source. However, the labour status is tested separately; if the physician also takes part in device-based or interventional work, only those actual controlled-area hours are calculated.

Should the radiation claim be brought by the physician or by the physician's company?

As a rule the radiation leave is a personal labour right of the physician, so the physician is the claimant. The company may claim its own unpaid invoice receivable. The same amount cannot be recovered twice in two different capacities.

Is a physician paid by performance premium not paid overtime at all?

That conclusion cannot be drawn. In Court of Cassation decision E.2021/6818, because of the concrete progress-payment system, the non-increased part of overtime was held to have been paid and only the fifty per cent increase part was calculated. Each performance model is different; the contract and the payment formula are examined.

If the hospital owner company and the company that signed the contract with the physician are different, whom should I name as defendant?

The licence holder, the operator, the contracting party, the company that pays and the legal persons that give the actual instructions must be mapped. The parties to mediation and the action are determined on the basis of these facts; using only the hospital's brand may create a procedural risk.

Conclusion

Setting up a company and invoicing a hospital does not, by itself, change a physician's genuine working relationship. A physician who in past periods personally and dependently worked within the hospital's organisation may claim employee status together with seniority, pay, overtime and, where the conditions are met, a radiation-leave claim. Simulation, however, is not an assumed label in every file; it is a legal claim in which the difference between the apparent contract and the actual arrangement must be proved by evidence.

The 4/a rule under Article 12 of Law No. 1219 came into force on 24 July 2025; the period for renewing existing work permits ended on 1 June 2026. This change has fundamentally affected the company-invoice model in in-house medical practice. None of these dates automatically extinguishes past claims; but for continuing hybrid models they make the work-permit, SGK, actual-pay and tax dimensions more visible.

Radiation-leave status alone is not enough for a labour claim. Ionising source, controlled area and actual hours must each be proved separately. In the pay calculation, the invoice amount must not be grossed up uncritically: VAT, real company expenses, personal labour and regular premium must be separated. Until the owner of the claim, the real employer and the amounts already collected are determined, a claim formulated cannot avoid the risk of double recovery and standing.

Final legal principle: The correct file is built not from the question "Did the physician issue an invoice?", but from the joint answer to the questions: "In whose organisation, for whose patients, at a time set by whom, with what entrepreneurial risk, and with which ionising source did the physician provide the service?"

Confidentiality and legal notice

Contracts, invoices, company records, patient-procedure logs and health data shared with Güneş & Güneş Law Firm are assessed under the rules of professional legal secrecy, the duty of confidentiality and the protection of personal data. Patient data must not be sent through insecure channels, and evidence samples must be limited to the necessary fields and masked.

This article is for general legal information. It does not constitute legal advice or a guarantee of outcome unless the concrete working period, work permit, physician status, contract, device, controlled area and payment records have been examined.

Official, judicial and academic sources

• Law No. 7557 — full text of the Grand National Assembly of Türkiye
• Law No. 1219 — Ministry of Health
• Private Hospitals Regulation — full text of the Ministry of Health / Antalya Provincial Directorate of Health
• Regulation on Health Services Provided Using Ionising Radiation and Radionuclides, dated 13.04.2023
• Law No. 7589 — full text of the Grand National Assembly of Türkiye
• Court of Cassation 9th Civil Chamber, E.2020/5049, K.2021/5141
• Court of Cassation 9th Civil Chamber, E.2020/5953, K.2021/3837, 15.02.2021
• Court of Cassation 9th Civil Chamber, E.2021/12186, K.2022/528
• Court of Cassation 9th Civil Chamber, E.2024/8203, K.2024/11882
• Court of Cassation 9th Civil Chamber, E.2021/6818, K.2021/11272, 01.07.2021: overtime calculation of a physician paid by performance or progress payment, increase part; not concerned with radiation leave or the status of labour.
• Joint panel of the 12th and 10th Chambers of the Council of State, E.2023/3008, K.2025/2739
• Miraç Şamil Pekşen, “Radiation Leave from the Perspective of Labour Law” (İş Hukuku Boyutuyla Şua İzni), Çalışma ve Toplum, 2025/4, pp. 1913–1942.
• Özkan Bilgili, “Social Security of Physicians Working in Private Health Service Providers” (Özel Sağlık Hizmet Sunucularında Çalışan Hekimlerin Sigortalılığı), Sosyal Güvenlik Dergisi, 2021.
• Mehtap Yücel Bodur, “Physicians as an Example of Workers Subject to Article 4/1(b) of Law No. 5510” (5510 Sayılı Kanun m.4/1-b Bendine Tabi İşçi Örneği Olarak Hekimler), Legal İş Hukuku ve Sosyal Güvenlik Hukuku Dergisi, 2024.
• Ahmet Malik Cansunar and İbrahim Subaşı, “Employment of Physicians under the Appearance of Service Procurement in Private Hospitals” (Özel Hastanelerde Hizmet Satın Alımı Görünümü Altında Hekim Çalıştırılması), Euroasia Journal of Social Sciences & Humanities, Vol. 12, No. 7, February 2026, pp. 420–436, DOI: 10.5281/zenodo.18800735. The study is an academic analysis of apparent service procurement in terms of evasion of law and actual employment relationship; it is not binding case law.
• Samet Can Olgaç, “An General Assessment of Radiation Leave Claims in Labour Law in the Light of Court of Cassation Decisions” (İş Hukukunda Şua İzin Alacağı Üzerine Yargıtay Kararları Işığında Genel Bir Değerlendirme), TBB Dergisi, No. 117, 2015, pp. 333–358. A supplementary academic source for the former Regulation period.
• Istanbul Chamber of Physicians, “Information Note for Physicians Who Will Sign an Employment Contract” (İş Sözleşmesi İmzalayacak Hekimler İçin Bilgi Notu), 21.05.2026. A professional-body opinion on transition contracts and waiver provisions.
• Ankara Chamber of Physicians, “Information Note on Changes in the Working Pattern of Physicians Employed in Private Health Institutions” (Özel Sağlık Kuruluşlarında Çalışan Hekimlerin Çalışma Biçimindeki Değişikliklere İlişkin Bilgi Notu), 08.05.2026. A professional-body opinion on the risks of keeping a company open and of hybrid payment.

Source method: Legislation and full decision texts are the primary sources; academic articles are supplementary doctrine; chamber information notes have been used as current professional opinion. Texts on third-party decision websites have been compared with the uploaded decision samples and with the bibliographic details. No decision whose full text or legal scope could not be verified has been cited as a precedent in the article.