31st May 2023

Tackling 'healthcare drain': lessons from Eastern Europe

  • Between 2007 and 2013, 14,000 doctors left their jobs in the Romanian public health system to practise abroad. (Photo: Unsplash)
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For years, Romania topped all lists of staff shortages in the healthcare sector.

Since its official entry into the EU in 2007 (and until 2013), 14,000 doctors left their jobs in the national public health system to practise abroad. Around 21,000 nurses applied for recognition of their qualifications for the same reason.

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  • Over half of the Romanian physicians are concentrated in the big cities. (Photo: Unsplash)

Where to tackle the problem? In 2017, a survey among public healthcare personnel provided some clues to the Romanian authorities.

Seven out of ten doctors surveyed expressed their intention to leave the country. They cited low salaries, but also the workload and the poor equipment and infrastructure of domestic hospitals among the main reasons to emigrate.

In response, wages were increased the following year. The basic net salary of a primary care doctor was raised by 131 percent, and that of nurses by as much as 65 percent.

The move paid off. The ratio of doctors is now 346 doctors per 100,000 inhabitants, close to the European average, and a far cry from the 276 in 2015.

"[Five years later] It is not such a severe phenomenon, but still young physicians prefer to look for better opportunities abroad, and not because of revenues," executive president at the Center for Health Policies and Services Dana Farcasanu told EUobserver.

"The system lacks some important elements, like good working conditions, equipment resources, or the way they are perceived and treated by decision-makers," explained her colleague Mirela Mustata, who is also taking part in the EU project 'Action for Health and Equity — Addressing Medical Deserts' (AHEAD).

In addition, demographic trends are tightening the screws. In the next decade, approximately four out of ten doctors in the region will retire. If the profession does not become more attractive, there will be no replacement, and patients in Romania will suffer longer waiting times and poorer quality of care.

The figures tell their own story: there is a shortage of specialists, and also a lack of a better geographical distribution of health care staff.

"Over half of the physicians are concentrated in the big cities," Farcasanu stressed. Around 120 municipalities have no family doctors, according to the country's associations of general practitioners.

Romania's health minister himself, Alexandru Rafila, pointed out that the challenge of attracting doctors to so-called 'medical deserts' (areas with insufficient access to health services) is not just about providing them with an equipped office.

"We have to find solutions that address their families as well, which means access to education for the children of these families of doctors or nurses and, last but not least, a living standard that will allow them to practice without worries," he said during a meeting of the member states of the World Health Organization Europe Regional Office.

Romania has taken measures on working conditions, salaries and better equipment and structures, but to retain its talent, the country still needs to implement more focused measures to give value to the profession, offer training opportunities or improve the attractiveness and services of rural areas in need of these professionals, experts believe.

"There are some things money cannot buy," Mustata said.

Payments for 'extreme adverse working conditions'

At the bottom of the European statistics are now other Eastern European countries, such as Bulgaria or Latvia.

Their personnel problems sound similar to those of Romania: high stress, high workloads, low salaries, poor medical equipment.

Around 70 percent of new physicians graduating from university leave Bulgaria to practise abroad because of better economic conditions and the high cost they have to pay to obtain the necessary training to specialise, according to a reportby the European agency for the improvement of living and working conditions, Eurofound.

Bulgaria's response? Offer a monthly supplementary payment to family doctors calculated according to the 'extreme adverse conditions' they face. On average, this payment has been €240 per month and has reached 860 doctors each year from 2016 to 2021.

The Latvian measure is co-financed by European funds and offers a one-off payment to medical staff who relocate to areas where there is a lack of personnel (albeit with access to further payments if they relocate with family members).

In just two years, they managed to get more than 1,100 doctors to relocate to rural areas of the country, and around 180 emergency medical professionals.

However, as the Eurofound analysis notes, this is only about half the targeted number, and other measures also contributed to achieving these results.

The results of these measures are positive, and may help other European countries to tackle this shared problem, but there are still barriers that prevent them from having the desired impact.

The European agency lists some of them: complex bureaucratic procedures, poor infrastructure, extensive workload or lack of professional development.

Despite the challenges and barriers, Farcasanu is positive about the future. She believes that the pandemic has opened up an opportunity for these countries that could make a difference in the healthcare sector: European recovery funds, which could be translated into more infrastructure, equipment and, above all, investment in people.

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