When Imre Varju graduated from Hungary’s Semmelweis University in 2011 and qualified as a medical doctor, his starting salary would have been the equivalent of about €300 a month, a pittance after six years of study. Dr Varju chose to pursue a PhD, while almost half his classmates emigrated, mostly to Germany and Austria.
“They are now only a 10-hour car drive or a two-hour plane ride away, and they can earn up to eight times as much . . . with a huge difference in the quality of life they can have for themselves,” said Dr Varju, now a lecturer at Semmelweis.
As a second wave of the coronavirus pandemic sweeps through central Europe many in the region fear that the lack of medical staff — the result of years of underfunding and emigration — will add to pressure on already strained health services.
Milan Kubek, head of the Czech Medical Chamber, last week appealed to Czech doctors working abroad to return home to help the country cope with a surge in cases. Meanwhile, Hungary has approved a significant pay increase for doctors.
Staffing problems could be even more critical than equipment shortages. In the first months of the pandemic, the Hungarian government ordered 16,000 ventilators, said Peter Almos, vice-president of the Hungarian Chamber of Doctors. However, with only 2,000 intensive care unit doctors and the same number of nurses, it does not have enough staff to operate them.
“Ventilators you can buy easily with money, but doctors you can’t,” he said.
For decades, medical staff have been leaving central Europe in droves, an exodus made easier after 2004 when ten central and eastern Europe countries joined the EU. In Hungary for instance, about 1,200 new doctors qualify each year. But 900 emigrated in 2018, the most recent year for which there are statistics.
In Slovakia, according to President Zuzana Caputova, the shortages have been compounded by the fact that many of the country’s doctors are in an age range that makes them vulnerable to Covid-19 themselves.
The Czech Republic has similar problems. Mr Kubek said on Thursday that, on current trends, the number of infected medical workers could rise from 5,500 to 40,000 within a month.
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“That would be a disaster that would really mean a collapse for healthcare,” he told the Czech website IDNES.CZ.
But Mr Almos said the problem in Hungary was that doctors in their 40s and 50s, who had the most experience and could train their colleagues, were missing. “They leave the country and don’t come back,” he said. Those left behind are newly qualified and older doctors.
Many of those emigrating complain about the low salaries and poor working conditions at home.
“At the moment resident doctors make €3 per hour after taxes, or €6 as a specialist,” said Mr Almos. “If you work in Tesco [in Hungary] as a cashier you can earn more.”
According to Eurostat data, Poland has the lowest number of practising physicians per capita in the EU, with 238 per 100,000 inhabitants, while Romania has 304, Hungary 338 and Slovakia 352. By way of comparison, Austria has 524 and Germany 431.
Filip, an anaesthetist who moved from Poland to the German city of Dortmund with his wife, who is also a doctor, said they decided to make the switch after working in a German hospital during their studies.
“The more time we spent in hospitals [in Poland] the more we saw how badly they functioned, how unhappy doctors were. Then we did a three-months Erasmus internship in a German hospital and we saw how big the difference was, most of all in the organisation of work. [In Germany] the doctor deals with medical procedures, much less with bureaucracy and paperwork,” he said.
Romania has lost one-third of its home-trained doctors, according to the OECD. Clotilde Armand, a French-born Romanian MEP, said the emigration was a loss for medical services but also a lost investment — on average, it costs €100,000 to train a doctor in the region. Ms Armand calls for a Medical Works Compensation Fund into which countries that heavily recruit medical professionals could pay.
“In eastern Europe everybody wants free circulation of people — they suffered so much [under the closed borders of communism],” she said.
“But we as responsible politicians have to understand the economics behind it.”
Hungary is trying to remedy the shortage with pay increases. The country’s parliament adopted a law raising doctors’ salaries by as much as 120 per cent, the biggest increase since 1990.
The new salaries, which will put wages at about half of what an equivalent doctor in Austria would earn, were approved alongside other reforms, including a ban on accepting extra cash from patients.
Mr Almos said the rise was in line with his organisation’s demands, but he warned that some of the other conditions in the law could worsen the brain drain. Many doctors hold down multiple jobs to support themselves, and a new condition would require approval to do so — even in an unrelated field — from a government body. By far the most worrisome was a contentious clause legalising mandatory relocation to any hospital in Hungary for up to two years.
“If the law would state that you can be ordered in case of medical emergency, that’s one thing . . . but it seems that the chronic shortage of doctors would be treated this way, which is unacceptable and doctors will leave,” said Mr Almos.
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