Several actors in the health field are looking for solutions to attract doctors to underserved areas. In this sense, the Medical Association for Romania, together with the WHO and the Ministry of Health, visited seven hospitals in the country in July. They found that wages are not the reason why young people do not want to work in the country’s smaller hospitals.
As part of the project “Support initiatives for medical personnel”, part of the National Program for Recovery and Resilience, seven hospitals in the country were visited. During these visits, discussions were held with doctors, managers and representatives of local public authorities.
“Discussions focused on best practice models for recruiting and retaining medical staff in underserved areas. The visits were carried out in health facilities in the counties of Brasov, Timiş, Argeş, Iasi and Călăraşi. During these meetings, the dialogue was initiated with hospital managers, teachers, doctors from different specialties, as well as residents, medical assistants and representatives of the town hall. The purpose of the interviews was to identify successful solutions in attracting and retaining medical personnel, the opportunity for extrapolation at the national level, the feasibility of adapting and adopting international best practice models, as well as reasons why resident doctors would consider or reject offers of work in underserved, rural or non-academic areasă”, it is stated in the press release of the Medici Association for Romania.
The project visits revealed the willingness of doctors to practice in small and underserved communities, especially in their home areas. Personal and professional support is essential in doctors’ decision to work in hospitals outside of university centers, the release states.
The Association of Doctors for Romania will distribute a questionnaire through the Ministry of Health to collect the opinions of resident doctors, and a workshop will be organized in September to discuss the recommendations. Legislative changes will be proposed by the end of 2024 to support doctors to practice in small and underserved communities.
“It is a project with potential, but it itself needs help from other entities in the system, from civil society and from other structures in the administration, so that it can look at the problem completely as a whole. But it is a step forward and there is still an entity working towards solving the problem. Furthermore, it remains to be seen how this initiative will materialize.“, said Dr. Vrîcianu Rareș, president of the Multidisciplinary Society of Resident Doctors, for “Adevărul”.
Why don’t doctors want to work in the province
At the moment, no concrete solutions have been found to attract doctors to work in smaller towns in the country. According to the Medical Association for Romania, contacted by “The Truth”at the moment things are focused on identifying the shortcomings of the medical staff in these hospitals.
“We are currently in the process of collecting information. We have made seven visits, we have a few more to do until August 10th. And after we serialize the information we will work on a series of proposals. In the first phase, we will present the situation, what are the problems and what we have identified, and only later will we come up with a series of proposals.“, said Alexandru Costache, president of the “Doctors for Romania” association
Among the problems that doctors working in underserved areas have communicated are the poor infrastructure of the health system, problems in the education system, but also the difficulty for other family members to find a job.
“The doctor who goes to an underserved area, has to have a school, has to have the husband, wife or whoever goes there with a job as well. There are many elements to consider, it is a complex problem, the right ones, which not only Romania faces. The perspective of professional development is an extremely important aspect. Because if you go to an underserved area, the case study is automatically simpler, and the development perspective is not as great as in a university center“, explained Alexandru Costache.
While money is no longer the reason why such positions are refused, malpractice policies, as well as shortages in hospitals, are driving doctors away from the country’s provincial areas.
“The financial part is no longer a problem. Doctors at the moment have reached a financial comfort. Maybe not like in the western countries, but the living and costs in the western countries are not the same either. Other problems relate to infrastructure in hospitals, i.e. the endowment part. This is a problem that is being solved, because we have this PNRR, through which we hope that in the next 4-5 years hospitals will look completely different. The malpractice policy is another subject that I have noticed, it is one that does not cover them much for malpractice and as a result they practice defensive medicine, being very afraid to make a diagnosis or make certain medical decisions, precisely in the idea of not being held accountable later.“, emphasizes the representative of the organization.
A family problem
And Cezar Irimia, the President of the Federation of Associations of Cancer Patients warns that many doctors are concentrated in large university centers, and their distribution is not uniform.
“Young families leave our country, not only doctors, with children, not for financial satisfaction, but to ensure their children access to a correct health system and a correct education system for their future. The problems are much deeper. It’s not that a doctor doesn’t like the salary in a smaller town, that he might have a higher salary than in a university town. That’s not the problem. The problem is the family. How does the young doctor ensure his family a harmonious development with access to education and health for his family.“, Cezar Irimia transmitted for “Adevărul”.
A study carried out by the Romanian College of Physicians reveals that 57% of young doctors, under 35, intend to emigrate. The main reason is not the salary, but the working conditions. Residents complain about the lack of equipment and treatments needed to care for patients in hospitals. Things are also confirmed by the patient representative.
“These professional developments cannot be followed in Romania. Any doctor who has gone through six years of college, five years of residency, wants to progress, wants to have professional satisfaction. With what? Access to zero investigation. Access to zero medication. So the problems are complex and multiple, it’s not just that they don’t have money, there is money, there are good salaries for Romania these days. What doesn’t work is this country, the health system doesn’t work, the educational system doesn’t work and I don’t know if anything works in this country, the perspective of young people is close to zero in Romania.“, points out Cezar Irimia.
Consequences for patients
Both patients and doctors working in hospitals in big cities bear the consequences. The Guard Rooms of the medical units in the urban centers are crowded at all hours of the day and night.
When you don’t have a doctor for a certain specialty, “you automatically go to a big city and crowd that hospital”.
“The staff, even in the big hospitals, is not enough. Capacity is undersized. It affects us primarily through the quality of services, automatically, when a doctor is overworked, it is natural for the quality level of the medical act to decrease“, says Alexandru Costache.
Moreover, Cezar Irimia brings up the lack of more than 1,500 family doctors in the system, both from rural and urban areas.
“Patients in these areas only call 112 and crowd the emergency receptions of the nearest hospital, the medical staff can no longer save a life in that UPU center, because it is very busy with various minor problems that they could have solved the family doctor. No one cares about getting the right healthcare. Our policy makers have not relied on family medicine which is the foundation of any responsible health care system. In Romania, the family doctor is ridiculed, he is marginalized, he is the Păun Mite in the current system. This is where we have to start, this is where all the trouble comes from, a small lump of inadequacy will become a major avalanche that will cover us all“, draws attention to Cezar Irimia.
This issue should be resolved, especially as many GPs are due to retire.
“A family doctor should be the gateway to the health system, and not as they were called peirotaiv in a discussion «trimitologists». GPs’ responsibilities, indeed, should be greater, not just referring. It should be resolved somehow in the sense that family medicine becomes more attractive to new doctors.“, declared the president of the Medici association for Romania.
What to do
Meanwhile, the president of CNAS, Dr. Valeria Herdea, recently criticized the weak involvement of local authorities in supporting the medical system, stressing that this lack of involvement contributes to the depopulation of the system. Valeria Herdea mentioned that local administrations must provide decent conditions, including equipment and equipment, to attract and retain doctors.
She exemplified the situation in Suceava county, where four localities on the border with Ukraine face a lack of specialists. In Tulcea county, however, almost complete coverage with family doctors was achieved. In order to attract medical personnel to rural areas, increases of up to 200% are granted, the CNAS president mentioned.
“We have 52.5% of the population in the city and the rest is in the rural area. I would like to talk about places where there is water, where there is electricity, where there is a road that does not slide or houses that do not slide. And I want average staff, alongside the doctor, whom he can pay, because otherwise there is no one left. (…) We make every effort to bring young people, to motivate them, we got in touch and we have ongoing partnership projects with the universities of pharmacy and medicine in the country, so that they are included in the curricular training, in the specialization of these young doctors, including a short internship in the country, so that they can see what the rural area means. During this period, we are trying to supplement people’s access to medical services in areas where there is no easy access.“, the president of CNAS sent.
Dr. Vrîncianu Rareș says that complex solutions are needed, but also cooperation between the state authorities for the problem to be solved, although he welcomes the initiative launched by the Medici organization for Romania.
“The problems are well-known, let me say that they are not necessarily very quantified. We also want to do a larger study, but not to identify problems, but to see their magnitude. In my opinion, the shortage of doctors is part of a larger phenomenon of the depopulation of those areas. In the short term, there are ways to correct this deficit by equipping hospitals to provide a better working environment, or by providing financial incentives or support. Another solution would be to increase the number of positions at the residency. But in the medium and long term, we need solutions aimed at time, unfortunately for several areas, several ministries and the local administration are involved, because the city and the region itself must become more attractive, through a uniform economic and social development . The doctor finishes his work at the hospital, but afterwards he keeps going out into society, he keeps going out in that city, in that area that is not very developed and does not have many possibilities.”, says the representative of resident doctors.
Cezar Irimia believes that we should develop “systems that work“. Otherwise, “ne young people will leave on their heads and not only doctors. They will leave because they want to develop professionally, they want to provide their families with access to education and health, they want a life that is not enriched, a life on the edge of normality. Today’s Romania no longer offers these minimum natural guarantees after all“, concludes the patient representative.
