The Ministry of Health has recently launched a good practice guide, suggesting to hospital administrators what measures could adopt to alleviate the labor deficit. Many hospitals have been left without guard for certain specialties due to the exodus of doctors.
Well -equipped hospitals, even from small cities, could become attractive photo: Shutterstock
The crisis of doctors is a major problem in many hospitals, leading to the suspension of the guard lines and even to the closing of some sections. The biggest problems have the hospitals in the small localities, bypassed by the highly qualified workforce for the most diverse reasons. Including these reasons were studied by representatives of the Ministry of Health, mentioning them in the guide and suggesting solutions to be overcome.
Why do the doctors leave
The Ministry of Health speaks not about a crisis of medical staff, but of a “defective geographical distribution”, especially in non-university rural and urban areas. “This deficit affects access to quality health care and creates disappearances regarding health results. Although notable improvements have been registered in recent years, the density of doctors, nurses and other health professionals are still below the WHO media for the European region and EU 27, the small communities being the most affected. ”mentions the guide.
Why do doctors bypass small hospitals? Have limited career advancement opportunities in smaller cities. They also have difficulty securing a home, sometimes they are dissatisfied with the options they have for children’s education or the job opportunities for their partner. On the other hand, small hospitals have insufficient medical equipment and technologies. All these difficulties, the Ministry of Health suggests, can be more easily overwhelmed if the local administrations, subordinated to which many of the hospitals are more involved than they do. The financial resource is most often a barrier for county mayors and councils, the national and European funding programs being an opportunity during this period.
20% of the total doctors are in Bucharest
Between the counties of the country there are big differences when it comes to the number of doctors per 100,000 inhabitants. According to the data from 2020, the number varies between 120/100,000 inhabitants and 897/100,000, being the counties that have university clinics and even the countless counties. “Only in the municipality of Bucharest there are 20% of the total doctors in the country, although only about 9% of the country’s population has a residence in Bucharest. On the other hand, 328 administrative-territorial units in the rural area have no family doctor”is shown in the guide. This is the overcrowding of the emergency system and the increase of waiting time, but also on long roads that patients do to hospitals away from home. In parallel, the medical staff in these disadvantaged regions are difficult to face the extremely large volume, increasing the risk of medical and burnout errors, warns the ministry.
What can local authorities do
Local authorities can contribute to the “depressurization” of the hospital system confronted with insufficient human resources and large number of patients first by creating variants for prepitalic services: multifunctional health centers, permanence centers, medical and dental services for the disadvantaged categories, day centers for the patients, the centers of the Paliative, Prevention and Health Education Services.
The well -developed infrastructure in the educational units could also decrease from the number of patients who arrive at the hospital.
Also the local authorities have the opportunity to legally support hospitals. This happens, but with considerable differences between regions.
In 2023, it is shown in the guide, the total current expenses with the health funded by UATs were only 638 million lei, which represents below 0.65% of the total health expenses with the national level. Of the 378 public hospitals, less than half (178) received money from the local authorities and only 59 of them received more than 1 million lei. The average of the allocations is around 550,000 lei. Bucharest, Timiș, Iași, Bacău and Prahova had the biggest allocations, while in Ialomița, Călărași, Sibiu or Mehedinti the allocations were below 300,000 lei, confirming that all the university hospitals remain the best financed.
Apart from financing the current expenses, local authorities can also support the investment projects of the hospitals. In 2024, the total of the current investments and expenses supported from the funds of the local authorities amounted to 1.2 billion lei. In addition to transfers to hospitals, all local authorities have supported investments of 1.79 billion lei.
What a walk
The crisis of doctors in small hospitals is not a problem that has arisen now, but dates for decades. The residency on the post is one of the measures designed by the authorities since 2008, which had no expected result. The young doctors could be hired for an indefinite period, after passing the residency exam, in a hospital that faced with the deficit of doctors, followed by the training program in a university center. At the end of the training period they were committed to return to the post. This happened in too few cases for the method to be considered a success, and this is because there are no negative consequences as a result of the contract violation. Neither the substantial growth of the revenues of doctors and assistants, throughout the state system, starting in 2018, has not been able to solve the problem of small hospitals, even though a stagnation was observed in the exodus to the hospitals abroad. The density of 374 doctors per 100,000 inhabitants remains below the European average of 410 doctors/100,000 inhabitants. Doctors remain in university centers and rarely choose small hospitals, although local authorities have thought of additional financial incentives.
The Medici Association for Romania and the representatives of WHO made in July 2024 field visits to find out what are the obstacles in ensuring the appropriate human resource, but also how the few small hospitals have succeeded that have become models of good practices.
Methods that have proven their efficiency
Among the methods of recruitment that have proven their efficiency are some adopted in recent years and taken from one hospital to another. Some hospitals have been authorized and offer residents the possibility to work in hospitals during the residency, hospitals thus becoming training providers. The hospital thus covers the need for labor, and the resident has a diverse case and coordinating doctors. The collaboration with the universities of medicine and pharmacy in order to set up “satellites” in small cities is another way to form, at least for part of the academic road, on the doctors in the hospital. Such “extensions” of the universities of medicine are, for example, in Ploiești and Bistrița.
Another way to ensure their human resource is the collaboration between local authorities and universities by supporting young people from small localities, to take courses in the university centers, to be professing after graduation in the locality.
Competitions open to residents of the last year are another attempt that has given fruit.
Moreover, it was passed to promote several positions, from different specialties, at the same time, to encourage the formation of interdisciplinary teams. The ministry also speaks in the guide mentioned and about the active promotion regarding the stimulants offered that hospitals are encouraged to do in universities and even the recruitment of staff on the faculty banks.
Through participation in events in universities and by recruitment ads in mass information media has been able to attract doctors at the Bistrița Hospital. Buhuși Hospital, on the other hand, has been authorized to carry out residency programs in the specialties anesthesia and intensive care and internal medicine and infectious diseases, “being one of the few hospitals in Romania, except those in the university centers, which use this opportunity”. In Satu Mare county, the representatives of the ministry in the guide also mention, when there were employment opportunities, it appealed directly to the Timișoara University Center, and after occupying the position the management of the hospital maintained the collaboration, making efforts to take over the practice standards in the university center.
The financial support of doctors to participate in scientific events is another measure that attracts, as well as partnership with universities or online platforms for courses in requested specialties. Supporting the staff to take skills of skills, the settlement of transport, ensuring access to the equipment, supporting various initiatives were other ways to attract the workforce.
Encouraging doctors who want to get involved in mentoring activities, supporting the internships for students during the summer are also ways to make the working environment.
Above all, the offering of bonuses and wage incentives, over the basic salary, has also proved effective, as measures such as offering subsidized housing or settlement of transport expenses. The Vâlcea County Council has purchased 17 apartments that will make available to the doctors who are employed at the hospital in Râmnicu-Vâlcea. Oltenița Municipal Hospital, on the other hand, offers an incentive of 1,000 lei/month/doctor who performs a minimum number of six guards. Făgăraș Municipal Hospital offers rent subsidies (up to 1,539 lei/month) and support for transport expenses.
Ploiești Pediatric Hospital, on the other hand, implements a payment model according to performance. All are practices inspired by the experience of other countries.
The doctors who form in the university hospitals, where they have the opportunity to work with modern equipment, will also be interested in equipping the hospital that “courts” them, therefore the equipment that benefits the health unit is an important criterion when choosing to take the step.
