The doctor, a luxury for half of the Romanians

Romania has an acute shortage of family doctors, and from one year to the next the situation becomes even worse: according to the latest data, over 50% of the rural areas do not have access to medical services. Under these conditions, many people living in the village sometimes travel tens of kilometers to the nearest town where they receive a diagnosis and treatment.

The coordinator of the Mother and Child Health program within Save the Children, Silvia Burcea, sounded the alarm about family doctors working in rural areas. According to her, 53% of rural areas do not have a family doctor or have insufficient doctors. Also in rural areas there are situations when a family doctor has even 10,000 patients on his list.

Most family medicine practices are located in rural areas. It is an interesting statistic from the INS that shows us that a family doctor's office in rural areas serves more than 10,000 people, while in urban areas, 13 offices serve 10,000 people“, stated Silvia Burcea, in a televised statement.

Village doctors, retired workers

The inhabitants of Bățani commune, Covasna county, a commune where almost 5,000 souls live, also face such a situation. Until 4 years ago, two family doctors worked here. In 2020, one of them, who was well past retirement age, retired. He was 74 years old when the COVID pandemic broke out and did not want to risk his health. It was the moment when thousands of inhabitants of the commune flocked to the list of the only doctor left: Dr. Matei Cătălina, now 71 years old. “She is retired, but still active, taking care of thousands of patients, she couldn't leave them“, the town's mayor, Simon Andras, told “Adevărul”. But, says the mayor, the doctor recently informed him that this year he will also hang up his coat.

We don't know what we will do then. Over time, we kept trying to attract doctors to the commune, but without success. Not one of them stayed with us, although we offered them accommodation in a three-room apartment furnished and equipped with modern equipment, we provided them with two offices equipped with everything they need. Some, as they came, so they left, and others only promised us. And I was left with only a promisei”, the mayor confessed to us bitterly. “The last case… a doctor who should have come from Tulcea and who has been taking us with sugar since September“, he complained. And because a shortcoming never comes alone, for half a year the commune he shepherds has also been without a dentist.

Today, the only doctor in the commune, Dr. Cătălina Matei, works for two. It cares for nearly 2,000 patients, mostly the elderly and children. The doctor, who has lived in the locality for 30 years, works eight hours a day, and when he gets home he starts all over again. “In the evening, I validate the day's consultations in the platform“, he told for “Adevărul”.

It is about the consultations that cannot be validated in the office because the computer platform does not work as it should. This morning, for example, I woke up at six o'clock and did the reporting for March because that's when the schedule went“, the doctor also told us.

Why did he remain a doctor in the village even after retirement age? “Of my 40 years of experience, 30 have worked here. When I reached retirement age I realized I couldn't quit. I still had power, I liked it, I live in the commune, it was not the time to say stop“. And when the pandemic came, even more so he could not leave his patients.

I know whole families from grandparents, children and grandchildren. Can you imagine how to leave an entire commune in the midst of Covid without a doctor? Let me go too. It was very convenient to withdraw then. But what were we doing with people? They were my patients!”, Dr. Cătălina Matei told us.

The doctor could not have been replaced, because new people hardly come to the village. “Doctors run away from work in the village, seek to work in cities, and many go abroad. Maybe something should be done about it. Let's keep our doctors in the country, let them be supported by the state, motivated to work in the countryside, attracted here. Maybe a higher salary, maybe better working conditions“.

It doesn't matter where your office is if you want to do your job

Dr. Mihai Mara lives in Cluj Napoca, and commutes daily to the office in Ceanu Mare. “I do 40 kilometers one way, 40 kilometers back. The journey, all in all, takes me about 90 minutes. But it's good that I have a car. 10 years ago we didn't have it and it was very difficult“, says the doctor. Why did he choose the office in the village? “That's how was ment to be. Initially, I searched in the city, in Cluj“, he says. But, because the prices were high in the city and he couldn't find something that suited him, the doctor chose to go 40 kilometers away. And now, if he could, he wouldn't leave there. “I have about 1,300 patients on the list and I couldn't give them up to start over in the city. I like the country. I'm used to it. It's quiet, people are respectful, they listen to me, I get along well with them. I wouldn't leave here. The commune is big, it's beautiful. It seems you are more peaceful working in the country than in the city“, the doctor confessed.

Why don't we have enough family doctors in the villages? For several reasons, the specialists we spoke to told us. First of all, it is a reality that many retired, and there was no one to replace them. “The existing ones have become fewer and fewer, and young people want to open offices in big cities“, is the opinion of Dr. Cătălina Matei. Dr. Mihai Mara completed the idea by explaining that “it is much more convenient to work close to home, family, friends and relatives. You went to college in the city, you did your residency there, you're young and you want to stay in the city. That's six years of college plus four more of residency in family medicine. It's 10 years of being in the university center and then it's like you want to stay there. You have become accustomed to a certain lifestyle. It's hard to give it up“, he said.

Then, continues Dr. Mara, family medicine is the Cinderella of specializations that students follow in college. Therefore, it is not very crowded. “The first and last internship that students go through in college is family medicine. And no one wanted her. Because whoever was teaching was not teaching properly… We were going to internships in hospitals and everyone presented family medicine as a job for secretaries, the last specialization in the system. And when I did the family medicine module in year 6, it wasn't who knows what. I had already gone through all the departments..after you saw how she is in surgery, cardiology, orthopedics..and you don't find her so interesting, so attractive” is the opinion of Dr. Mihai Mara.

What solutions would there be for young family doctors to open practices in rural areas? The mayor of Bățani comes up with two proposals:May it be possible that all the years of RESIDENCY it can be done even in a family doctor's office, and then the apprentice can take the master's place. And there should be an obligation for family doctors to work for the first three years in the country”.

The Salvaţi Copiii representative believes that, indeed, the Romanian state should get more involved in order to attract young doctors to the villages.