The mortality rate among children in the village is 30% higher than that recorded in the city. And the main cause is the chronic lack of family doctors and outpatient specialists. This is the conclusion reached by the specialists of Salvații Copiii Romania who brought doctors and health policy experts to the same table during a debate.
Dozens of villages and communes in Romania do not have a family doctor. Source: archive
One of the causes of high infant mortality in the village is the extremely small number of family doctors working in the rural area. They are 51% less than in the urban environment. On the one hand. On the other hand, we are not doing very well when it comes to money for health either, as per capita spending is less than half of the European Union average, according to Eurostat data. Moreover, according to Save the Children data, despite the increase in the health workforce over the last decade, the number of specialist doctors and nurses has also fallen dramatically.
Valeria Herdea, president of CNAS, admitted that “there are many problems related to human and material resource. Almost 20% of family doctors are over 70 years old. We need 1,530 family doctors needed throughout the country, of which 1,222 are in rural areas”. Who replaces these people after they retire? Who comes from behind? A young generation that doesn’t really exist anymore. Because, although year after year medical faculties produce graduates on the conveyor belt, although year after year there are residents who finish their training and could practice, they are not evenly distributed throughout the country, there is no balance between villages and cities. “Doctors prefer to go to urban areas and open their offices there. Unfortunately, this situation is generally valid, despite the efforts that the public administration sometimes makes”, Valeria Herdea described the gloomy situation in which we find ourselves.
Why don’t doctors want to go to the village? Valeria Herdea: “They don’t have good working conditions”
The rural environment is unattractive from several points of view, the doctor believes. “We need 1,530 family doctors across the country. Of these, 1,122 should practice in rural areas. But people want access to education for their children, they want a stable community and independence from the local administration in the community”. Among the most remote counties from this point of view, without a family doctor and without family medicine offices, are Alba county, with 11 localities, Arad county, with 10 localities, Bacau county, with eight localities. We have, in the same situation, Bistrita. “Here, at one point, there were almost 40,000 people without a family doctor”the head of CNAS also specified.
Another reason for the lack of family doctors in the village would be the underpopulation of certain areas. There are towns far and wide from cities, lost among hills and mountains, far from any trace of civilization. No water, no electricity, no infrastructure. Isolated. “There are also situations where we have doctors and offices, but the number of residents in those areas is very small. And then, two, three, five such localities unite and return to the care of a single doctor. In Botoșani, for example, one family doctor serves nine localities. In Caraș-Severin county there are 18 localities with one doctor”, Herdea also specified.
Then, without medical assistance, without nurses, without the community assistant, you cannot cope. Or all this means financing. “The family doctor can be an impeccable manager, but he needs human resources that, in turn, are properly paid to stay in the rural area.”
Why are our doctors leaving the country? “Not just because of the money”
Sandra Alexiu, president of the Bucharest-Ilfov Association of Family Physicians, stated that “we started with 14,000 family doctors and reached 9,200 in total in Romania. The deficit can also be seen in the cities”. Why are we talking about a deficit? Because, explains Sandra Alexiu, many doctors left to practice abroad, some left the countryside for the city, some retired from the activity. “It’s clear that those who stayed have more work to do because they have to take over the patients of those who left for various reasons.”
Sandra Alexiu believes that in the rural area, contrary to what is circulated in the medical space, very well trained specialists should arrive. “Seeing what kind of pathologies there are, what level of medical education of patients there is, I honestly tell you that the best doctors, the most trained, should be sent there.”
But these people must be motivated to come and work here. And the local authorities must understand that these doctors are basically stolen from us by countries like France, Italy, Germany who know how to motivate them. “They don’t leave Romania because they don’t have enough money. This is also one of the reasons, but they leave because they have nowhere to carry out their activity, they have nowhere to live, they have nowhere to learn, to improve themselves. Medicine is not done with what we learned 30 years ago”, transmitted dr. Sandra Alexiu.
Hospital overcrowding requires more money from the budget
Family doctors are the gateway to specialist care and provide primary care, mainly in individual offices contracted by county health insurance companies. For complex services, they can only issue a referral and are not allowed to provide the treatment themselves, according to Save the Children representatives. It’s why patients want to skip this time-consuming step and seek care directly at the hospital, even for non-urgent conditions. “Accordingly, almost half of the funding for health in Romania is intended for hospital care. Avoidance of primary care is partly the result of patient preference, but also the limited availability of family doctors, especially in rural areas” completed the idea Gabriela Alexandrescu, president of Save the Children Romania.
Solutions
In 2023, the infant mortality rate in rural areas was 6.9 per thousand live births, above the national average of 5.8 per thousand. Pediatrician Mihai Craiu stated that there would be solutions to save these lives if they wanted to. “It is clear that we will not have more GPs overnight. The residency lasts four years. And we will continue to export doctors. Macron even thanked the Romanian doctors working in France”, he stated during the meeting. What could be done under these conditions? “We could look at what others are doing who also have long distances to high performing hospitals. The American model for example. The Americans proposed telemedicine”. In Romania, the doctor believes, there are mobile phones even in the most remote villages. “So it would not be an impossible solution to implement after all”.
