The Health Ministry introduced new specialization rules at the beginning of this year, according to which each clinic is required to conclude an employment contract with the physicians who will work alongside specializing. The aim is to put an end to the free labor of young doctors.
The problem is that most young doctors cannot specialize under the new rules this year, because hospitals have no money with which to pay them salaries. There are no new funds for the recruitment of young doctors and fewer openings are announced for specializing doctors than previous years.
A major problem of the new graduating doctors is the few openings in university hospitals in the country, and there are specialties in those hospitals for which no openings have been announced.
The total number of pediatricians in Bulgaria is 1401. A single pediatrician treats an average of 688 children. Children’s gastroenterologists, however, are a total of 9 specialists for the whole country. There are very few children’s nephrologists and oncologists, but still the medical institutions which will launch a specialization in pediatrics are few and far between. In addition, the appointed according to the new regulation specializing doctors in some hospitals are forced to sign contracts that bind them to remain in the hospital 4-5 years after receiving a specialty. If in this period they decide to leave, they are obliged to return all salaries received over the years.
The regulation also posits some questions that give rise to confusion and uncertainty among specializing doctors in the so-called “specializing doctors status quo”. Most of them want to undergo training according to the new regulation for specializing doctors. Hospitals, however, are not motivated to employ them and for a significant part of them medicine continues to be an expensive hobby – they pay a monthly fee of BGN 180 to work. It is this fee that is one of the main problems among specializing doctors. Most work is at the expense of young doctors, who except working in hospitals often work in another 1-2 places. The reason for this is the low pay and the pursuit of higher incomes. And since quite a lot of them do not receive income from work in clinics, but pay (BGN 180 per month) to treat patients in Bulgaria, this forces them to earn a living by putting in extra work, sometimes unrelated to medicine.
According to Health Ministry’s records hospitals announced 2820 openings for specializing doctors last year, but the actually employed people were 814. The reason was that most of the openings are paid. Among those, the state funded 409 positions, and the major specialties were not sought after by young doctors. For the other openings doctors had to seek education funds on their own, and even for pay for their own work. This year the state will be paying the fee for 415specilizing doctors, but not their salaries. Physicians’ salaries will have to be paid by the hospitals.
Although dozens of young doctors have already begun work under the new Regulation on Specializations, there remain few openings, announced by the largest university hospitals in the country. Many future doctors are considering the question of whether to stay in Bulgaria at all.