Archive for the ‘Discussion Board Archive’ Category

INTERVIEW: Dr C.M., Anesthetist – France

Thursday, August 10th, 2017

Dr C.M., Anesthetist – France

I have been practicing for more than 6 months in a Public Hospital in Lorraine, in France and I’m very satisfied with my situation.

I have been well-received from the very first moment by the Management, by the Head of Anesthesiology Department and by the whole team, so my integration went well. The Hospital offered me a flat during 6 months with a very low rent, which also helped me a lot at the beginning.

After my first visit at the Hospital everything went quickly and smoothly: 2 months after that the College of Doctors in France registered me and I started to practice with a Contractual Practitioner status.

I really love my new professional environment and I would like to thank You hereby that You’ve allowed me to join such a great team.

Dr C.M., Anesthetist

INTERVIEW: Dr. Laurentiu Iosif

Friday, March 3rd, 2017


Dr. Laurentiu Iosif is a young doctor with whom we collaborated to find a job in Germany.
After he worked 5 years as Resident Doctor in a hospital from NRW which we proposed to him, the time has come for him to pass the specialist exam in Internal Medicine.
Because we believe that his story is of interest for the medical community, we decided to publish the interview with Mr. Iosif.

VLAD SARCA (EGV): How did you find out about the structure of the specialist exam?
LAURENŢIU IOSIF : On the following page- – I read about other colleague’s experiences. This page contains a lot of resources, it helped me so much. Beside this I looked for advice from acquainted doctors.
VLAD SARCA (EGV): How often does the exam takes place?
LAURENŢIU IOSIF:  In NRW it takes place frequently, at least once a month.
VLAD SARCA (EGV): How can one establish the appointment for the exam?

LAURENŢIU IOSIF:  A doctor can register up to one month prior reaching the minimum time to execute the residency, which in the case of Internal Medicine is 60 months. On the other hand, the exam file folder must be complete and procedures from Logbook (Logbuch) must be performed and this performance certified by the Heads of Department.
I want to say that people from the College of Doctors are very careful regarding submitted documents and it happened to ask for additions from me.
Also, once they get the documents and as they are certain that these are complete, they automatically plan the exam, in my case it was July 9, 2016 and I was announced a few weeks before.
What I recommend to my colleagues is to be well prepared for the exam once they submit their documents, because the exam date can be changed only if there are founded reasons.

VLAD SARCA (EGV): What about the exam?

LAURENŢIU IOSIF:  It lasted one hour and we were two candidates. Each of us had 30 minutes available and I watched the examination of my classmate who also took the exam.
It’s an oral examination and there are three people in the committee including two teachers and an exponent from The College of Doctors.

The decision is taken by the three of them and each one votes for or against obtaining the specialization.At the beginning they asked me general questions, and then the questions became more concrete focusing on the details.

VLAD SARCA (EGV): Do you believe that there are other factors influencing the specialist exam?
LAURENŢIU IOSIF:  I think that it is a plus if the commission or members of the committee know the head of department where the candidate worked during the residency or if they worked together because it is like a trust transfer which means a benefit to the candidate, but that does not mean that the candidate will take the exam without fulfilling the criteria.
VLAD SARCA (EGV): Thank you very much for your time and I wish you a lot of success further on!

Young Romanian Doctors – being sued by their hospitals

Wednesday, March 18th, 2015

According to the Romanian law, once a young doctors starts a residency program inside a Romanian hospital he is required by law to practice medicine inside the hospital for at least 5 years after becoming a specialist doctor.

Of course, we know that this is not always the case. Recently, hospitals have decided to take matters in their own hand in order to keep young doctors inside the public hospitals in Romania.

Some hospitals have considered being good employers and offering young doctors extra cash besides the 1000 Ron starting salary (225 Euros) and even accomodation, and some hospitals have decided to use the law, and sue if one decides to accept a position abroad or at another hospital within Romania, thus requiring the young doctor to pay back the hospital the equivalent of all salaries earned inside the hospital during the residency program.

But is it ok to “tie doctors to the land” or in this case to the hospital?!

Do you consider this action moral and ethical?!

What’s your oppinion on this subject?!


On the other hand, the article also comments on the fact that patients continue to “bribe” doctors and nurses. Patients in Romania consider that if they give the doctor or the nurse some extra cash, they will recieve better care and won’t be required to wait to long for a check-up.

Of course, this segment also underlines the fact that in the majority of cases doctors and nurses don’t ask for extra money from the patients. 

Patients consider that giving the doctors and nurses a “extra attention” they reward the specialists that are underpayed and keep them practicing medicine in Romanian hospital.

What’s your oppinion on this subject?




Wednesday, October 26th, 2011

The fact that the salary of a doctor was reduced with 25% last year fuels the ever growing negative feelings that Romanian doctors have for the Romanian healthcare system. A study conducted by the “Solidaritatea Sanitara” Federation underlines the fact that 70% of doctors are considering the possibility of a better medical career abroad.

The specialists believe that the medical migration trend will last for about 20 years from now on, a fact that will bring underprivileged countries an acute lack of quality medical services. The profile of those who leave consists of people between 30-39 years with experience in their medical field.

The official statistics show that, in the present, over 6000 doctors of the 40.000 doctors registered in Romania have already left the country. Among doctors, the number of nurses and other medical staff that have left the country in order to work abroad is about 6.800 of 120.000.

The current numbers show us that a medic should take care of over 647 patients, and a nurse should take care of over 200. If the forecast should turn out to be true, Romania will have about 10.200 doctors for 22 million people, which means that 1 doctor will have in his care over 2000 people.

The migration of the specialists

The main reasons that make the medical migration trend so appealing are first of all the money related ones. The Occident pays better, there is more money for a better life for the family needs.

According to the study conducted by the “Solidaritatea Sanitara” Federation, the percent of those determined to work abroad is about 38%. The proportion of those that consider it is at over 50%, but there are still some hesitations fueled by factors such as age and family. The majority of doctors that want to seek a career abroad are between 30 and 39 years old and have been working as doctors for about 10 years.

“I don’t know not even one case regarding a doctor that came back, because he didn’t manage to accommodate himself from a professional point of view”, declared Vasile Astaratoae, the president of the Romanian Medical College. He added that the medics that leave do not consider coming back: “they will come back only if the political powers will invest heavily in the health system, so that the doctors can practice at a western level their profession, and if their salary will be at least 3 times bigger than the average salary in Romania.” According to the data, the doctors that leaved Romania in 2009 chose to practice in countries such as France, the UK, Ireland, Sweden, Germany and Belgium.

The study also shows that 30% of the employees in the medical system have already started to make the procedures needed for working abroad.

Even if this doesn’t mean that all 30% of them will leave to work abroad, the figures are still representing a dangerous trend that will most certainly affect the healthcare system.

67% of the persons on which the study was conducted feel a depression in the healthcare system because of the migration.

One of the reasons that motivates 30,4% of the doctors is the prospect of better wages. The final decision depends in the majority of cases on the solutions regarding the internal reasons such as wages, working conditions, future prospects etc.

The story of a Romanian doctor working in Great Britain

Wednesday, October 26th, 2011

“Last year, in Romania graduated 6000 med students. In the same year, 7000 medics decided to leave the country in order to work in countries such as Italy, France, Germany, the UK…” declares the president of WONCA World, Prof. Dr. Richard Roberts.

“Romania has a great number of family doctors that are dedicated and well prepared but are frustrated by the fact current laws don’t give them the chance to do enough for their patients”, said Prof. Dr. Richard Roberts.

Among the doctors that opted for working abroad in the last years is also Dr. Larisa Sava.

Larisa Sava is a young doctor and a young mother of two from Sibiu, Romania, who opted for living and working abroad.

“I was afraid that after graduating medicine and after getting a specialty I would get to work at the boutique shop on the corner”

“Why did I choose to leave Romania? Is one of the simplest questions for me to answer; it was a simple decision to make. I didn’t have to think about it that much. After graduating in 2007 I gazed into the future and there was nothing”, said Dr. Larisa Sava, Senior House Officer Pediatrics, Great Britain.

“Six years of med school were hard. Besides the studying I chose to be a mother as well. We struggled financially. In the last year of med school I had to get a part time job as a nurse. One day I had enough and realized that in this country I have no future, no money and no friends in high places”, added Dr. Larisa Sava.

Now Dr. Larisa Sava is working as a medic in a hospital in England in a training position. She chose to become a family doctor, a profession that in Great Britain has a different meaning and responsibility than in Romania. “In Romania everybody that did not have good results in his residency years chose to become a family doctor. Here on the other hand, this career is wanted and competitive. It is the only medical field that requires a preliminary exam.”

“In conclusion, I don’t regret moving to Britain. It is harder and harder for Romanian doctors to start a career in the UK because access to training positions is limited and without training positions it’s hard to progress. But to be honest even if I would not have made it as a doctor, even as working at a nursing home I would have earned about 1000 pounds per month, and life in Britain would still have been better than in Romania”, states Dr. Larisa Sava.

My home is England now. I don’t think I will ever go back to Romania!

Source of the article: Magazine nr.77, 9/2011

Brain Drain of Doctors Worsens in Romania

Wednesday, October 26th, 2011

The outflow of doctors heading abroad for more money is continuing to rise, threatening Romania’s already dilapidated health system.

Around 1,700 doctors left Romania to go to work abroad in the first eight months of this year, a figure that is steadily increasing, the Colegiul Medicilor, a professional organization for doctors, said yesterday.

The number, which represent 4% of the total number of doctors in Romania, was established on the basis of certificates issued for good medical practice, which are required for working abroad, Vasile Astarastoae, the president of the organization, said.

By comparison, around 1,100 doctors sought to leave Romania over a similar period last year.

The brain drain is particularly acute in the highest ranks of the profession. Most of those leaving were anesthesiologists and surgeons followed by urologists, orthopedists and pediatricians. The favorite destination was Western Europe, mainly France, Germany and the UK.

Romania already has a shortage of doctors. There are around 1.95 doctors per 1000 people in Romania compared to an EU average of 3.18.

The chronic lack of specialists hampers medical activities and threatens the safety of patients and doctors alike. To many doctors say they work to the point of exhaustion.

“The small salaries and the extremely difficult conditions in which doctor work have prompted a considerable number to leave the country,” Vasile Astarastoae added.

Romania has been struggling to reform its public health sector, which has fallen into growing chaos as o result of chronic underinvestment. Hospitals around the country are understaffed and are short of specialists and modern medical equipment. Low pay in the health sector and the government’s unwillingness to carry out changes, have encouraged the exodus of doctors and nurses.

The average salary of a junior doctor is around 300Euro/ month and under government austerity plans, wages are being cut by a quarter. A doctor who gets work in Britain, for example, may expect to earn many times that figure.

Romania spends less on healthcare as a percentage of the budget than any other country in the European Union. Last year, Bucharest spent only around 4.5% of its GDP on healthcare, almost half the EU average.

By contrast, Britain spent only 6.9%, and France spent 9.4% of its GDP on health, followed closely by Norway and Canada, according to a recent OECD report.

Unsurprisingly, Romania’s healthcare system is considered one of the worst in Europe. Last year it ranked last among 33 countries, according to the European Healthcare Consumer Index.

Hungary’s Doctor Shortage

Wednesday, October 26th, 2011

Low pay at home, plus poor prospects and conditions spur hundreds of physicians each year to seek work elsewhere in the EU

For seven months, psychiatrist Ildiko Szabo got up every day before 5 a.m. and caught the first train from Szeged to Budapest. Three hours later she would be sitting in a Swedish language class. In the afternoon she took the train back home to southern Hungary and prepared dinner for her three children. After they went to bed, she would go online to practice her Swedish.

One week after finishing the exhausting course and passing the language exam, and after 23 years of practicing psychiatry in her homeland, Szabo left Hungary with her husband and kids for a job in Orebro County, Sweden.

That was two years ago. Today Szabo is one of 12 Hungarian psychiatrists in the county in central Sweden. She makes several times more money than she did in Hungary, has much more free time to spend with her family and does not have to accept tips from her patients to make ends meet.

Since Hungary joined the European Union in 2004, 500 to 600 doctors have left the country each year, and a recent survey by the Health Services Management Training Center at Budapest’s Semmelweis University indicates that 60 to 70 percent of first-year medical students plan to seek a job abroad after graduation. In a country already facing a doctor shortage, the migration has health-care professionals talking about a human resources crisis in the system.

Low pay is the main factor, but poor prospects for professional development and promotion and substandard working conditions also play a part, studies show. Experts say deep structural changes in Hungary’s health-care system are needed to stop the exodus.

Since Hungary’s EU accession, 2,218 doctors have applied for an official certificate enabling them to work elsewhere in the union. “This step does not mean that they definitely will leave the country, but it suggest a strong will to do that, considering that the certificate costs 40,000 Forints[150 Euros] and the monthly salary of a resident is less than 100,000 Forints”, says Dr. Edit Eke of the Semmelweis University team, which has been researching health professionals migration patterns for four years.

The university researchers found that as of the end of last year, 2,065 Hungarian doctors were registerd in EU countries including Belgium, Denmark, Finland, France, Germany, Portugal, Sweden and the United Kingdom. Last year 590 doctors applied for an EU working certificate; the annual number of medical-school graduates is 750-800.

Not all those doctors move outright. Many just hop on a low-cost flight Friday afternoon, work all weekend at a British hospital and return with what might amount to triple their monthly pay at home. And many medical students say they only want to spend a couple of years abroad, which Eke says is not a bad thing in itself.
“We are not against foreign experience and learning. But it is a question of how that experience can be integrated into the Hungarian system of training, “she says. Even if a doctor leaves with every intention of coming back before too long, she adds, a good offer of better working conditions abroad could change his or her mind.


Hungary currently has about 35,000 doctors. Eke said there were 2,200 vacancies for doctors in 2005, the most recent year for which statistics are available. Those data do not reflect big cuts made in health-care system last year, she noted.

Money remains the chief motivation for doctors to leave. A new medical graduate earns less than 380 euros/month. A security guard or shop assistant can usually expect to take home 300 euros; a 22-year-old with a bachelor’s degree working as an assistant auditor for a multinational corporation makes more than 600 euros.

Ildiko Szabo says she saw the situation steadily deteriorate for practitioners during her career in Hungary. She typically had night duty 10 times a month, and hardly had any time with her family. “If you see the light at the end of the tunnel and know how much more you have to take, you will bear the difficulties,” she says. “I waited for more than 20 years but only saw things worsening.”

For her the informal system of tipping, or hálapénz—typically handed to health-care professionals in white envelopes before treatment—is no help. “The basic strategy of all governments was to save money on health care and to force doctors to accept the tips by keeping their salaries low. & You can’t work like that. And this was bad even for us, the doctors,” says Szabo, who acknowledges taking tips but says she never favored those who gave her envelopes.

Some doctors leave primarily to pursue professional opportunities unavailable in Hungary. Peter Sipos chose a less typical path, going to Namibia for three years.

“I was aleready doing my practical training and wanted to go into obstetrics and gynecology. But I soon realized that though I could get my certificate easily in Hungary, I would not learn all the most recent techniques in this field,” he says. He spent three years in the obstetrics department at a Nambic clinic and says he learned all he needed there. Today he is doing research on stem cells in Britain, although he does not rule out returning to Hungary one day.

According to Eke, poor working conditions and doctors’ low standing in public esteem also contribute to the departure of physicians and physicians-to-be. “This is a complex process comprising the workload doctors have to take, their social status and their conditions, as well as many other factors,” she says.

Countries like Sweden that also face a shortage of doctors are eager to import medical professionals from Central and Eastern Europe. Intermediary agencies advertise on the internet and in the journal of the Hungarian Medical Chamber. Sometimes they even contact doctors directly.

It was in a professional journal that Szabo saw an offer for psychiatrists willing to work in Sweden. After e-mailing in her CV, she was invited to attend an information session and soon afterward had an interview. Prospects and their spouses were taken on a five-day trip to Sweden to look around; on the final day she signed a preliminary contract and agreed to take an intensive seven-month language course.

Szabo did not have to pay for any of this; moreover, she and the other doctors got a monthly 300,000 forint stipend—far more than she earned practicing in Szeged—plus rent and travel allowances so they could support their families while learning Swedish, and help finding a home and settling in after the move.


In addition to the 590 physicians, 324 nurses, dentists, and other health professionals applied for the EU working certificate in 2007. Opinions vary on how serious an impact labor migration is having on the Hungarian health-care system, although Eke sees a definite effect.

“Officials have always considered this problem to be smaller than the professionals. But every day hospital directors have to face not having enough doctors,” she says. “Many of the doctors leaving the country are experienced specialists. They are vital in the practical training of young doctors, and their leaving the country endangers training as well.” Almost half of the doctors applying for the EU working certificate in 2007 were aged 40 and above.

Higher salaries alone will not eliminate the problem, but Eke says research indicates it could significantly reduce migrants’ numbers. Such an increase could actually be cost-effective, she maintains, given the costs of training doctors who leave (about 40,000 euros for six years of medical school) and filling the health-care vacuum they leave behind, particularly in small towns.

“We asked the medical students how much money they would like to get after graduation and as a young specialist. They are not expecting a million forints, which they might make abroad, but 200,000 forints on average for a resident and 400,000 for a specialist,” she said. “These are not unreal numbers and show that even a small increase would help the situation.”

Eke says there is talk in the medical community of the Health Ministry working on a new strategy, “but nothing has been made public yet. If there was a strategy people could trust, that salaries will rise in the future, it would have an effect on migration plans.”

Source of the article here:

Bulgarian Doctors: Unmooring of user fee of minimum wage is populism

Wednesday, October 26th, 2011

A day after the government announced the intention that part of the social taxes should not be tied to the minimum salary, the Medical Council gathered to discuss the new rules.

According to the doctors, the General Practitioner tax of 2 leva and 70 stotinci, which currently are paid when you visit the family doctor should not be changed. According to them, the goal of the government is to reduce the taxes of the retired people before the local and presidential elections.

A couple of months ago, the decision to make the tax for the elderly 1% of the minimum pension, was discussed in parliament. As a result of the discussions, the bill drafted by the red deputy Emilia Maslarova was rejected by the Health Committee and by the Ministry of Health.

The doctors were surprised by the decision taken by the government now, because a few days ago the Health Committee in parliament has decided that the General Practitioner tax remains 1% from the lowest wage.

A couple of months ago, the Minister of Health Stefan Konstantinov shared the same opinion.

Besides the tax for visiting the General Practitioner, there are in discussion 53 more taxes, including the subsidies for the political parties. The new shape of the taxes is yet not clear. The government states that the new tax mechanism will be clarified by 01/10.

Source of the article here:

Bulgarian doctors look for better life abroad

Wednesday, October 26th, 2011

Working conditions, equipment and salaries are seen as key factors in brain drain.

The number of doctors leaving Bulgaria to look for opportunities abroad could almost double this year, according to the union representing the profession. Most will never come back…

About 80% of those leaving have just graduated. After emigrating, they find positions in foreign hospitals and establish themselves in their profession.

In all, Bulgaria could lose around 1000 doctors by the end of this year, estimates the Bulgarian Doctors Union.

Svilen Stoychev is one of the many who decided to work in Germany, a popular destination for young specialists, along with France, the UK, Northern Ireland, Denmark and Sweden. “The current system in Bulgaria forces doctors to work in a way that is benefiting neither the patients, nor the doctors,” said Svilen Stoychev, explaining his decision to move.

“The lack of medical equipment and money turn you into a Doctor Quinn”, he said, referring to a character in a popular TV series set in the pioneer era. “This is not acceptable for a European country.”

According to a study by the Medical University in Sofia, 84% of grads Emigrate because they believe this will be better for their career. They expect that going abroad will give them access to a better organized health care system, better working conditions and technical equipment, and higher salaries.

Bulgaria’s healthcare sector underwent a major overhaul in the late 1990. The communist-era system of funding and ownership was replaced with a new model of health care establishments were granted economic, legal and financial independence.

Many specialists, however, argue that the new system has turned doctors into traders. Instead of focusing on treating patients, they are constantly trying to think of a way to get around the system and survive financially.

Despite the trend towards emigration, there are young doctors who have decided to stay, at least for the time being. One of them is Klementina Gerdzhikova, who works at a big hospital in Sofia.

“I decided to stay because as every young specialist I need to gain some experience and routine in my work. For these difficult first steps, I thought Bulgaria would be better, because here I don’t have to worry about things such as the language barrier and having to get used to living in a foreign country.”

Bulgaria’s health ministry disputes the doctors union contention that the number of those leaving has picked up in recent years.

In reality, the ministry told SETimes, the number of doctors has remained stable over the past ten years, at around 30,000 people.

But the ministry concedes there is a deficiency of specialists in some fields, such as infectious diseases and forensics. Authorities plan to increase the number of students admitted to universities in these disciplines in the coming academic year.

Meanwhile, in the wake of the union’s dire forecast, Prime Minister Boyko Borisov proposed taking steps to keep doctors in the country.
According to Borisov, medical students whose tuition is being paid by the state could be asked to sign contracts obliging them to work in Bulgaria for a certain period following graduation.

“We are talking about taxpayers’ money to prepare specialists who go to work in another country. Is this right?” Borisov asked.

Echoing the suggestion, Education Minister Sergei Ivanov recalled that state-sponsored students formerly had to either sign five-year agreements to work in Bulgaria, or repay their tuition. These suggestions, however, have faced criticism, particular from the medical community.

Source of the article here:

Bundesaerztekammer supports government plans for reform of medical education

Wednesday, October 26th, 2011

Bundesaerztekammer supports government plans for reform of medical education

The coalition engages the change in licensing regulations with longstanding demands to the medical profession.

Berlin, 30.09.2011

“In order to obtain out of motivated medical students practical trained medical graduates who actually understand the medical profession, we must reform requirements for training doctors urgently. German “doctor-days” have been for a long time a more practical approach in the study, family-friendly conditions and new regulations are demanded for the state exam. Now also the legislator is considering appropriate changes in the medical licensing regulations” said the president of the Federal Chamber of Physicians Dr. Frank Ulrich Montgomery.

By the Federal Ministry of Health presented draft bill amending the licensing regulations for physicians provides the abolition of the highly controversial “Hammerexamination”. Instead, the written part of the second section of the medical examination before the practical year will be relocated. “The fact that future physicians acquire the necessary theoretical knowledge before the internship year in which they acquire the practical skills, is didactically very useful”, praised Montgomery.

The BAK- president stressed that the draft amendment also contains the appropriate measures to combat the shortage of physicians. “It is particularly important that the medical students should be brought closer to the work of family doctors. Anyone who has studied the insight into the interesting and diverse range of healthcare activities provided by family doctors, is more likely later to decide to consider a career in the general practice”, said Montgomery. The flanking position of the medical boards will enable students and young doctors the opportunity for partial training and education in the countryside. This contract could reduce fears and prejudices.

“The proposed changes in licensing regulations can also help ensure that more students successfully complete their training and therefore there will be more available junior doctors. The proposed new regulation that by request allows the practical year to be attended part-time, gives many students the chance to find the harmony between family and studying”, stated Montgomery. It would also be good if in the future the practical year could be obtained outside of the University Hospital or its associated teaching hospitals. This would expand the choices available to students, thereby also increasing the opportunities for hospitals in the country, to win junior doctors for patient care. Positive, said the BAK president that in the future in addition to palliative care pain medicine should be explicitly included in the licensing regulations.

Source of the article here: