Archive for the ‘Hungary’ Category

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:


Tuesday, October 25th, 2011

The Hungarian government is trying to tame the wave of medical doctors leaving the country by offering them money to stay. But as the application deadline approaches, few have expressed interest in the government scheme.

Under the program, Hungarian doctors can receive 100,000 forints ($530) net on top of their monthly salaries for a period of 5 years. This means the doubling of their wages during that time. In return, the program’s participants have to make a commitment to practice medicine in Hungary for at least 10 years and to never accept any gratuity money from patients, a widespread practice in Hungary.

“We have begun a battle for souls,” state secretary in charge of health care, Miklos Szocska, said on private television HirTV.

But it appears that the initiative has fallen well short of the originally expected 600 professionals. Fewer than a hundred career-starting doctors have so far preferred some extra pay over the possibility of working abroad, according to Hungarian daily Nepszabadsag. The ministry announcing the scholarship noted that there were also 11 pharmacists applying. Due to the low turnout the ministry has extended the scheme hoping that more doctors would be willing to get involved.

“Residents are skeptical about the scholarship and only about 10 people (within the association have shown any interest in applying”, Magor Papp, head of the Hungarian medical residents association, told local news agency MTI.

Career starters apparently don’t want to make such commitments because they don’t see that their livelihoods would be guaranteed once the five years on a double salary are over. A survey conducted by the association fund that 74% of new medical graduates are planning to work abroad.

The migration of doctors is quickly becoming an acute issue for Hungary’s healthcare system in general. Some 1,500 medical professionals are missing in the county, which threatens the stability of the system. The situation could soon turn even worse.

A survey conducted by the Hungarian doctors association found that 6.000 doctors and residents are considering leaving Hungary unless their salaries go up. Residents also launched a campaign in which they deposit their resignations at an attorney. The documents are to take effect at the end of the year unless the government is willing to increase their pay.

Doctors want to get a 100% increase in their salaries, which would take 200 Billion forints in total. But the rise would still mean they’d be making less than the European average, they say. Hungary’s medical residents now earn in the range of 80.000 forints to 100.000 forints net, while the average net salary in the country was 140.300 forints in June.

Source of the article here:


Tuesday, October 25th, 2011

Like governments the world over, Hungary is seeking ways to rein in spending on health care. If anything, the problem may be even more acute for the Fidesz party-led Hungarian government, which has the highest debt-to-GDP ratio in Central and Eastern Europe and aims to trim its budget deficit to close to 3% of GDP this year.

The government and the country’s pharmaceutical industry are at loggerheads on how to best tackle the issue of bringing down the roughly 340 Billion forints (1.84 billion dollars), or 1.4% of GDP, Budapest is spending on subsidizing drugs. While the government proposes to cut the subsidies, the pharmaceutical lobby suggests levying a new tax to help raise the money to keep the subsidies flowing.

While the industry’s proposal will do little to address the issue of outsized spending on healthcare, the lobby does address an important issue. They want the extra tax income to be spent on higher wages for physicians and other healthcare professionals.

Hungarian doctors including job starters, have been leaving the country in increasing numbers to seek higher wages elsewhere in Europe. Some of them work part-time in neighboring Austria or even hop on a plane to work weekends, or for a week or two each month in the U.K.

Latest data from Hungary’s health care license office, or EEKH, shows that 1,777 health care workers requested a license to work abroad last year, more than twice as many as just four years ago. Within that, the number of doctors wanting to work abroad totaled 1,111, double, again from 2006. The most popular country of destination was the UK, followed by Germany, Austria, Ireland and Sweden.

Those aged between 25 and 44 were most keen to go abroad in recent years, but the numbers pf those hardly out of med school also started rising sharply.

While those numbers may seem low, the departure of doctors for better pay elsewhere is reducing Hungary’s quality of health services. The number of doctors per 1000 Hungarians was 3.1 in 2008, Organization for Economic cooperation and Development figures show, ranking Hungary above Finland, the UK and Japan. Not to mention the doctors training costs to the taxpayers.
Faced with the prospect of relatively poor pay, many of those doctors who have the opportunity and the ability are opting to leave.

Dentists, gynecologists, plastic surgeons or dermatologists – those who can have a private practice – can live well-off. Not least, because they can take in patients from abroad who travel to Hungary because of the relatively cheap service there. But an anesthesiologist or a radiologist – who can hardly conduct a practice outside the mostly state-run health sector- has not much choice. Many doctors have become drug sales agents for a higher wage, a company car and other benefits.

A specialized doctor earned a gross HUF 4.18 million, or 20,700 dollars a year in 2009, data from the National Employment Service NFSZ show. That’s the official figure, but wages are so low that many health care workers do accept additional payment, untaxed and illegal, termed parasolvency, from their patients, who feel obligated and ready to pay extra in hope for extra care.

The government has turned down the drug association’s proposal to use the extra tax to raise health sector wages. The number of doctors wanting to work abroad will likely continue to rise and parasolvency will remain an accepted form of gratitude for doctors and nurses.

Are you affected by this situation?

Is it the same in your country?

How will this affect your future?

Are you a doctor that wants to work abroad because of these reasons?


Tuesday, October 25th, 2011

Without constant recruiting of foreign doctors East Germany would have no sustainable medical care. Although the Federal Chamber of Physicians is not considering it permanent solution, Saxony, Thuringia and Co. go on promotional tours in countries such as Austria, Hungary, Poland, etc. in order to attract foreign doctors.

If the television series “A Country Doctor” did not exist, it would have had to be invented for this place. The town Waldheim is a province in the best sense, idyllically situated on the river Zschopau, located right between Chemnitz, Dresden and Leipzig. The houses around the square beam freshly renovated, the town hall along with its tower lights in the sun, and diagonally across the street on a two-story house is a brass plate: “Dr. Peter Laub MD, specialist in general medicine.”

“It was love at first sight between me and this place”, says Dr. Laub. A year ago I took over the practice here in Waldheim Niedermarkt, after moving here from Hungary at the age of 39. The fact that he is from Hungary is easy to notice from his accent and from all the Hungarian professional books on his desk. Practice is of course entirely in German. “I’m getting better with each passing day,” he says proudly. Laub is a stocky, jovial man who pursues his work in jeans and a blue shirt, but by wearing a stethoscope around the neck he makes it clear who’s the doctor.

Laub grew up in Budapest, where he studied medicine and worked at the university hospital as a pediatrician, and six years in his own practice. But the city became too much, it was loud and hectic, and the stress added by the madness of the Hungarian health system had to end: “The bureaucracy is worse than here, you get no help, but penalties are immediate if we cross over the budget”. In school, Laub learned German and English, and he really wanted to follow a colleague to Great Britain, just as a agency invited him to a roud trip to Bavaria, Thuringia and Saxony.

They looked at medical practices that sought an urgent successor, and as Laub and his wife Waldheim saw, they quickly knew that they wanted to stay: “We immediately decided!” His predecessor had been there for years, unsuccessfully looking for a successor and continued to practice despite age and health problems. It took half a year, until Laub had all his permits and approvals for Germany. After that he moved with his wife and three children from Budapest to Waldheim. The next day there was a grand opening celebration, attended by the mayor, fellow doctors, directors of the surrounding hospitals and of course the patients.