Weekly Briefing, Vol. 18, No. 3 (RS), May 2019
Emigration of medical professionals
Abstract
The problem of emigration of medical personnel from Serbia is gaining momentum and visibility in Serbian society. According to unofficial data, more and more doctors and especially medical technicians are leaving the country for better paid jobs in EU countries, especially Germany. These countries are encouraging the migration by lowering the criteria for employment and signing agreements with National Unemployment Service to search for available medical personnel from the earliest moment, even at the end of medical high schools. The number of doctors available still covers the needs of Serbian population, but the negative trend of emigration will likely increase, and another factor is the aging and retirement of active doctors, while new and young professionals are among those that are most prone to leave the country, and represent the highest percentage of unemployed medical professionals. The government in Serbia recognizes this problem and has started several projects to try to combat its negative implications.
Introduction
The migration of professionals from Serbia sometimes reaches worrying proportions which some experts often term as the “exodus of doctors”. However, precise figures for this phenomenon still remain elusive. The lack of official statistics on the one hand enables the government to minimize the migratory problems of educated workforce, and on the other, it creates a situation in which any interested factor gives its own impression of this problem.
What is out of doubt is that the best chance in European and wider global labor markets is offered to information technologies experts, various engineers and especially in Western Europe, doctors and medical personnel. The problem of the exodus of medical professionals from Serbia certainly exists to some extent and this briefing will provide the available data and analysis of this social challenge for Serbia.
Dimensions of the Problem
Precise statistics are unavailable, but Syndicate of medical technicians claims that more than 1.000 technicians leave the country every year, while the Medical Chamber, a professional association of medical workers, issues yearly 800 certificates of good practice to doctors (good practice certificate is given to medical professionals willing to leave the country as an indicator of their adequate qualifications, it is required as a qualification for finding work in foreign countries).
On the other hand, these numbers, although nominally high, still do not pose a threat to normal functioning of Serbian system of healthcare. Serbia has around 30.000 doctors. In relation to a population of 7 million people this number is approximately the European average. However, what is alarming is the age structure of these doctors. Half of young medical professionals that spend some time in European Union countries for professional perfection stay after the end of the period permanently, due to better working conditions, more flexible labor market and higher salaries. In addition, Serbian government has adopted a Regulation on the ban of employment in the public sector as a part of its effort to cut state spending, which is still in force. In the meantime, older generations of experienced doctors are retiring, naturally.
The result is the unemployment of young medical professionals and aging active medical personnel. According to the Syndicate of doctors and pharmacists, around 3500 young medical professionals are registered as unemployed. The unemployment is especially visible with specialized medical personnel. According to the Serbian Medical Chamber, there are 1500 unemployed general practitioners and none specialists in Serbia. This is absurd and indicates that specialists are not trained at the same rate as general practitioners. Young students who graduate from medical schools experience difficulties in gaining specialization.
The reason for this occurrence is that in the period 2010/2018 the state strategy of development of medical profession was based on the assumption that too many specialist doctors exist, therefore, specializations for the past 8 years were approved rarely, if ever. Now the gap exists in the medical education of young doctors, which is currently being overcome by intensive additional education and other special measures.
Causes of Migration
The reasons for medical professionals to emigrate are various – gaining professional expertise which is available only in the rich countries of the west, financial reasons (salaries in health sector in Serbia from 250-380 euros for medical technicians and from 530-760 euros for doctors according to the data of the Syndicate of the employees in health and social care sector), family planning. Salaries are definitely lower in Serbia than in average European country, but another strong reason for emigration is that medical professionals are not satisfied with conditions in which they operate, especially when it comes to equipment which is outdated and inadequate in many health institutions in Serbia. The state tries to improve the state of affairs by investing in health infrastructure and acquisition of modern equipment. Salaries were also raised for medical professionals working in the public sector at the end of 2018.
Nevertheless, today it is easier more than ever to enter European labor markets, especially in Germany, which has opened its borders to attract foreign medical professionals to its depleted health institutions in eastern parts of the country. German language is being learned by medical professionals in Serbia massively, and the National Employment Service signed an agreement with its counterpart institution in Germany which regulates the migration of medical technicians (the type of medical personnel most in demand) and in organized way acts as a broker for German employers in Serbia.
Serbia, therefore, experiences similar problems as Poland, Czech Republic, Romania, Bulgaria, Croatia and other eastern and south-eastern European countries – they cannot compete with conditions offered in Germany, or Switzerland for example. According to good practice certificates’ statistics, the most frequent destinations are Germany, Switzerland and Norway. Some doctors also commute on weekends or free days to border countries which lack professionals even more than Serbia, such as Montenegro and Bosnia and Herzegovina. Recently, popular destinations have become the gulf countries such as Qatar and Saudi Arabia, but these contracts are usually short and do not last more than three or six months, after which period doctors return to Serbia.
As for the general profile of the emigrating medical professional, he or she is usually young, still single and not planning to found a family in nearest future, general practitioner, prone to be mobile and to change places of residence often. While older practitioners, especially specialists tend to work already in the established medical institutions in Serbia, and emigrate just for short periods of time to, most commonly, countries in the Arabic peninsula, as we have already mentioned, work there to earn some additional money and then come back.
Government Projects to Combat the Consequences of the Migration
Ministry of Health of the Republic of Serbia currently works on a large project which includes professional associations of medical workers, Institute for Public Health “Batut”, medical faculties, National Health Insurance Fund. The purpose of the project is to plan a national program for medical professional’s education and training for the period of ten years. The aim is to predict how many doctors will retire during this period, what would be the needs of citizens concerning numbers of doctors available, and consequently to create an education and employment plan. At the same time, new investments in the infrastructure and raise in salaries are expected. It remains to be seen how the plan will develop in the years to come.
Leading politicians in Serbia, realizing the problem that state of medical profession represents for Serbian society, announce additional projects for its improvement. Thus, at the end of 2018, president Vučić stated that he will back personally a project “Billion Euros for Health System”, however he did not expose to the public any details concerning terms of realization of these project. Fiscal Council, governmental institution made of experts for state finances, claims that investments in health and education in Serbia represent just a half of the amount spent by average Central and South East European country. On the other hand, priorities for state spending last year were army and police, which gained four times the amount in the budget for 2019 than for 2018. This means that the health budget for 2019 is 158 million euros, while army budget is 796, and police budget 718 million euros. If Serbia wants to solve the problem of excessive emigration of medical professionals it would need to change its list of priorities in government spending.