Health workers going abroad - exodus or "normal migration"? photo. S. Djordjević

Health workers going abroad - exodus or "normal migration"?

februar 29 2020

A doctor's or medical technician diploma is a safe ticket for leaving Serbia. That is why foreign language schools are full of attendees from medical profession. While patients worry about who will be left to treat them, and officials say there are no problems, two doctors per day leave Serbia.

There is almost no person in Serbia whose family member, friend or acquaintance does not work at a foreign hospital or nursing home. Agencies for employment mediation offer hundreds of ads for all levels of education. Years and experience are not the limitation, so both young and experienced medics are leaving. How many of them exactly who were educated in Serbia are and now work abroad, the state does not know.

"You really have no way of getting to the right number because you can't force anyone to report when they leave the country. You have the right to leave and you are not obliged to report to anyone”, says Secretary of State in the Ministry of Health Ferenc Vicko.

That is why the conclusion about the number of doctors left is made based on the number of licenses for work abroad issued by the Serbian Medical Chamber. It is estimated that two doctors leave Serbia every day.

 "This is the only one that is relevant. Who wants to work abroad must obtain a license from the Chamber. And that's the maximum number. Whether they leave or change their mind and do not leave at all, we don’t know about that. We can guess that maximum figure, it's probably below that. How much below - we don’t know. If we talk about a figure of 700, then the maximum of 700 people has left, but at the moment we do not feel it in the system. We have the same number of doctors in the system”, Vicko claims.

He adds that the Ministry's analysis shows that there is "territorial diversity" in the number of doctors per capita, but that the total number of doctors does not vary so far. He also claims that there are "relatively many educated nurses" in Serbia.

The state denies the problems, but at the same time makes efforts to prevent migration. Thus, the Ministry of Labor announced the termination of the German-Serbian agreement on the employment of caregivers in Germany for the next year. It is a project of the German Society for International Co-operation, the Federal Labor Agency and the Serbian National Employment Services, concluded seven years ago. The Germans also made it with Bosnia and Herzegovina, Tunisia and the Philippines, and Serbia is the first country to break it. A month before the announcement of stopping the project, Serbian President Aleksandar Vucic said during an appearance on television with national coverage that he had told German Health Minister Jens Span "in the face" that he was not coming for nurses. The German media reported Span's statement that he had never spoken to Vucic like that, but also that Germany would respect the "sudden interruption of cooperation".

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Examination at Nis Clinical Center(photo© Sasa Djordjevic)   

While the agreement was in force, the National Employment Service mediated in employment of 730 medical technicians. Its termination will not prevent independent departures or the ones made through the private agencies, which, in exchange for a smaller share of the future salary, provide language classes, taking certified tests, translation of documentation and even assistance with finding an apartment.

Most specialists in adulthood

Representatives of the profession also point to the problem of the age structure of domestic doctors. Specialists are estimated to be 55 years old on average. This means that they will soon have to retire, and the question is whether their young colleagues, assuming they remain in Serbia, will have sufficient time and possibilities to get trained in order to replace them worthily.

"Patients, in five years, will have no one to treat them. If you find a doctor who is under 55 at maternity hospital in Nis, then you tell me.odlazak lekara 02

Incubators in the maternity ward of Nis Clinical Center (photo© Sasa Djordjevic)   

That means that those who want to have children should have them in the next 5 years. After that, either an emigrant will come or some novice doctor because there will be no more neonatologists. And one cannot become a neonatologist in two, three, or five years”, says Prof. Dr. Sasa Zivic, employed at the Children's Internal Clinic of the Clinical Center in Nis.

The director of the Clinical Center Zoran Radovanovic claims that "everything will be right" because the staff is regularly renewed.

"The Ministry has helped us and we have now announced a call for the admission of new doctors, nurses and technicians and non-medical staff. We are recruiting staff so that the shortage will not be felt", he says.

The shortage that is discussed presents doctors and nurses on unpaid leave, who work abroad without giving a cancellation at the previous workplace. Of the 688 doctors, ten are on unpaid leave and out of 1800 medical technicians - 62 are on unpaid leave. Although the director claims that their absence is not problematic, he says that each of them has been "sent a letter to return or to quit." The new paid leave is no longer approved.

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The building of the Clinical Center in Nis (photo© Sasa Djordjevic)   

"For a year, I have not signed requests for a number of reasons. Let's go with the logic ... I'm here, my family is here, so I don't want to think about it. If one thinks that there are better conditions somewhere, these are normal migrations everywhere in the world," says Radovanovic.

He adds that we should accept migrations if we have already accepted to be part of Europe.

"This migration of labor force from one country to another, for better conditions, was evident in Bulgaria, Romania, Hungary and countries with lower GDP than Germany. From Germany they go to Norway, from Norway to Arab countries, from Arabia they go to America. So, where better conditions are offered, high-profile staff, such as medical professors, doctors, go for higher pay, "he says.

For whose doctors would working in Serbia be worthwhile? The Ministry of Health promises to raise wages but does not specify how much. Still, low salaries are not the only reason for leaving.


What's different there?

Professional fulfillment is a key reason why pediatric specialist Dr. Tijana Nikolic moved out of Serbia a year and a half ago. Another reason is because of salary which is five times higher. She replaced the Health center in Niš with a hospital in the city of Ler and there she realized that there was a business culture different from ours - employers finance the training of employees according to their wishes and do not condition them in any way, even when they pay them specialization.

"There is a lot of investment in medicine, a lot of investment in healthcare, hospitals are more equipped, diagnostic methods are more modern, faster, more accessible, therapy also ... Medicine as medicine is the same in the sense that the diseases are the same, the diagnoses are the same, all this is true. But what they have at their disposal is a whole different thing, "she says.

In order to work in such conditions, she was ready to specialize in the same medical branch for the second time.

"Now I have a permanent job at the hospital, I am satisfied with my colleagues, working conditions. The working time is a little bit tiring, on-call duties are also present, but all that is paid by the Germans. It all pays off in the end. And what I have learned in the past year and a half I have not learned in Serbia in the last ten years”, Tijana points out.

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Patients in front of the Nis Health Center (photo© Sasa Djordjevic)   

Family medicine specialist Dr. Jelena Rakovic also speaks about positive experiences abroad. In Slovenia, where she moved 8 years ago, she is no longer a stranger. She got a job three years after completing her studies, after having internship in Nis, learning a language, then validated the diploma in Slovenia, passing the state exam and having internship for the second time.

"As the end of the college was approaching, I saw the way how the job was acquired here, in our country, so I realized that there was not much chance that I would get one. Then I was looking for some plan B, so I was looking where to go. Then by chance Slovenia came along, I didn't even know anyone who left there. The options were either Slovenia or Germany, the diploma had to be validated, it was not valid in either Germany or Slovenia. There were fewer exams in Slovenia, the ex-Yugoslavia, not far away. It all made an impact", Jelena remembers.

In Slovenia, where salaries are better and hospitals cleaner and more equipped, she has succeeded, both professionally and privately.

"When you go like this alone, and when so much things are waiting for you, you basically do not have much choice, you have to succeed. You don't have time to think if it’s hard for you. I was just working. I tried to create a normal life, not only related to work, but also to meet as many people as possible, to have a normal social life. I had a lot to learn, to work. In the meantime, I met other doctors, and there were also a lot of strangers at the hospital where I started", Jelena says.

After the specialization she works in a private clinic, on an equal basis with her Slovenian colleagues.

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  Dr Andjela Ognjanovic (photo© Sasa Djordjevic)   

Andjela Ognjanovic also intended to join the doctors who had achieved their work dream outside Serbia. She graduated from the Faculty of Medicine in Nis, began to study German and contacted the family with whom she needed to live while perfecting her language. She was expecting a visa, but the call she received in May last year came from the Ministry of Health instead of the embassy. She got a job as one of the best graduates of medical colleges in Serbia.

The goal of this program to keep the best ones in Serbia, according to Angela's example, is realized.

 "It was a week of thinking because I had already entered the story of going to Germany, but only once in your lifetime you are offered to have a job in your country and here are my friends, family and of course I accepted that job”, says Andjela, pleased to receive the desired specialization at the expense of the state in addition to the job.


However, Nikola Radovanovic pays his specialty in radiology. He has no salary because he volunteers at the angio hall of the Nis Clinical Center. He talks about the job with great passion, and he definitely does not want to leave Serbia because, he says, he is driven by emotions.

"When you feel and see all the enthusiasm of people involved in interventional radiology, that love of work and the sacrifice they make every day, it's something that is beautiful and very stimulating to us younger people, so I wish I had an opportunity to stay here among these wonderful people to continue my work, "says Nikola.

Still, he admits that "not everything is that nice."

 “One specialist pays about 600 - 700 thousand dinars to the faculties for the specialization, while the faculties and the state have no obligation to us. They didn't give salaries, they invested literally nothing, with the excuse that we would find a job easier, which is somewhat true. Very few specialists are at the bureaus, so you get some chance”, says Nikola.

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Dr Nikola Radovanovic (pfoto© Sasa Djordjevic)   

Nikola is right. While 30 general practitioners are waiting for the job at bureau, there is only one radiology specialist registered with the National Employment Service. On the same list are 2660 graduates of medical faculty from different courses, and only 96 specialists.

Nikola expects that volunteer specialists in future competitions will be perceived better and that "the Ministry of Health and the state will pay attention to their problems". Having invested money, time and effort into his knowledge also means he hopes for employment.

Author: Sanja Janackovic

Translation: Mladen Djordjevic

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