How to Stop Bulgaria's Medical Brain Drain?

Bulgarian doctors are currently on strike over problems with late government payments and issues with the ongoing health reforms. Bulgaria PM Boyko Borisov reacted quickly as always - increasing health insurance contributions and paying a large amount of the overdue funding – BGN 25 M was handed over Tuesday to doctors and dentists across the country in an attempt to placate the men/women in white coats.

By slamming the health professionals for not calling off their strike immediately Borisov, however, seems to have missed the main point – the health reforms his government is currently pursuing will only be successful if enough of the nurses and doctors currently planning to join the massive brain drain to other EU countries decide to change their minds!

After personally visiting Pavlikeni Hospital last year I can not imagine how any health professionals can cope with the working conditions they are provided with – to call them 'Third World' does not do them justice: The 19th century equipment, the crumbling buildings, the lack of heating, to name just a few of the problems, led to me wishing I had never entered the doors.

The current center-right GERB government’s plan for health reforms sadly only touches the surface of a dilapidated health service that is leaking more than 1800 nurses each year to foreign hospitals. In the rest of the EU the average number of nurses per 100 000 people is 745, while in Bulgaria the number is as low as 421. Moreover, the average age of nurses in Bulgaria is over 47, with nearly 11% of them being working pensioners.

The Bulgarian brain drain has long been talked about and it is a serious problem in all sectors of the economy – the health sector, however, seems to have been affected even more than most. The question is what can the new hopeful government do about it?

There are some things which Bulgaria should not do: Attempt to 'buy' professionals back through incentive schemes or try to increase pay to induce professionals to stay in the country. These strategies will result in an escalating cost spiral which Bulgaria will and can not win, with respect to its older EU partners.

There are, also, things that must be done to reduce the 'push' factors: Provide better working conditions: Ensure better clinical support to all health professionals, especially to those who are not in central hospitals. Ensure that there are sufficient funded posts to cover the workload without overwhelming individual professional staff. Make use of teleconferencing to link rural health facilities to central ones to provide clinical support to reduce the sense of isolation and ensure a leaming environment. The most important of all has to be to improve facilities: A hospital revitalisation program should be implemented as rapidly as possible.

Another fact that scared me while researching the Bulgarian health system was that about 7 000 patients die annually as the result of medical errors committed in Bulgaria, according to World Bank data. This can of course only be expected with such over-worked doctors and nurses.

If Bulgaria fails to invest in solving these problems, the professionals, not the problems, will go away.

I don’t think that Borisov and his merry men/women have yet realized that the short-term solutions they have suggested will not solve anything and that this problem will continue to bite at their heels throughout their term in office. Borisov himself called the doctors “the most intelligent people in the country” recently - it is about time that he treated them not only as the most intelligent but also as the most important!

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