Bulgaria’s health system in critical state due to staff shortage

Bulgaria has just under 29,000 nurses, some 16,900 less than is needed for the health system to function normally, according to a study by the Bulgarian Council for Economic Analyses, leading to a critical situation in many parts of the system, putting patients at risk.

The Department of Paediatric Oncohematology at the key hospital “Tsaritsa Yoanna” in Sofia is about to stop providing services το sick children because there are no available nurses. The situation is similar in many smaller hospitals outside the capital Sofia.

But there seems to be no solution in sight as many public institutions cannot offer nurses salaries of higher than €750 as this would also trigger an increase in doctors’ salaries, which they cannot fund.

“10 years ago, we first realised that we would have a problem with medical professionals in the long term. In 2019, we updated the forecasts for the labour market, and these deficits appeared even larger. Then we decided to dig deeper into the topic and try to measure the shortage in depth, using Eurostat data for all EU member states”, Ralitsa Ganeva, one of the report’s authors, says.

In a European context, Bulgaria offers lower salaries to its medical specialists, meaning many seek better-paid positions abroad.

In addition, the Bulgarian language, as the primary language in healthcare workplaces, is an obstacle that prevents the attraction of specialists from other countries, the analysis notes.

In Bulgaria, there are 419 nurses per 100,000 population, compared to the EU average of 666.3 per 100,000 people. The ratio between the number of nurses and the number of doctors is 0.97:1, which means that there are more doctors than nurses in the Bulgarian health system. The World Health Organisation recommends a ratio of 3:1 to ensure an adequately functioning health system.

Serious state of psychiatric care

The survey data may show that in 2021 in Bulgaria, the number of doctors per 100,000 population was higher than in Europe, but specific deficits stand out.

There is a shortage of approximately 1,000 general practitioners and over 460 psychiatrists. A thousand general practitioners are equivalent to 1/4 of those needed to keep the system functioning.

The shortage of psychiatrists is over 70% for 2021, and the education system only partially compensates for the number of doctors and nurses leaving the health system. Over the past 20 years, the Council of Europe has repeatedly identified problems with Bulgarian psychiatric services and the inhumane treatment of some of the patients who are committed to legal custody due to a lack of staff.

“Certainly, the education system today cannot compensate for the outflow of personnel from the system,” Ralitsa Ganeva says.

Uneven location

Another problem of the Bulgarian healthcare system is that between 1/3 and 1/5 (depending on the speciality) of its staff is located in the capital Sofia.

More than half of the specialists are located in six out of 28 regions in the country – Sofia, Plovdiv, Varna, Pleven, Stara Zagora and Burgas. Medical universities in Bulgaria are located in the centres of these regions.

Fewer professionals are now entering the system than leaving it, and the number of doctors who have taken the speciality “general medicine” to become GPs is insufficient.

“The interest in some specialities is too low,” the study reports. For example, a dozen psychiatrists acquire specialisation annually, and 460 are missing.

The education system does not compensate for the doctors and nurses leaving but only partially covers the outflow. There is also the problem with the ageing of the personnel in the sector.

The market is not working

“The market organisation of health care is such that there are incentives to complete certain specialities and no incentives to complete others,” the authors of the analysis said. Examples of popular specialities are plastic surgery or cardiology and, an unpopular one, internal medicine.

“General practitioners are overworked precisely because they are woefully understaffed. This is also the case with nurses.”

“We must think very seriously about how we can bring back, even partially, the doctors and nurses who left Bulgaria. How can we attract them back? In addition, we must think about whether we can attract students from the Bulgarian diaspora to strengthen the capacity of the system,” Ganeva says.

The analysis concludes that this would upgrade the functioning of healthcare in Bulgaria and significantly improve the health of citizens in the long term.

[By Krassen Nikolov – Edited by Vasiliki Angouridi | Euractiv.com]

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