Personal Doctors without specialty drafted to carry Greek primary health care

Greece plans to abolish the institution of “rural doctors”, utilising young physicians as “personal physicians” to boost the numbers and increase population coverage, but doctors warn about the implications, foreseeing further downgrading of the health services provided to the public.

The history of the Primary Health Care (PHC) system in Greece is complicated.

For decades, the country lacked a comprehensive strategy for primary healthcare services, instead placing hospital services at the centre of healthcare. But things started to shift after the financial crisis with restricted funds, an ageing population and growing costs making the need for an efficient PHC system more evident.

Efforts included introducing the institution of the “family doctor”, but nothing seemed to stick, as hospitals and private practices were still preferred by most.

During the COVID years, with health taking centre stage, the Greek government decided to use funding from the Recovery and Resilience Fund to reshape healthcare, including the primary healthcare system. During that time, the institution of “personal physicians” was introduced.

However, the uptake of the endeavour by physicians, mainly the ones with private practices, was not the desired one. The Health Ministry, therefore, decided to take a different path to find the doctors it needed to cover the population, with one doctor registering up to 2000 people.

The end of ‘rural doctors’

The new reform was announced in a press conference by the Deputy Health Minister, Irene Agapidaki.

According to Agapidaki, to increase the number of pathologists and general practitioners (the two main specialities that constitute “personal physicians”), young doctors just out of medical school and before studying for their chosen medical speciality will serve a mandatory one-year term as personal physicians.

After that, they will be given economic incentives to choose the specialities of pathologists or general practitioners to close further the gap in the numbers of personal doctors in Greece.

Only 6% of medical graduates in Greece choose the speciality of pathology or general medicine, when the EU average is at 25%, said Agapidaki.

Not specialised Personal Doctors

Medical associations are generally in favour of the abolishment of rural doctors as its mandatory nature has been seen as the leading cause for young doctors’ “brain drain”.

But, “the pressure exerted by the EU to adopt a [primary health care] system in line with other EU countries is also wrong”, the president of Panhellenic Medical Association of Greece, Athanasios Exadaktylos, explained to Euractiv.

“Greece owns a great medical wealth and must exploit it in its own way because these [external directions] do not fit with us”, he added, referring to the European Union’s deadlines about the personal doctors’ scheme adaptation and WHO’s advice for African countries.

“This has nothing to do with us”, he commented.

But it’s the decision to place inexperienced doctors in highly demanding posts like the one of PD, which has been received with criticism by medical associations and agencies.

“This measure is part of the further promotion of ‘gatekeeping’, [that is] the strengthening of the operation of the PHC as a barrier to hospitals and doctors of other specialities”, the Federation of Hospital Doctors of Greece highlighted in a press release.

“Our main objection is that it is impossible for doctors who are not specialised and have just received a general degree to take on the same role as the specialised and experienced doctors”, Exadaktylos told Euractiv, adding that this cannot offer the quality service to patients when the optimisation of service should be the only goal.

Economic imbalances 

According to the plan, young doctors who chose to study the speciality of pathologists or general practitioners could receive annual salaries of up to €46,000 (net salaries of €36,000).

“We are afraid of absurd situations regarding financial rewards of first appointed doctors compared to the specialised doctors with multiannual experience and training”, the President of Panhellenic Medical Association of Greece told Euractiv.

“If this scheme is a herald for a total revision of doctor salaries, then it is welcomed”, he added while he expressed concerns on how economic balances among different types of doctors could be achieved.

On top of that, Agapidaki also announced the implementation of a targeted repatriation program for GPs and Pathologists from Cyprus and Great Britain.

According to the Greek Association of Hospital Doctors of Athens and Piraeus, this will undoubtedly create distortions in Greek doctors’ earnings, as Greek hospital doctors earn a fraction of the €150,000 salary annually that the deputy minister mentioned.

“We didn’t participate in any discussion about the matter before the said announcements, and we expect to have more detailed information”, Athanasios Exadaktylos told Euractiv, explaining that the Panhellenic Medical Association of Greece is an agency that legally should advise the minister regarding these matters.

[By Marianthi Pelekakani | Edited by Vasiliki Angouridi]

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