As more doctors flee Romania in search of better working conditions abroad, the Foreign Investors Council (FIC) has launched a campaign in partnership with the public authorities that aims to slow down migration and promote the significant achievements of Romanian doctors. Pascal Prigent, head of the FIC’s Healthcare Work Group, outlined the main challenges in turning Romania into a career-friendly country for medics.
When did the FIC start the campaign promoting medical careers in Romania and what is your objective?
It started a while back when we were in discussions with several physicians, and we started to hear more and more the concern that a lot of young, and even not so young, doctors from Romania were actually leaving the country. We started to understand a little bit more about the issue and then we realized that already in Romania you have fewer doctors per inhabitant than in any country in the EU. It’s getting worse and worse because there are so many doctors leaving the country that every year the total number of physicians is going down: you have more physicians leaving the country than new graduates starting to work.
We though it was a very big issue for the future of Romania. We tried to understand a little bit why the physicians are leaving. Of course there is an obvious reason – people say they can make more money outside – but there are other professions where you can also make more money outside Romania and people are not leaving in these numbers.
We started to discuss it with the Association of Young Physicians, with students, with the Association of Physicians in Romania etc. We also had a survey done. The key findings of the survey were three main reasons why a doctor leaves the country. One is obvious: the economic reason, as they can make more money abroad. This we knew already and it’s true that it is one of the main factors. There are two more reasons. One is the profession’s image. In most countries, the physician has a very good image; he or she is seen as somebody you can trust and enjoys a certain prestige.
In Romania, a doctor’s image is not so good; people complain a lot about physicians, and there is a lot of negative noise, with scandals and people taking bribes. We’ve seen a lot of this. Therefore, physicians don’t feel valued. They say, I’m not earning a lot of money and also nobody really values me. Then, there is a third reason that has to do with career opportunity, namely the opportunity to do research, especially among young people.
Have you spoken with Romanian doctors working abroad in relation to your campaign? What do they say about returning to Romania at some point?
It’s interesting. I don’t pretend that I have a representative sample. I’ve spoken to a few – I don’t know if they are representative, as I haven’t done a scientific survey. But most of those I talked to are a little bit nostalgic: they didn’t leave Romania because they really wanted to live in France or the UK. They left Romania because they felt they had to. So they are a bit nostalgic and although there are things that they like in their new country, it’s not like it’s paradise and everything is fantastic. A lot of them would consider the possibility of coming back to Romania at some point, but most of them want to see changes in the system and that’s why we also have to work with the authorities to change things in the system.
We understand it’s a big societal issue. We felt we needed to do something because if we start doing something maybe another company will do something and then a third and fourth. If you have, say, 50 different projects from 50 different companies, maybe at some point it will start to make a difference. The idea is to get a snowball effect. We get it rolling and eventually at some point it will get critical mass and make a difference.
From what sectors are the companies that have agreed in principle to join your cause?
I’ve had people expressing interest from banking, the food industry, the cement industry and from oil and gas – nothing to do with healthcare, and a very wide array of sectors. All those that have expressed interest did it for the same reason: as a big employer or corporation in Romania first they need healthy employees and then healthy consumers. So they see it also as a shared value type of project that is good for society but somehow also good for them in the long term. I don’t know how much it will take. One project is not going to change anything; three or four is not going to change anything. But if we get it going, we are going to make a difference.
Do you have data on how many doctors have left Romania in the last five years?
With over 14,000 physicians having left the country since 2007, Romania’s migration rate for doctors is 9 percent, against a 2.5 percent EU average, according to the Romanian Association of Physicians (CMR). Eurostat data from 2011 suggests Romania has on average 2.4 medical specialists per 1,000 inhabitants, while the EU average is 3.4. Furthermore, studies carried out by the FIC and CMR in 2011 and 2012 show that 64 percent of the students enrolled in one of the biggest medical universities in Romania, namely 60 percent of the physicians, want to leave.
Getting the doctors back will be quite hard. What can you tell me about the financing of the healthcare system, because the authorities lack the funds to increase the healthcare budget?
Getting them back will be difficult but before we even get them back we need to prevent more from leaving. For me, the less difficult thing is to reduce the number that are leaving. The second would be to get some of those who have gone to come back. If we could reduce the numbers that are leaving, with the influx of new students we could at least get to equilibrium.
At the end of the day, there will be a financial component, although I think what we found out from our surveys is that money is not the only aspect, though it’s an important one.
For me, first there is a need to invest more in healthcare. I can’t pretend otherwise. I understand that it’s a tough economic climate, that there are many competing priorities – infrastructure is important. But there will be a need to invest more in healthcare. Currently, Romania invests about 4 percent of its GDP in healthcare. The EU average is 8 percent. Our score ranks us between Madagascar and another African country. We don’t invest enough. I think part of it is because there’s a perception that healthcare is a cost, but it needs to be seen as an investment.
There are numerous scientific studies that have demonstrated that you don’t need to be rich to start getting healthy. It’s the opposite. There is probably also a need to diversify the sources of funding and I think that was one of the principles in the healthcare reform: to progressively get private funding into the system, whether it is private insurance or private clinics. We probably need to think in terms of the state providing a certain level of coverage and then additional coverage. Also, companies could get involved.
In many parts of rural Romania there aren’t any doctors at all. This is another issue you are facing. How will you convince doctors to work in these areas?
It’s a very big issue and probably goes beyond healthcare because it also has to do with the issue of infrastructure. It’s something for which we need to think about a special incentive. I don’t have a solution; it’s one of those areas where we need to sit down and brainstorm. Is there any way to have a special incentive for people that go there? It’s not a problem specific to Romania. In France, for example, we have also seen this issue, where a big town is attractive and you have too many doctors but nobody wants to go and work in the countryside.
You can solve this by having a special incentive and also developing local networks of healthcare. At the end of the day, anybody should be able to access a reasonable amount of healthcare services within a certain time. Otherwise, you’re really creating a dual society where you have two kinds of citizens: those with access and those without access. Considering that a large proportion of the Romanian populations still lives in the countryside, we need to cater for these people.
Will more private sector help keep doctors in Romania?
I think so. The private sector can’t be the entire solution, but I think it will help because the private sector has to be competitive and therefore they are going to pay decent salaries. They will compete for the best and they will offer better career development opportunities. My view is that the private sector will help raise standards, because those people will have to be good to survive. Those that survive will help, so I think it’s part of the solution.