site.bta5th Medical Barometer Conference Focuses on Personnel Shortage in National Healthcare System

The shortage of personnel in the Bulgarian healthcare system was in the focus of the fifth conference under a civic initiative called Medical Barometer, held in Sofia on Thursday.

Bulgarian Medical Association (BMA) President Nikolai Branzalov said at the conference that in 13 of Bulgaria’s 28 administrative regions more than half of doctors are 61 years old and older. BMA data show that Bulgaria has 34,022 doctors, some of whom are not practicing. “Doctors in Bulgaria are very accessible, old, and underpaid,” Branzalov summed up.

He noted that the average age of practicing doctors in Bulgaria is 53 years. “Ten years from now, half of them will have left the country for various reasons,” he added. More than 15,000 doctors are over 50, and 12% are over 70. The youngest average ages are reported in places where there are medical universities.

About 70% of the nation’s 2,257 pediatric disease specialists are 61 and older. Bulgaria has only 211 infectious disease specialists, and the regions of Pernik and Dobrich have only one each, aged 61 and 51, respectively, Branzalov said.

In five years’ time, one doctor in three will be over 70. Nearly 1,000 medical students graduate as doctors annually, but between 400 and 500 of them leave the country or the profession, the BMA chief said.

Medical Barometer founder Daniel Valchev, who is Law Faculty Dean at the University of Sofia, said that available information about the national public health system is scattered, with multiple organizations using different methods to gather and collate the same information, which eventually produces incoherent data. Incomplete information shows that the number of doctors has increased by 1,500 in about 10 years, but medical specialists have decreased. The increase in doctors comes from their numbers growing in just seven regions and falling in the remaining 21 regions.

When the political configuration changes, the continuity of government policies is broken and processes in the public systems are interrupted, said Valchev, who is also former deputy prime minister and former minister of education and science. Such interruptions seem to be most significant in healthcare, he added.

According to further information presented at the conference, there were 44,523 nursing associate professionals in Bulgaria in 2023, which was 30 more than in 2022 but 3,283 fewer than in 2012. Three administrative regions saw an increase in nurses in 2023 compared with 2012, and the remaining 25 regions reported a decrease, which averaged 16%, with Kyustendil, Dobrich and Lovech losing more than 30% of their nurses.

Lachezar Traikov, former rector of the Medical University of Sofia, said that students’ interest in specializing in pediatrics has increased for the first time in years. The share of those choosing a pediatrics specialist course has grown from 3% four years ago to 12.3% currently. Traikov speculated that the government has mobilized resources for the training of pediatricians probably because a national children’s hospital is being built in Sofia. Cardiology (9.1%) is the second most preferred branch of medical specialist studies after pediatrics. The share of those who choose to study emergency medicine is 0.7%, the same as with pulmonology, while psychiatry accounts for 1.3% and general medicine 1.7%.

For the second year in a row, 13% of graduating medical students have not made up their mind about what specialty course to take, Traikov said. He noted that it would be wise to encourage them to specialize in domains which are short of personnel. Young doctors who prefer to build a career in Bulgaria rather than abroad, most often refer to a sense of duty to their home country and a strong national awareness as their reasons to do so. Family and friends are their second most important reason. Next comes a perceived moral obligation, and finally, a desire to develop medicine in Bulgaria.

So long as the funding of hospitals is contingent on their own earnings, there will be no doctors working in underpopulated and remote areas, haematologic oncologist Georgi Mihailov said. He noted that 80% of hospitals in Bulgaria are situated in five cities, and that is where young doctors want to work.