The constant shortage of money in Bulgaria’s healthcare system generated huge tension between medics and patients. However, it influences negatively the incentives for career development of those who work in the system. The low wages makes younger medics such as nurses, midwifes, rehabilitation therapists and laboratory assistants depart to other EU member states and other countries with better conditions.

The medical personnel receive very good education and qualification in Bulgaria. That is why they are highly esteemed worldwide. Even if the number of the people studying medicine increases, there will be always a lack of personnel, says Professor Stanka Markova who is an honorary Chairwoman of the Bulgarian Association of Health Professionals in Nursing. “No matter how many nurses graduate from universities in Bulgaria, they would be enough to cover the needs of one EU country only, let alone the whole European Union”, contends Professor Markova. The young professionals depart abroad right after they graduate from college the moment they sign in the professional register proving their qualification. Bulgarian nurses live and work in the EU, as well as in Canada, the USA, Libya, Algeria, Qatar, Bahrain and the Republic of South Africa. “Young people study these subjects knowing that they will later make career abroad. That is why they study foreign languages very hard”, Professor Markova further says. In Bulgaria they are paid between EUR 225 and EUR 300 depending on their qualification and the work intensity. These people have very little chances to make career in this country. A given nurse for example can become a senior nurse after many years of hard work in Bulgaria, let alone those who work for the general practitioners who usually work as secretaries. In Germany there are seven levels of career development. The nurses visit training courses to reach higher qualification level, specifies Professor Markova. In Bulgaria the hospital managers usually say: “Why give a certain qualification to a nurse, if she will anyway depart abroad?” In the beginning of the transition period there were some 55 thousand nurses in Bulgaria. Now there are just under 25 thousand nurses, of whom only 4% are aged thirty or under. “This is partly due to the clumsy reforms at the national healthcare system”, Professor Markova went on to say and added:

“Every new government and new Minister of Healthcare was pretending to make reforms in the system and their first steps were linked with staff cuts. The people who were usually made redundant were mainly nurses. Some of them retired, others went to work somewhere else and many nurses took different qualification, because of the low wages. The average age of the nurses who are currently working in the healthcare system is forty nine. Some 3 600 nurses have already reached retirement age and some of them work until they turn seventy, if they are fit enough to do the job, because they would receive meagre pensions after their retirement and most of them say they would not survive if they do not work.”

Over 65% of all nurses in Bulgaria have at least two jobs - in a state-owned hospital for example and a private one where wages are much higher. The pay in many hospitals in Sofia could reach up to EUR 500 for senior nurses, provided she works in a surgery or at intensive care department. “The managers of the private hospitals are forced to pay higher wages due to the lack of personnel”, Professor Markova says and adds:

“A surgery nurse in Great Britain for example could get around GBP 4, 000 - 5, 000 per month. I personally met a senior nurse whose monthly pay amounts to GBP 5,000. However, if nurses work in care homes, their pay is around EUR 1,200 per month,” contends Professor Markova.

The lack of medical personnel in Bulgaria is felt in all hospitals in Sofia and the big Bulgarian cities. This problem is not so huge in the municipal hospitals in smaller towns where the average age of the nurses is higher.

English version: Kostadin Atanasov