The shortage of physicians and public healthcare

The recent Euro Health Consumer Index says that “Romania does have severe problems with the management of its entire public sector, ranking last among 35 European states.

Christine Leșcu, 14.02.2018, 14:29

The Romanian healthcare system has such vulnerable points as the way patients are treated, Romania ranking among the last countries in terms of the patients’ rights and information, access to treatment, services provided and prevention.

However, patients can express their views in various surveys, objective data being thus completed by subjective impressions. One such survey was conducted by the Coalition of the Organizations of Patients with Chronic Diseases in Romania. Luminita Valcea, a member of the coalition, tells us about the patients’ main dissatisfactions:

Luminita Valcea “According to our survey, which involved some 300 patients, one of three patients was diagnosed in more than 6 months or even after one year. A quarter of our respondents say that there is no specialized physician, who can treat or monitor their disease in the town where they live. One of three patients has not received detailed explanations from the doctor after he was diagnosed. The survey also shows that one in five patients did not understand the doctor’s explanations. In most of the cases, the doctor just told them the treatment, without mentioning alternatives.”

The patient-doctor relationship is confronted not only with communication problems. The patient’s integrated treatment is missing and also missing are specialists, as Luminita Valcea points out.

Luminita Valcea “As far as chronic patients are concerned, we don’t talk only about the first diagnosis or the diagnosis for their main disease because chronic patients can also develop collateral ailments. That triggers additional problems, because the treatment of a certain disease can be contraindicated for other diseases. There is no system where the patient should be regarded as a whole with all his or her diseases and get an adequate treatment for all of them. It’s true, a lot of physicians have left the country and so have a lot of nurses. Moreover, the number of specialists has dropped dramatically.”

According to the National Institute of Statistics, some 15,700 Romanian physicians work abroad. Can the shortage of physicians be an explanation for the Romanian healthcare system as highlighted by the Euro Health Consumer Index? Stefan Voinea, a member of the team working on a project of the NGO the Romanian Health Observer explains.

Stefan Voinea: “There is a clear-cut connection between the de-professionalization of the Romanian healthcare system, the great number of physicians who leave, and the situation we’re in at the moment. There is this brain drain phenomenon, and we are currently facing a situation in which the system barely survives being largely based on resident physicians who do way too many on-call shifts. And so it happens that the remaining physicians get more and more exhausted. Mix that with the poor wages in the system and the lack of a strategic vision regarding human resources, and you’ll see why we’ve ended up in this situation.”

It is not only the low incomes, mainly those of the medical doctors who are at the beginning of their career, that explain the aforementioned brain drain. Technical facilities in German or French hospitals as well as the lack of professional promotion opportunities in Romania are also to blame for the situation. Speaking about that, here is Stefan Voinea once again.

Stefan Voinea: “The promotion system is so closed up; there are castes and insider groups that are prompting many young doctors to leave because they feel they cannot penetrate the system. There are many people who, because they lack the required connections, are unable to get a job. Furthermore, a hospital manager told me that, although he did have the available jobs for medical doctors, he wasn’t going to put them up for a competitive exam as certain people in the local administration would fight him, since each of them had their own favorite candidate for those positions.”

Despite the fact that the aforementioned problems have been exposed, patients declared themselves satisfied with the treatment they got in Romanian hospitals, According to the satisfaction questionnaires dispatched by the Healthcare Ministry and electronically filled in by more than 120,000 patients, the general satisfaction rate as regards the medical services offered by hospitals stood at 79.8%. Patients in Romania may have low expectations and the satisfaction of having survived and recovered from illnesses could influence their perception of the system, experts with the Romanian Healthcare Observer believe.

The aforementioned questionnaires may also contain not-so-pleasing information. In some cases the medical staff have allegedly demanded money or gifts from more than 4,000 patients, accounting for 3.92 per cent of the total number of respondents. Here is Stefan Voinea once again.

Stefan Voinea: ”In such a case, it is of crucial importance to make a distinction between informal payments, which the physicians do not demand and which unfortunately have become customary in the Romanian medical system, and the conditioning of the medical act. So in this case, to me, those more than 4,000 patients are in no way a small number, since it appears that there are more than 4,000 cases in which the medical act seems to have been conditioned. And that is something very serious.”

In order to secure a better knowledge of the patients’ opinions, experts recommended the Ministry that the present mechanism of fathoming the patients’ degree of satisfaction after a consultation session with their family physician be extended.