Dr. Tsvetan Raichinov, Chairman of the Bulgarian Medical Association: We have no dialogue with the Ministry of Health

- Mr. Raichinov, what are the matters which the Bulgarian Medical Association intends to tackle at the beginning of 2012?
- The first thing that we want to do is to start the activity of the Accreditation Council at the Bulgarian Medical Association and establish the rules for good medical practice in various specialities. The Council will have two main tasks – the postgraduate education and the training of doctors in continuing education programs. The establishment of rules for good medical practice in various specialities has been delayed over the years. No one has worked on this issue. We started dealing with this issue last year -a slow and difficult process because we needed to reach agreements with the organisation of the specialists’ companies and with the medical universities. It took time to convince each other that we have to work in one direction - in favour of the physicians, for the patients’ benefit. We wanted to create a clear predictable system for training of doctors, criteria for training, criteria for those who would do the training and for the training events themselves. Meanwhile, the drafting of rules for good medical practice was initiated. Collaboration with the Ministry of Health was needed there, as the rules should be approved by the Minister of Health. The rules were drafted and sent to Mr. Stefan Konstantinov for approval. We have no response so far. The rules have to be supplemented with medical records which, generally speaking, contain two things - what is required to be done in the case of a specific disease, what is recommended and what is prohibited. Otherwise, the rules are quite general.

- Messages were released about a likely closure of community hospitals because they will not be able to sign contracts with the National Health Insurance Fund (NHIF) due to administrative obstacles?
- What I’m hearing of such hospitals is that mainly the funds they earn are not sufficient to cover their expenses. They cannot meet the liabilities accumulated in previous years. Hospitals without sufficient staff will not be able to conclude contracts with the NHIF, but this is not an administrative reason.
I have learned recently about a hospital in Velingrad which was facing closure. But the personnel was increased there from 12 to 30 doctors and now they earn about BGN 400, 000 per month. The lack of staff is the main problem of these hospitals. The shortage of specialists and the corresponding regulations established by the Ministry of Health on the standards and level of competence are crucial, regarding the contracts which hospitals will sign. If these do not meet the standards and the requirements for level of competence, they will be able to operate at lower levels, but then their incomes will be less because of the fewer Diagnostic Related Groups serviced, which are not paid so well. That's the problem.

- The shortage of staff seems to be a major problem ...
- Doctors have left and continue to leave the country. Our universities are very good. Before, only medical specialists with experience were sought abroad, but now they take them from their student days and train them on the spot. The fact is that universities have recently worked to create medical staff primarily for Europe. The bad thing is that our outstanding, experienced doctors have left the country. These were more than 600 in the previous year. Assuming that we produce 100-200 medics per year and half of them go abroad, there is no way to cover the loss. Training a doctor takes at least 15 years. You have 6 years of university training, 5 years for the acquisition of a specialty and 5 years for recognition of the doctor’s name and for his further training. The trouble is that we talked about a shortage of specialists in smaller hospitals before, but now even larger hospitals face the same problem. Especially when in comes down to the most deficit specialists in pathoanatomy, anaesthesiology, and imaging diagnostic recently. Paediatricians are not sufficient either. There are regions in the country where there is not even a single doctor in some of the deficit specialities.

- And the situation seems dire ...
- There is a solution, of course, but it largely depends on how the system will be changed in order for three things to happen. First, doctors should be granted good jobs in terms of working conditions. Nice hospitals, well managed, well equipped and they should be offered better pay and enough training time. When all these conditions are met, then we will be able to keep our medical staff in the country. The example of Europe is quite indicative. Nobody dares to intervene roughly in the established health systems. This rule is not observed only in Bulgaria. Reforms are being launched and intentions are being announced, and nothing happens afterwards. That is why these attacks and the staged campaign against the medical profession as a whole started - because the expectations for good healthcare cannot be met. The doctors are not the guilty ones - otherwise they would not be sought abroad. I cannot see any French, English, German specialists waiting to get the unoccupied positions of physicians in Bulgaria and coming to work here.

- Do you really think that it comes down to a staged campaign?
- Of course. I know that it was so and that it was provoked by someone. I am not going to name anyone. The peoples’ misery and distress were used for other goals. If not - my condolences to all those who have been affected by unpleasant circumstances. We do not differ from the medical practice in the world, but when you cannot solve the problems in a system, then the easiest move is to start looking for guilty persons and to blame the people who work in it.

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