Why do doctors leave medicine

Pandemic accelerates brain drain : Why Polish Doctors Are Leaving Their Homeland

Wojciech Kusior has a dream. The Polish family doctor from Masuria wants to work in Germany. Preferably in Dortmund. He has liked North Rhine-Westphalia since he lived and worked in Düsseldorf for a year after leaving school 30 years ago. Kusior would have liked to stay at that time, but life got in the way. “Unfortunately it didn't work out,” he recalls.

Kusior studied medicine in Poznan. But instead of working as a doctor, he first worked on his parents' farm. The doctor has now been working in the polyclinic of a community of 4,000 people, a good 100 kilometers north of Warsaw, for ten years.

Of course he also has to do with Corona. “We are experiencing a tragedy right now,” he says. The old longing for Germany still drives him today. Kusior wants to leave Poland. The 50-year-old is looking for a change of scenery.

Several reasons play a role, as he explains, money is one of them. “The earnings in Germany are higher than in Poland.” Kusior's plan to emigrate could soon be joined by other doctors.

Underfunded clinics, high workload

The pandemic is likely to be the reason even more than money. The second and third waves hit the country hard. Doctors, nurses and paramedics worked to the limits of their resilience.

"We are one step away from being able to treat patients properly," warned Prime Minister Mateusz Morawiecki of the national-conservative PiS party at the end of March. At the beginning of April, the maximum number of newly infected people within one day was 35,251.

After a tough lockdown to prevent the impending collapse of the health system, the seven-day incidence is now falling - it is currently almost 200. But Corona has painfully brought Poland's health problems to light. The system has bled to death for many years. Hospitals are underfunded and patients have to wait a long time for an appointment with a specialist.

According to an estimate by the Medical Association, there is a shortage of 70,000 doctors in the country. Only 2.4 doctors are available on average for 1,000 citizens. It is the lowest value within the EU, as an OECD study from 2017 shows.

In Germany the rate is 4.3. The workload in Poland is correspondingly higher. A doctor there gives 3,200 consultations per year, in Germany there are 2,300.

Hundreds of doctors emigrate every year

The expenditures in the health sector amount to only 6.2 percent of the gross domestic product. This puts Poland in third from last place in the EU. Per capita spending there was almost 1,500 euros in 2019, Germany spends around three times as much.

Doctors have turned their backs on their country for years because they expected a multiple of this amount as wages abroad. Health experts warn that the existing shortage of doctors is taking revenge in the pandemic.

According to official figures, more than 20,000 doctors have emigrated in the past 20 years, accelerated by joining the EU in 2004. However, fewer and fewer have recently left.

Up to 4,000 medical graduates graduate from the university each year. According to the Medical Association, several hundred of them are leaving their homeland for the west. Many want to go to English-speaking countries, France or Scandinavia, where they can earn the most.

“Hardly anyone wants to go to Germany today,” says the operator of a mediation agency for doctors who does not want to be quoted by name. He had tried to bring more Poles to Germany, "but there were only a few interested parties," he explains. "It was different 20 years ago."

Researchers warn of a personal catastrophe

That could change again with Corona. Nine percent of doctors plan to emigrate, according to a study by the University of Krakow. "The research results herald a personal catastrophe in the health sector in the period after the pandemic," warn the researchers.

It is not uncommon for German clinics close to the border to benefit from doctors who have turned their backs on their country, and they themselves complain about a shortage of doctors. Poles often make up a large part of the workforce there.

"We depend on Polish colleagues," says Daniela Kleeberg, site manager of the St. Carolus Malteser Hospital in Görlitz, where a third of the workforce comes from Poland.

Many institutions needed the support, the Saxon State Medical Association recently declared. "This became particularly clear when the borders with the neighboring countries of the Czech Republic and Poland were closed last year," said Medical Association President Erik Bodendieck. "Without an exception for the medical field, some wards would have had to be closed."

Live in Poland, work in Germany

The Malteser in Görlitz last recruited staff in the spring. Posters were hung on the city's exit roads, including those in the direction of Poland. Your hospital is attractive because Polish employees and their families live in the neighboring country and could, for example, send their children to Polish kindergarten while they commute across the border themselves, says Kleeberg.

[Also read: The pandemic weakens the rights of loved ones (T +)]

According to the German Medical Association, almost 2,000 Polish doctors work in Germany, more than half of them in hospitals.

The emigrants are not always concerned primarily with money. For many who have completed their specialist medical degree, it is no longer financially attractive to go to another country, says Dawid Gocal, pulmonologist and senior physician at St. Carolus. “The wages are still below the German level, but they adapt, you can make a living from it. That wasn't possible in the past. "

If you are looking for an apprenticeship for a specialization, it will be easier to find it far away, says Gocal, who has been working in Germany since 2004. "In Germany there are more hospitals that can impart specialist knowledge."

Low salaries and few opportunities for advancement

Jowita Zwierzanska can confirm that. The 38-year-old works as a senior physician in neurology at the municipal clinic in Görlitz. In 2010 she started her specialist training in Wroclaw. However, there quickly grew dissatisfaction with the working conditions.

Routine procedures such as ultrasound or EKG were a rarity for them. Only a few doctors in the clinic were allowed to perform them. Patients have to pay for many services privately. Doctors use this to supplement their salaries. The average wage of a doctor is 2,200 euros per month.

Experienced doctors sometimes have little interest in investing a lot of time in their offspring, complains Zwierzanska, because that would create more competition for themselves. “They want to keep this system, because a lot is done in private practices,” says Zwierzanska.

In 2017, doctors across the country went on strike, prompting the government to slightly increase government spending on health care and the salaries of doctors. But there are still big differences in salaries between Germany and Poland, explains Zwierzanska.

Criticism of emigrating doctors

"Some doctors earn very well, others very little," says Kusior. Some of my colleagues earned “in some cases a lot more than in Germany” - especially in areas where there was a lack of specialists. “They then take advantage of the shortage,” he says, and finds “what is happening in Poland is not ethical”.

Zwierzanska only stayed in Breslau for six weeks after a colleague told her about a job in Görlitz! E. “I wanted to work in Poland, but I didn't see any other chance.” Ten colleagues from her year also went to Germany.

However, the emigrants are also exposed to criticism. When Federal President Frank-Walter Steinmeier offered help to Warsaw in the second Corona wave, a member of the PiS party replied: If Germany wanted to help, it should send the Polish doctors back from the neighboring country.

Zwierzanska heard such accusations years ago: she would betray her country and only run after the money, colleagues said at the time. She would not have been able to live on the equivalent of 900 euros gross, she replies.

Poland is recruiting doctors from Belarus and Ukraine

In order to stop the migration, “the conditions have to be changed”, says the Polish doctor. It doesn't just mean pay, but training and investments in the health sector.

She also wants to be able to interact with colleagues on an equal footing. Too often there is a strong hierarchy in Polish clinics.

[You can find all current developments in the coronavirus pandemic here in our news blog. At this point we will keep you up to date on developments in Berlin in particular.]

“The state invests money and energy in training, but in the end doesn't get any of it,” says Kusior. It is not good for the country, but understandable if someone wants to go abroad. "The state is losing," said Kusior. But the government itself is responsible for the brain drain. "We live in an open Europe."

Poland itself is now recruiting doctors from neighboring countries to compensate for bottlenecks. A simplified approval procedure for medical professionals from non-EU countries has been in place since January.

The Ministry of Health is particularly hoping for doctors from Ukraine and Belarus.

It was previously difficult for her to obtain a license to practice medicine in Poland with her foreign degree. The government now wants to attract more than 1,000 doctors.

A possible incentive for them should be the higher salaries in Poland. How many come because of it is questionable. Many are allowed to move further west where they earn more.
The research was supported by the Foundation for German-Polish Cooperation

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