Croatia's smaller hospitals face doctor exodus after contract changes

Croatia's healthcare system faces a growing crisis as smaller hospitals struggle to maintain essential medical services due to a significant outflow of specialist doctors.

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As soon as they pass their specialization exam, they resign. 23 specialists have left the Sisak hospital, mostly internists, mainly for Zagreb or larger clinical centers.

Two years ago, the country abolished contracts that previously bound newly qualified doctors to work in hospitals that funded their specialization for a set number of years. This change, intended to free doctors, has instead created a "brain drain" from smaller regional facilities to larger, often Zagreb-based, clinical centers.

Young doctors now find it easier to secure specialized training at smaller hospitals, which are often less competitive than major urban clinics. However, immediately after completing their specialization, they terminate their contracts and seek positions in larger hospitals. In one instance, a newly specialized doctor resigned on her very first day of work, just minutes into the afternoon shift.

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Doctors are no longer motivated by money; they seek greater protection, meaning that in a large hospital there are more professional, rested people, which reduces the possibility of error, which is more likely in a smaller hospital due to the large number of shifts and consequent fatigue, all due to a smaller number of doctors.

Igor Vrga, director of the Sisak hospital, highlighted the severity of the issue, reporting that 23 specialists, primarily internists, have left his institution for larger centers. He noted that financial incentives are no longer the primary motivator for doctors' departures. Instead, they seek the greater professional support, reduced risk of error due to less fatigue, and better working conditions found in larger hospitals. This creates a vicious cycle where the remaining, often overworked, staff in smaller hospitals face increased pressure, making the situation more precarious.

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Staff planning is almost impossible because a trivial reason is enough for them to change institutions without any consequences or penalties.

The difficulty in staffing has led to a surge in demand for temporary medical assistance from other institutions. This has driven up costs significantly, with the price for a single on-call shift reportedly doubling from 500 euros to 1000 euros in the past year. Vrga argues for the reintroduction of some form of national obligation for doctors to stabilize the system, suggesting that those who abandon a specialization should be required to work in primary care or emergency services for three years before pursuing another specialization.

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In the interest of stabilizing the system, some national obligation for doctors should exist because, as he points out, it is also stated in the Constitution of the Republic of Croatia.