There has been a growing deficit in recent years of employees in the Polish healthcare system. Staff shortages in hospitals and clinics have become more severe due to emigration of medical personnel and the COVID-19 pandemic. On December 28, 2020, President Andrzej Duda signed the Law “On Amendments to Certain Laws in Order to Provide Medical Staff during the Period of Epidemic Emergency or an Epidemic State”. It provides for a simplified procedure for the recruitment of doctors, dentists, nurses, midwives, and paramedics with professional qualifications obtained outside the European Union.
Problems in the Polish healthcare service and attempts to solve them. The Polish healthcare system has been struggling with staff shortages for a while. The COVID-19 pandemic has exacerbated this problem even further. According to data from the Supreme Medical Council (SMC) from January 2021, the number of members in the Council is currently 196,738, including 153,238 doctors and 42,895 dentists. At the same time, the number of practicing doctors and dentists is 181,126 people, including 142,239 doctors and 38,445 dentists. Despite the recently introduced vaccinations, this group of professionals is most exposed to SARS-CoV-2 infection. The disease has contributed to the death of 86 doctors, 67 nurses, 2 laboratory workers, 12 dentists, 5 pharmacists, 7 paramedics, and 4 midwives, according to the estimates of Poland’s Ministry of Health of February 5, 2021.
The SMC currently estimates a deficit of doctors of approximately 68,000. According to the latest edition of the OECD report “Health at a Glance 2020”, which was based on the data from 2018, the number of medics in Poland per 1,000 people was 2.4 doctors and 5.1 nurses, while the EU average was 3.8 and 8.2 respectively. The most needed specialties are general practitioners, anaesthesiologists, radiologists, paediatricians, specialists in the field of emergency medicine, infectious and internal diseases, and nurses. The main reasons for the shortage of health professionals are emigration of young doctors, low salaries in the country compared to Western Europe, and underfinancing of medical universities.
In order to counteract the staff deficit, the Polish government opened its borders to doctors from outside the EU. On November 27, 2020, the Sejm had adopted the Law “On Amendments to Certain Laws in Order to Provide Medical Staff during the Period of Epidemic Emergency or an Epidemic State”. It provides, among other measures, a simplified path to employment in Poland for medics who obtained professional qualifications outside the EU. President Andrzej Duda signed the law on December 28, 2020. This document stipulates that the recognition of diplomas, postgraduate internships, and passing appropriate medical examinations are not required. However, at least three years of professional experience in the last five years, sufficient knowledge of the Polish language, and obtaining a certificate from an entity performing medical activities in Poland are required. A conditional license to practice as a doctor or dentist is valid for a period of five years. After that the person can continue working in the profession only if a medical diploma recognition has been obtained or a Medical Verification Examination has been passed, completing or recognizing the postgraduate internship and passing the Final Medical Examination.
The state of the healthcare system in Ukraine. For many years, the healthcare sector in Ukraine has been financed at the level of 3-3.5% of the GDP. Despite the fact that in the state budget for 2021 36.8% more funds were allocated to this sector than in the previous year, the situation has not improved. Expenditures envisaged by the state budget for 2021 for the Ministry of Health of Ukraine are set at UAH 159.2 billion (USD 5.47 billion), of which UAH 35.2 billion has been allocated to finance the Ministry’s employees, UAH 116.2 million for the State Drugs and Medications Control Service, and 123.8 billion UAH for the National Health Service of Ukraine (NHSU). Most of the NHSU funding – UAH 123.5 billion – is targeted at continuing the implementation of the state medical guarantees program, which started in full on April 1, 2020.
From the Ministry of Health’s point of view, the funds allocated by the state are insufficient for proper functioning of the medical system. In the budget request for 2021, the ministry suggested UAH 296 billion (USD 10.2 billion). This sum included UAH 225 billion for the implementation of the state medical guarantees program, which is 5% of GDP, in line with the requirements of the Law “On State Financial Guarantees for Medical Care for the Population”. According to the Minister of Health of Ukraine, Maksym Stepanov, this amount would allow for setting sustainable pricing in medical care and would significantly increase the salaries of healthcare workers. However, the Ministry’s proposals were not taken into account by the government or the parliament.
As a result, the salaries of the doctors did not increase in 2021 to UAH 23,000 (approx. USD 790) per month, nor did the earnings of middle and junior medical personnel increase to UAH 17,000 and 12,000 respectively, as the Ministry of Health suggested. The salaries of the medical personnel, which went up temporarily in 2020 because of the onset of pandemic, have now returned to the average level from before the pandemic, i.e. to approx. UAH 9,000 for doctors (approx. USD 310), UAH 7,000 for nurses, and UAH 5,000 for nursing assistants per month. The slight growth in earnings for healthcare workers was caused only by an increase in the minimum wage on January 1, 2021, from 5,000 to 6,000 per month (taxes included). However, against the background of inflation, rising prices of basic goods, and fees for housing and utilities, this increase did not improve remuneration in healthcare services. Thus, the level of salaries of healthcare workers remains one of the lowest among sectors of the Ukrainian economy.
This leads to a worsening of staffing problems. The accelerated reduction of doctors, nurses, nursing assistants, and midwives has been observed since 2018, when reform of the healthcare financing system in Ukraine began. The latest available data were provided by the Medical Statistics Centre of the Ministry of Health on the eve of the COVID-19 pandemic. According to these data, as of December 31, 2019, the medical care in healthcare facilities was provided by a total of 184,713 doctors of all specialties (including dentists) and 330,322 nurses. Most of them worked in institutions that belonged to the state. Only 11.1% of doctors (mostly dentists and dermato-venereologists) and 5.7% of midlevel medical personnel indicated private institutions as their main workplace. Since 2014, there has been an increase in the share of health professionals in the private sector.
At the end of August 2020, the Ukrainian healthcare system lacked over 24,700 doctors, including approximately 8,000 in rural areas. In total, about 34,000 medical workers left their service from the beginning of the COVID-19 pandemic to November 2020, according to the statistics from the Minister of Health. This number includes those who were dismissed or retired, as well as those who did not want to risk contracting COVID-19 due to insufficient wages and those who decided to move abroad. Poland is one of the main destinations in Central Europe for emigration of Ukrainian medical workers.
Doubts and fears. Both the Polish medical community and Polish employers are quite sceptical about the idea of employing medical personnel without a recognized diploma and without a language exam. This is mainly due to the fact that the administrative bodies of hospitals and clinics, as well as guardian doctors, will be responsible for the actions of medics from outside the EU. Critics of the law argue that the liberalization of employment of foreign medical workers may pose a threat to patients’ health and the healthcare system and may also lead to a reduction in the standards of medical care.
However, if medical professionals from outside the EU are not employed, some Poles may be deprived of medical care or access to certain specialists. The Polish healthcare system should not allow this to happen because the shortages of medical staff would increase the burden of the currently working doctors and nurses, inevitably affecting the quality and availability of medical services. The invitation of medical staff from outside the EU will help to reduce the staffing deficit of the Polish healthcare services and to fill existing vacancies. Past experience of adaptation of Ukrainian specialists in other sectors of Polish economy has shown that they effectively contributed to the economy.
In the period before February 3, 2021, the Ministry of Health of Poland received 74 applications asking permission to practice the profession under the so-called simplified system, and five doctors from Ukraine and Belarus have already obtained positive decisions from the Minister of Health. It is also worth noting that at the end of January 2021, 1,594 doctors from abroad have been working in Poland, including 318 from EU countries and 550 from Ukraine.
Conclusions. The Polish healthcare system lacks approximately 68,000 doctors. Due to the emigration of medical personnel and the COVID-19 pandemic, staff shortages in the sector have become even more severe. In order to mitigate this deficit, the Sejm of the Republic of Poland adopted the law amending certain laws to counteract crisis situations related to the emergence of COVID-19. This document provides for a simplified procedure for employing medical professionals with qualifications obtained outside the EU. The statistical data on the current level of employment of foreign physicians in Poland show that the authorities rely primarily on the arrival of medics from Ukraine.
The Polish labour market is attractive for Ukrainian medical workers for the following reasons: low wages in Ukraine (they are among the lowest of all the sectors of the economy), the reduction of medical positions due to reforms in the health service, and territorial, cultural, and linguistic proximity of both countries. Among the obstacles that may prevent medics from coming to Poland are a lack of fluent Polish language (oral and written) and an inadequate level of qualifications of doctors, etc. However, these problems can be successfully solved, as the practice of involving Ukrainian specialists in other sectors of Polish economy has proven to be a success.