Four out of ten doctors offering services in 11 medical clinic networks works exclusively in the private healthcare system, according to an analysis by Ziarul Financiar based on data provided by medical companies.
Ziarul Financiar has attempted to draw up a first statistic of the number of doctors that have left the public healthcare system and has requested information from the main players on the local private medical services market. On the other hand, the Health Ministry doesn’t know how many doctors work exclusively in the private sector.
Existing data from the Health Ministry and the National Statistics Institute don’t provide accurate information on the matter, as statistics only count doctors who have working contracts in the private sector but don’t specify whether they also have services contracts within the public healthcare system.
According to data, which are the same, from the two institutions, the number of doctors working in the private sector has reached 11,028, from less than half in 2005.
However, data required by ZF show that nearly 2,100 doctors working in private networks such as MedLife, Regina Maria, Gral, Medicover, Medsana, Romar, Arcadia, Anima, Delta Hospital, and Euromaterna have decided a long time ago to leave the public healthcare system and seek higher wages.
The ten private medical companies employ nearly 5,000 doctors, both full time and as collaborators.
More and more doctors work in several private clinics
“There are times when equipment in state hospitals doesn’t work (…), and the income per hour is less than half compared to the private sector. I’d rather work two hours in a private healthcare facility,” says Gheorghe Iana, a university professor who runs the radiology and imaging clinic of the Bucharest University Hospital, and who collaborates with the Elim medical center in Bucharest.
Iana was the manager of the Bucharest University Hospital between 2006 and 2009. The University Hospital is one of the largest hospitals in Romania and the Ministry of Health has placed it in the top category but the hospital still needs to meet certain criteria to remain in that category.
Asked whether he is considering leaving the public sector, Iana said he is and the private sector is an alternative if authorities don’t invest in the public healthcare system.
“The market is not very developed, but two years ago this number would have been a lot lower, below 10%,” said Fady Chreih, executive manager of the Regina Maria network, a private medical services company that employs 1,000 doctors. Of these, 60% are collaborators who also work in state hospitals.
The survey conducted by ZF has shown the only unit whose doctors work exclusively in the private sector is the Euromaterna maternity hospital in Constanta, southeastern Romania.
The maternity estimates a sales figure of EUR4 million this year, up 14.2% compared to last year, due to increasing demand for private medical care. The unit had sales of EUR3.5 million in 2010.
Low wages in the public sector, the heavy workload, on the one hand, and the opportunities offered by the expansion of private clinics prompts doctors to go work in the private sector.
Still, there are very few cases where doctors are loyal to a single private operator and most try to boost their income by working in as many clinics as they can.
“In the past years, a new category of collaborating doctors has emerged. They don’t have a position in a public hospital but have several part-time contracts with different private clinics and thus maximize their income. This category includes ultrasound technicians, radiologist, biologists, lab technicians,” said Cristian Sas, chief operating officer of Anima clinics, an operator that entered the Romanian market in 2010.
Young doctors have no choice: they can only work in public healthcare
According to previous data obtained by ZF, the average salary of a doctor working in the private sector is of 3,000 lei (EUR714) countrywide, while in Bucharest, the average salary amounts to nearly RON4,000 (EUR952).
The top of the pyramid belongs to “celebrity – doctors” who can earn as much as EUR3,000 – EUR3,500 a month.
By comparison, at the Floreasca Emergency Hospital in Bucharest, one of the top hospitals in the country considering its doctors, a resident doctor’s salary starts at RON900 (EUR214), while a primary care physician’s salary starts at RON1,200 (EUR285).
Still, most doctors in Romanian state hospitals who decide to leave the public system go abroad, and over 4,000 doctors have migrated in the past years.
But young doctors need experience before they can work in private clinics, so they have no choice but to start in the public healthcare system.
“I’ll work in the public system because there’s a slim chance of being hired in the private sector unless you have experience and can even bring patients with you. I’ll start out with the minim wage, of about RON700. I think it would be normal for my wage to be higher than that of a flower vendor, who can earn RON1,200 in Bucharest,” says Andreea, a fresh graduate of the Carol Davila Medical University in Bucharest.
Forced to choose between public and private healthcare
Last year, former health minister Cseke Attila was the first to call attention to the situation of doctors working both in the public and private healthcare sectors and proposed that they be forced to choose between the two.
The former minister cited cases when patients who go see a doctor in the public system are brought to private clinics by the very doctors that examine them in public hospitals.
“The patient goes to a public hospital in the morning, gets tested, and is then called in the afternoon, by the same doctor, to go to a private clinic, where he is many times forced to pay. Basically, a patient who pays social security contributions ends up paying for a service performed by the public hospital, using the funds of the public hospital, because it is performed by the same doctors who works both in the public and the private system,” Cseke said last year.
(English version by Oana Gavrila)