MEDICAL students in Slovakia currently show little interest in working as general practitioners in regional clinics. This means that the average age of such doctors has gradually increased, and now stands at about 55 years. This was one of the arguments that the Health Ministry used when presenting its new concept for education for young medics, the so-called Residential Programme. It is designed to make the specialisation of general medicine more attractive, partly through allowing students to gain experience directly at clinics rather than hospitals.
“Unfortunately, we do not have enough young medics who want to devote themselves to this specialisation [i.e. general medicine] after graduation,” Health Minister Zuzana Zvolenská said, as quoted in a press release.
The aim of the new strategy is, according to the ministry, to decrease the average age of general practitioners, significantly improve the level of education in general medicine and improve the quality and accessibility of primary health care.
The programme, composed of two parts called Medics and Residents, will be co-financed from European Union structural funds, which will contribute €2 million during the first two years of its operation.
The Slovak Society of General/Family Practice SLS (SSVPL SLS), which unites general practitioners, has welcomed the initiative, saying that the ministry has realised how serious the situation is. But it says details are still lacking, especially in terms of money.
The main problem that graduates who want to go into general practice have to face is that their starting salary is zero, since they do not get a job at a hospital, unlike their counterparts in other specialisations. Moreover, they have to obtain work experience for which they do not get a salary; instead they are required to pay between €100 and €400 a month for it. This creates financial barriers to anyone who wants to become a general practitioner, Peter Makara, head of the SSVPL SLS, told The Slovak Spectator.
According to him, the Residential Programme should deal with providing graduates with money to cover the practical stage. The association now expects the ministry to obtain the money needed and present them with a detailed concept and rules.
“Financing is the fundamental component of the project, and without resolving details of financing we cannot talk about a successful launch of the Medics part of the project,” Makara said.
The Slovak Medical University in Bratislava (SZU), which plans to cooperate with the Health Ministry during the pilot phase of the programme, also praised the government’s initiative.
“It is a method which has the potential to help move health care provided by general practitioners to the level which everyone, including the medical public as well as patients, expects,” Martin Urmanič, head of the media-marketing department at SZU, told The Slovak Spectator.
The pilot phase of the Medics part of the programme could be launched during the next school year in cooperation with medics from the SZU. Aside from lectures, students will go through practical training in regional clinics where general practitioners work.
“It is added value for fifth-year students since up to now they have been acquiring theoretical knowledge and practical skills only in lecture rooms and in-patient facilities,” Monika Palušková, the main expert of the Health Ministry for general medicine, said, as quoted in the press release.
Urmanič added that the school would inform its students about the opportunity to participate in the programme. He said he believed that students would be interested and willing to take part.
The second part of the programme, entitled Residents, will allow young doctors to acquire specialisation at regional clinics, in a process which should last three years and three months, according to the ministry plans.
Palušková said that general practitioners have been waiting for changes to the system for several years.
“I am glad that we managed to create project which can strengthen our advice and show students that work in clinics is varied and interesting, and that the task of general practitioner in the health-care system is really important,” she said, as quoted in the press release.
Other problems for general medicine
As well as the high average age of doctors, Makara also identified other problems that general practice currently faces. One of these is a lack of money, which at the moment only covers about 60 percent of the costs of the clinics. This lack of money means that private doctors do not get paid as much as doctors in hospitals, who receive salaries set by law, Makara said.
Moreover, he pointed to some prescription and competence restrictions which “prevent comprehensive and quality treatment [being provided to] patients”. Makara hopes that the Health Ministry will try to remove these legislative obstacles in order to improve the accessibility, complexity and quality of primary health care.
“A successful Residential Programme might be the first stage in improvement,” he told The Slovak Spectator.