Medical collapse on the horizon: how the emigration of doctors is destroying the Ukrainian healthcare system
Ukraine found itself in the face of another crisis, which could have catastrophic consequences for each of us. The war led to serious tectonic shifts in Ukrainian medicine – since the beginning of the full-scale invasion, Russian attacks have killed 194 civilian doctors, saving the lives of others. Hundreds of hospitals have been destroyed, most of the medical facilities are under occupation, and hundreds of thousands of doctors have gone abroad. The Ministry of Health is sounding the alarm, because there are currently approximately 12,000 unfilled medical vacancies in Ukraine.
The crisis of the medical system in numbers
Experts predict that by 2030, the staffing of medical institutions in Ukraine will be only 75% of doctors, and 73.6% of the need for middle and junior medical personnel. But was it only the war that caused the mass outflow of medical workers?
Hundreds of thousands of doctors are moving abroad in search of better working conditions, leaving behind devastated hospitals and queues of patients who do not receive care. Doctors started leaving Ukraine since the beginning of the pandemic. Yes, for calculations experts, during 2020, due to unsatisfactory working conditions, such as the lack of personal protective equipment, a sharp increase in workload, and an outdated material and technical base, more than 34,000 medical workers were laid off.
For data research According to the Ukrainian Center for Health Protection, as of the end of 2022, there were 6,300 fewer doctors in medical institutions subordinate to the Ministry of Health than at the end of 2021. The number of junior and intermediate medical personnel (nurses, nurses, paramedics, paramedics) decreased by 35,000.
Today, the combat zones of Donetsk, Luhansk, Kherson and Mykolaiv regions are the least equipped. The problem is acutely felt throughout the country in rural areas, where doctors have always been in short supply even in peacetime.
The development of the medical industry is complicated by the aging of personnel – almost a quarter of doctors (23.6%) and 11% of middle and junior medical personnel have reached retirement age.
Despite the state’s loud statements about raising the level of wages for medical workers, it remains one of the lowest in the economy. At the same time, there is a very noticeable imbalance between the incomes of medical workers who hold administrative positions (the average salary is 23.5 thousand UAH) and medical personnel who are directly involved in medical practice (the average salary is slightly more than 8 thousand UAH). That is why we observe a sad picture, when every day dozens of qualified doctors are forced to leave the country not because of desire, but because of the impossibility to live and work with dignity in their country. A doctor with 20 years of experience earns so much in Ukraine that he cannot provide for his family. At the same time, his colleagues in Europe earn many times more for the same work. This cannot help but encourage the search for a better destiny abroad.
In addition, due to a staggering shortage of personnel, those doctors who remain are forced to work overtime. But instead of the expected gratitude, they often face criticism and bureaucratic humiliation. And this despite the fact that many hospitals lack modern equipment, and sometimes even basic medicines. Doctors are forced to look for a way to help the patient literally “on the knee” with improvised means. Meanwhile, the government is engaged in empty reforms. There is neither a systematic approach nor real changes that would improve the working conditions of doctors.
As a result, Ukraine is already feeling the consequences of the outflow of doctors. But this is only the tip of the iceberg. In rural areas, there are almost no doctors, and in cities there are only units that physically do not have time to serve all patients. Due to the lack of doctors, even simple diseases become fatal for many people, because they simply do not receive timely and proper medical care. Meanwhile, young doctors en masse go abroad at the internship stage, seeing no prospects in their native country. And it is not surprising, because in neighboring countries, the salary for their work by profession is on average 4-5 times higher than the Ukrainian one. According to various sources, Ukrainian nurses abroad are offered a salary of 700 euros per month at the initial stage of work. Qualified doctors in Europe can earn between 1,500 and 3,500 euros.
But even here, not everything is as good as it seems. Brothers of our doctors who have just graduated from the university are interested abroad. But it is already more difficult for older people to find a job. In addition, Ukrainian doctors who have moved abroad, especially to EU countries, have to overcome the difficult path of licensing and confirmation of their specialty. The process includes several stages: confirmation of diplomas, passing language exams, as well as taking specialized medical exams that meet the requirements of the host country. Due to differences in health care systems and high standards, the procedure often takes from several months to several years. The requirements can be tough and require additional training, internships, as well as significant financial costs, making it difficult to quickly start practice in a new country.
Many doctors, when they find themselves abroad, usually do not work in their specialty, because, if they are lucky enough to get a job in a medical institution, it is more likely to be a junior medical staff, and not a doctor in their specialty. Many professional doctors in Ukraine work outside of their specialty in foreign countries. And this confirms the fact that our doctors are even ready to sacrifice their own qualifications in order to get at least some kind of stability, which they do not find in their native country.
The importance of doctors for society during the historical past
The attitude towards doctors in different historical periods changed depending on the development of society. In different eras, doctors could be both revered heroes and objects of criticism or even enmity. However, their role has always remained key to the preservation and maintenance of human life.
In primitive societies, treatment was done by shamans, priests or elders. They combined magical rituals with the use of natural remedies. They were afraid and at the same time asked for help. In Greece and Rome, doctors gained respect through knowledge and practical success. Hippocrates laid the foundations of medical ethics, and the Roman physician Galen influenced the development of anatomy and physiology. At this time, medicine began to separate from religion, but doctors were not always respected. For example, slaves could be trained in medicine to serve their masters.
In medieval Europe, doctors were perceived ambiguously. They were often associated with monasteries, and their work was based on religious dogmas. Sometimes they were suspected of heresy or witchcraft, especially if they used unconventional healing methods. But in the Islamic world, medicine was at a high level. Doctors were respected for their knowledge. Avicenna (Ibn Sina) and Al-Razi became famous figures.
With the development of science and the discovery of microbes (Pasteur, Lister), medicine gained a new level of trust. Doctors have become key figures in society. However, there was also a skeptical attitude due to insufficient knowledge of many diseases or due to the mistakes of doctors. In the 20th century, the medical profession became one of the most respected due to the progress of medicine, especially after the achievements in the fight against infectious diseases, vaccination and surgery. In times of wars and disasters, doctors were heroes who saved lives even in the most difficult conditions. In general, the attitude towards doctors in the modern world depends on the level of trust in the medical system, the availability of medical care and the general level of education of the society, and on how the state itself treats its doctors.
Attitude towards doctors in foreign countries
In many countries, doctors have a high status in society, decent working conditions and social guarantees. Doctors in the EU receive stable and high wages. For example, in Germany the average annual income of a doctor is around €80,000–100,000, in Sweden – €70,000–90,000. Doctors are also socially protected. After all, doctors there have full health insurance, paid vacations, pensions and additional bonuses for overtime work.
Hospitals in the EU are well equipped, work is organized in such a way as to minimize the overload of doctors, and professional growth is actively encouraged.
And in society itself, doctors are perceived as authoritative specialists, and the state values their work, creating incentives for training and development.
American doctors are among the highest paid in the world. Their annual income can reach $200,000–400,000 depending on their specialization. Although the cost of medical education in the US is high, the state offers grants, scholarships and programs for young professionals. Doctors themselves have a very high reputation and respect in society. They are considered an important part of the state health care apparatus.
The National Health Service (NHS) operates in Great Britain. Under this system, doctors have a stable job, good working conditions and social guarantees. Earnings of British doctors range from £40,000 (junior specialists) to £120,000 (consultant doctors). The NHS regularly campaigns to support doctors, and during crises such as the COVID-19 pandemic, doctors have been hailed as national heroes.
In the Nordic countries, doctors work in a well-funded health care system that focuses on the well-being of patients and physicians. Doctors have a flexible work schedule. Overload is rare here, doctors have clear working hours and more time for personal life. In these countries, the medical profession is considered one of the most respected, and young specialists receive support at every stage of their studies and work.
Salaries for doctors in Australia and New Zealand start at $80,000 and can reach $250,000 per year. These countries actively invite doctors from other countries, offering favorable conditions for living and working. Doctors have access to regular trainings, courses and modern technologies in medicine.
As you can see, the emigration of doctors in Ukraine is not just numbers in reports, it is a diagnosis that the state has made for itself. And if measures are not taken immediately, medical collapse will become a reality for every Ukrainian. But there is a way out. It is only necessary to adopt the experience of foreign countries and resort to decisive, drastic changes, and not engage in populist solutions. Ukrainian doctors should be paid according to their qualifications and work. Otherwise, they will simply be forced to look for better conditions abroad. The state should start investing in medical infrastructure, because outdated working conditions are another reason for the outflow of personnel from the profession. Modern hospitals, equipped with everything necessary, should become a reality, not a dream.
It is worth thinking about future specialists, creating scholarships, grants, training and internship programs that will motivate young people to stay and develop medicine in Ukraine.
The state should stop using medicine for PR and start acting responsibly. And it is necessary to start with elementary and simple things – to provide doctors with adequate insurance, housing and pension benefits. The medical system is the basis of a nation’s survival and security. If we allow it to decline, we will lose not only health, but also trust in the state. Doctors are not just a profession, they are people who save lives every day. And if we do not save them now, then tomorrow no one will treat us.
Ukraine is on the verge of a medical collapse, and this is no longer a hypothetical scenario, but a rapidly approaching reality. The exodus of doctors is not only a consequence of their desire for a better life, but also a sentence to a system that is unable to provide its citizens with basic rights to health care. Without radical changes, only empty offices will remain in hospitals tomorrow, and millions of Ukrainians will be doomed to self-medication or fighting for a place in the queues with those who have not yet left the country.
