When I talk about the situation of foreign health workers in Slovakia, most people ask me why this is so. Now I don't want to share with the public another batch of bad news, which the newspapers are already full of, but to present the facts and write possible suggestions for changing the situation.
Incompetence
We experienced the horror of the Slovak Republic when we topped the COVID-19 mortality ranking and saw headlines like For every 1 million people we have the most people dying in the world, or The Slovak Republic last year had the most people dying since World War II. Unfortunately, it is statistics that show our inability to protect the lives of our citizens. Why do less people die in other countries? If we compare the percentage of COVID-19 deaths in Slovakia and Austria for the first 12 weeks of this year, it turns out that in our country the percentage of COVID deaths to the total number of deaths is about twice as high. Although I requested Slovak statistics on the shortage of nurses from all wards, the Ministry of Health, and all VDCs, I either received no answer, or they replied that they had no such data. The data from before COVID is outdated, although even before COVID the shortage of 15,000 nurses in Slovakia might be surprising. According to official OECD statistics, compared to other countries such as Germany or Austria, we have two to three times fewer doctors and nurses per 1,000 inhabitants, and a very low percentage of foreign health workers (3.5 percent of doctors, only 979, and only 0.14 percent of nurses). Unfortunately, Slovak doctors and even the few foreign doctors who are in Slovakia are leaving Slovakia and new ones are not coming. It's simple math. The ability to retain those we have and to attract and integrate new ones should be in the hands of every government, including ours.
Concern for exceptional status
Doctors from abroad, even after the examination at the time of the epidemic, could not find work for several months because of Slovak bureaucracy, such as registration at the Slovak Medical Chamber. The reason for this was the condition of registration only with a certificate of no criminal record from the home country, which was and is required by law by the Medical Chamber (Law on Medical Professionals 578/2004 Coll., § 38 (2)). In general, this requirement is illogical, since a declaration of no criminal record is attached to the application for a residence permit upon arrival in Slovakia, and all foreign physicians must have it when registering with the Chamber. Thus, all foreign physicians have already submitted a criminal record statement to one Slovak authority (the foreign police), but another authority (the Slovak Medical Chamber) requires this statement once again. For years obedient foreign doctors obeyed because there was no crown. Now it is not easy to travel, and certificates of criminal records are not easy to obtain remotely. Over the past year we have seen hundreds of exceptions, and foreign doctors, trying to speed up implementation into the system, have asked the people in charge for an exception or for a waiver of this illogical condition in the law. After all, they have this law going through parliament almost every month. In this case, it is not a question of laziness, but of resistance and refusal to let them come.
Laziness
We must prepare for the 3rd wave. If only for the reason that we have hopefully learned from our unpreparedness for the 2nd wave. Our laziness should not win here. The 3rd wave could come in September or October, and we don't have enough staff. Even though the medical staff stayed with the patients after the emergency was lifted, they are tired and some of them are also disgusted and, unfortunately, about to leave. We still do not have a substantiated statement from Brussels about agreeing on minimum training requirements, especially for foreign medics who do not even make it here.
Suggested item changes
Here are 10 points that can help the successful integration of foreign health workers:
Incompetence
We experienced the horror of the Slovak Republic when we topped the COVID-19 mortality ranking and saw headlines like For every 1 million people we have the most people dying in the world, or The Slovak Republic last year had the most people dying since World War II. Unfortunately, it is statistics that show our inability to protect the lives of our citizens. Why do less people die in other countries? If we compare the percentage of COVID-19 deaths in Slovakia and Austria for the first 12 weeks of this year, it turns out that in our country the percentage of COVID deaths to the total number of deaths is about twice as high. Although I requested Slovak statistics on the shortage of nurses from all wards, the Ministry of Health, and all VDCs, I either received no answer, or they replied that they had no such data. The data from before COVID is outdated, although even before COVID the shortage of 15,000 nurses in Slovakia might be surprising. According to official OECD statistics, compared to other countries such as Germany or Austria, we have two to three times fewer doctors and nurses per 1,000 inhabitants, and a very low percentage of foreign health workers (3.5 percent of doctors, only 979, and only 0.14 percent of nurses). Unfortunately, Slovak doctors and even the few foreign doctors who are in Slovakia are leaving Slovakia and new ones are not coming. It's simple math. The ability to retain those we have and to attract and integrate new ones should be in the hands of every government, including ours.
Concern for exceptional status
Doctors from abroad, even after the examination at the time of the epidemic, could not find work for several months because of Slovak bureaucracy, such as registration at the Slovak Medical Chamber. The reason for this was the condition of registration only with a certificate of no criminal record from the home country, which was and is required by law by the Medical Chamber (Law on Medical Professionals 578/2004 Coll., § 38 (2)). In general, this requirement is illogical, since a declaration of no criminal record is attached to the application for a residence permit upon arrival in Slovakia, and all foreign physicians must have it when registering with the Chamber. Thus, all foreign physicians have already submitted a criminal record statement to one Slovak authority (the foreign police), but another authority (the Slovak Medical Chamber) requires this statement once again. For years obedient foreign doctors obeyed because there was no crown. Now it is not easy to travel, and certificates of criminal records are not easy to obtain remotely. Over the past year we have seen hundreds of exceptions, and foreign doctors, trying to speed up implementation into the system, have asked the people in charge for an exception or for a waiver of this illogical condition in the law. After all, they have this law going through parliament almost every month. In this case, it is not a question of laziness, but of resistance and refusal to let them come.
Laziness
We must prepare for the 3rd wave. If only for the reason that we have hopefully learned from our unpreparedness for the 2nd wave. Our laziness should not win here. The 3rd wave could come in September or October, and we don't have enough staff. Even though the medical staff stayed with the patients after the emergency was lifted, they are tired and some of them are also disgusted and, unfortunately, about to leave. We still do not have a substantiated statement from Brussels about agreeing on minimum training requirements, especially for foreign medics who do not even make it here.
Suggested item changes
Here are 10 points that can help the successful integration of foreign health workers:
- Health Workers Act No. 578/2004, § 30a fixing a long broken system through internships. It is important that the period of validity is not tied to the period of coronavirus. Extension to outpatient care.
- Law No. 5/2004 Coll. on employment services. Ability to work while preparing for exams and exemption from reporting job openings for health care providers because we know there is a shortage.
- Act No. 404/2011 Coll. on Residence of Foreigners. Priority acceptance of applications from medical workers for temporary residence permits and shortening the decision period.
- Law no. 422/2015 on the recognition of educational documents. Cancellation of the certificate of authorization of the educational institution to provide relevant education (bureaucracy), is a verifiable fact that the Ministry may deal with.
- The methodological guide of the Ministry of Education No. 36/2016. Changing the method of the exam so that real practical knowledge is tested. Now even Slovak doctors cannot pass the exam.
- Dual education for nurses with secondary education.
- EU lawsuit and EU doctors. The Ministry of Health should regulate the procedure through a government decree on professional competence and method of continuing education. Creation of a preparatory platform in cooperation with SZU.
- Residency training for foreign doctors as a basis for recognition of their qualifications. Allow participation with temporary residency, not only with permanent residency, which foreigners can get after 5 years.
- Pediatric diplomas from abroad are not recognized in Slovakia, but for example in the Czech Republic and also in Germany, pediatric diplomas are recognized, and this despite the fact that we have a common European Directive 2013/55/EU. Strange, isn't it?
- Chamber enrollment. Abolish the condition of providing a statement of no criminal record from the home country in the case of foreigners with a valid residence permit in Slovakia, who have already documented it.
Current articles by Alona Kurotova are also available at dennikn.sk