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FEATURE-Czech doctors threaten exodus as austerity bites

* Austerity in east EU states causing healthcare exodus

* Fifth of Czech hospital MDs threaten to leave their jobs

* Baltics, Romania also seeing outflow, Germany hiring

* Departure could hit govt popularity

By Roman Gazdik and Robert Mueller

TABOR, Czech Republic, Oct 20 (Reuters) - After years of long hours and low pay, Czech doctor Petr Klimak is threatening to quit and join an exodus taking many to western Europe.

Making less than a skilled carpenter or plumber, and facing government austerity measures that will cut funds going to healthcare, Klimak and thousands of other doctors in the east of the European Union are looking to fill higher-paid jobs abroad.

Although healthcare in the developing region has largely improved since the 1989 fall of communism, compensation and working conditions from the Baltics to the Balkans pale in comparison to those in Germany or Britain.

Now an increasing number of doctors fleeing the region could lead to hospital closures and erode support for governments whose cost cuts in public administration -- and state healthcare -- have prompted public outcry.

“My pay as a head physician is 250 to 300 crowns (10 to 12 Euro) per hour, less than a skilled workman,” said Klimak, an ear, nose and throat doctor in the industrial town of Kladno, just north of the Czech capital.

“If nothing happens here I will quit my job and leave, probably for Germany.”

As the new Czech right-of-centre government pursues austerity measures that will hit the state-run health sector, Klimak and other doctors fear a years-long fight for higher salaries will be thwarted.

He and some 3,500 other doctors -- more than a fifth of all practitioners in public hospitals here -- have pledged to leave by the year end if their wages do not rise.

They are not alone. Similar complaints have erupted in other countries in the European Union’s ex-communist east and happen to coincide with a push in developed EU states to attract more specialised workers.

Analysts say there may be little chance of an immediate collapse, but a large outflow of doctors and potential closing of hospitals will hurt ruling parties across the region as it is health care where people immediately feel any state cuts.

“It would make people very nervous and it would bring about an unpleasant mood, which would certainly hit political preferences,” said Jan Kubacek, a political analyst at Prague’s Charles University. “A doctor, a nurse, these are symbols which touch every single person.”

Last year, a fee of about a euro -- equivalent to the cost of a tram ticket -- helped bring down the previous Czech government, as patients protested against paying for healthcare that had been completely free.


Czech healthcare has improved considerably since Communism fell 20 years ago. The Czechs boast the best care in the region, surpassing Portugal and Spain, and are level with Britain and Italy, according to think-tank Health Consumer Powerhouse, which monitors health care systems in 35 countries.

But salaries average around 45,000 crowns a month (1,834 euros) and can include 80-hour work weeks. Hundreds of doctors have left for Britain or Germany, where new graduates can earn 4,000 euros a month, five times the Czech equivalent.

Now, Prime Minister Petr Necas’s right-of-centre government plans to slash the total public sector wage bill by 10 percent.

The move has prompted public demonstrations and contributed to worse-than-expected results for his Civic Democrats in municipal elections this month. It also helped push support for the three ruling parties to under 50 percent in a recent poll.

Necas has pledged not to touch doctors’ salaries, but an expected 5 to 7 percent fall in the healthcare budget next year has angered doctors who have waited for decades for better pay.

Pavel Vavra, an organiser of the signature campaign dubbed “Thank you, we’re leaving”, said he was ready to leave.

“I work three positions now,” said Vavra, 37, who drives a decades-old ambulance with other doctors around the country lobbying for their cause. “I don’t want my son to know me only from photographs, which is quite likely with my extra hours.”

And it is not just Czech doctors who are feeling unwanted.

The head of Latvia’s doctors’ association said dozens were leaving each month. In Estonia, years of budget cuts have prompted more than 100 doctors to leave the country of 1.3 million for Sweden, Finland, the United Kingdom and Germany.

In Romania, the EU’s second poorest state, the government has slashed public pay by 25 percent to avoid economic meltdown.

“Since 2007, about 3,000 doctors and 8,000 nurses have left for other countries because of low pay and bad work conditions,” said Marius Petcu, head of Romanian health sector union Sanitas.

“If this continues, I expect by the end of next year Romania will not be able to provide medical services for the public.”


Last month, the German Hospital Institute released a study showing clinics there needed 5,500 more doctors, a number that could rise to around 37,000 by 2019 if current trends continue.

Some 30 clinics will be visiting Prague at the end of October to fill more than 100 positions.

According to Arne Bjornberg, chief operating officer at Health Consumer Powerhouse, such initiatives could cause a shock to the emerging region’s health sectors.

“Rich countries should increase the numbers at medical faculties and train their own doctors,” he said. “It’s downright immoral for the wealthier part of Europe to solve their problem with a shortage of doctors by importing from eastern Europe.”

The Czech Health Ministry has said it does not expect all of the doctors who have said they will leave to make good on their pledge and that the healthcare sector can manage if they do.

But the Czech Association of Patients says if even 500 depart, it will put pressure on an already strained system, restricting services, causing hospital closures, and squeezing the availability of care.

For David Hoza, a Czech neurosurgeon who works in Halle in Germany’s Saxony Anhalt region, the choice is clear: “I am content there. I would recommend that the others leave as well.” (Additional reporting by Reuters bureaux in central and Eastern Europe; editing by Michael Winfrey and Charles Dick)