Doctors in Croatia: The Issues They’re Facing and Why We Support Them

16. February 2024.

On January 28,  the Croatian Physician Association (HSL) announced that it is starting “intensive preparations for union actions,” including a potential strike. The reason for this, as stated in the press release, is the gross violation of the agreement reached between the Government of Croatia and doctors in April 2023.

As consultants, we communicate with doctors every day. That’s how we know that the situation in Croatia is indeed unfavorable compared to many other EU countries. We agree with the doctors’ conclusions and believe that the current climate is extremely ill-suited for retaining quality personnel.

We will briefly discuss the parts of the agreement that were not honored and compare the situation to that in other countries.

Maska u ruci liječnika
Photo by Ashkan Forouzani on Unsplash

Doctors and the Croatian Government – Initial Agreement

Let us start with a quick reminder of the four main demands set by doctors, and accepted by the Government last April:

  • Alignment of salary coefficients,
  • Enactment of a law on the employment status of doctors,
  • Establishment of time-staffing standards,
  • Abolition of “slave” contracts for medical specialists in training.

However, as early as November 2023, it became clear that the deal would essentially not be honored.

That’s when the Government published its plan and program of health care measures for 2023-2026. According to HUBOL and KoHOM, this plan did not resolve any critical issues.

Appropriate coefficients were also not introduced, and a law on the employment status of doctors was nowhere in sight.

Penalty Contracts

Odobs pozp
Photo by Dimitri Karastelev on Unsplash

Doctors in Croatia are the only ones signing penalty contracts for specialist training within the entire European Union.

Such contracts oblige them to work at the same hospital where they completed their specialist training for however long their training lasted. There is no tolerance for changing circumstances such as poor interpersonal relationships, family relocation needs, low salaries, or opportunities to earn more elsewhere.

It should be noted that experts gave a legal opinion in 2020 which states that such penalties are contrary to the European law or, more specifically:

  • The provision on free movement of workers (Article 45 TFEU),
  • The provision on freedom of establishment (Article 49 TFEU), and
  • The provision on freedom to provide services (Article 56 TFEU).

The Constitutional and Supreme Court have also issued rulings declaring previous attempts to get reimbursement from employees who left their jobs early invalid.

Despite this, many hospitals have still not offered their doctors more favorable contract annexes (even though they were legally obliged to do so).

Salaries

And what about salaries?

Well, first off, it should be said that the average hourly wages for doctors in Croatia are around just 10€. For example, protestors claimed in March that medical specialists in training and young doctors work for HRK 55 (~7.30€) per hour while specialists work for HRK 70 (~9.29€) per hour.

Even with the salaries slightly increasing since then, it’s clear that they’re not competitive compared to the rest of the EU:

  • According to some sources, the average hourly wage for doctors in Ireland is 47€. According to others, hourly rates range from 22€ to 31€ depending on seniority. In either case, the rate is at least 2.36x higher than in Croatia.
  • Average hourly wages for doctors in Germany are almost double; 75.61€.
  • Average hourly wages for doctors in Denmark are even higher – around 88.41€.

Meanwhile, doctors in Croatia earn just slightly more than students – the minimum student hourly wage in 2024 is 5.25€.

During the tourist season, they often can’t even compete with cleaners who typically earn between 17€ and 20€ per hour.

Workload

Sat na zidu
Photo by Ocean Ng on Unsplash

Doctors at Croatian hospitals currently work up to 300 hours a month.

Primarius Stanko Belina confirmed this publicly. Media reported that he was the person to receive the highest salary in the public sector in January 2024 (9112.05€).

In his response, Stanko openly said that he had worked 300 hours just in December, despite his regular schedule including only 168 hours. This means he had worked an additional 132 overtime hours in just one month – while the legal maximum is 300 hours/year.

Moreover, doctors in Croatia are treated like they’re working on an assembly line. They treat a huge number of patients every day, which is why they initially requested new time-staffing standards.

For comparison, Sweden limits the number of patients a doctor can receive during one shift to 10. The average no. of patients, however, hovers around 6-7 per shift. Croatia, on the other hand, has no such limits. If 70 patients arrive and ask to be examined, the doctor is expected to serve them all, which further contributes to stress and burnout.

The Government indeed prescribed new “non-binding” time-staffing norms in the aforementioned Plan, but these only made the situation worse. The time frames within which examinations should be conducted are unrealistic. For example, vaccination should take just 5-12 minutes, while blood draws shouldn’t take more than 3.

Such norms clearly do not solve any problems. In fact, they only further burden the doctors and reduce the quality of service.

Relations

Finally, it’s worth mentioning that doctors in Croatia are also negatively impacted by the prevalent pyramidal hierarchy. This is partly why the interpersonal relations within Croatian hospitals are usually poor.

In Scandinavia, for example, a linear hierarchy is much more prevalent. Within it, every person is responsible for their own role and tasks, and there are no strict superior-subordinate relationships. Such hierarchy increases workplace satisfaction.

Scandinavia also boasts good human resource management within the healthcare system.

Every region has a department with 50-100 HR professionals that take care of the workers. They conduct surveys, monthly progress and salary discussions, and discuss potential problems that the workers have either in their private or professional lives. They act as department mediators, measure the quality of work, and so on.

Concluding Thoughts

The most important question remains unanswered – will Croatia reach the standards of “more orderly” countries soon, if ever? Unfortunately, it seems like there’s no genuine motivation to do so at the moment.

Lengthy negotiations were held; problems were publicly exposed. And yet, we’re seeing little to no progress almost a year later.

In fact, it seems like the only thing that happened was the continued emigration of doctors. At least 148 professionals have left Croatia since the last negotiations.

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