SIAULIAI - "We have a saying among doctors," says Mindaugas Sidaravicius, a surgeon at Siauliai Hospital. "No money for food on a single shift, and no time for it on a double shift." Hospital administrators who assign extended shifts, he says, effectively hand doctors the proverbial rope.
As a result, the pool of doctors in Siauliai, which has gone to great ends to meet European standards, is thinning. Many have packed their bags and moved on to find easier jobs abroad, leaving their colleagues to pick up the extra burden. Fresh recruits, however, have not yet replaced them.
In fact the situation has become so dire that Siauliai staff members do not hesitate to describe it as "a genocide of doctors," which will at some point undermine the entire city - the fourth largest in Lithuania.
Siauliai Hospital is dangerously understaffed. Although official data shows that 20 new doctors are needed to solve the crisis, hospital medics argue that the number should be at least 40. Siauliai currently employs a team of 275 doctors.
All medics in the children's surgery department work for a shift and a half, which is full-time with extra hours, while some are compelled to take on even larger loads 's double full time. Every third day the medical staff "moves in" to Siauliai, as there are nine night-duty shifts per month, which means 36 hours of work without rest.
The most highly qualified specialists at the Siauliai Hospital earn an average 600 litas (173 euros) 's 800 litas per month after taxes, while those who bear the shift-and-a-half system can earn the princely sum of 1,200 litas.
For several years now doctors have complained about earning less than the average Lithuanian employee 's the Statistics Department registered 1,310 litas as the average monthly salary by the end of 2004.
As their ranks dwindle and the workload balloons, Siauliai doctors say they are no longer confident of their capability to provide quality services. The long hours have made it more difficult for them to concentrate when assisting patients and making decisions.
"You should see my handwriting at the beginning of the day and by the end of my shift. After some night shifts my colleagues joke 's this is the hand-writing of a drunken man," Sidaravicius says.
Cardiologist Danute Andruliene, who has 20 years of experience, earns a paltry 770 litas after taxes each month. She doesn't hide her sentiment: "Doctors are burned out with their profession and no longer have much enthusiasm."
Andruliene has been particularly upset with the disrespect being shown for her profession by officials. Lawmakers recently altered hospital procedures, which were meant to help the patient learn more about their disease, and to settle medicine prescription dealings and compensations. Doctors now complain about spending more time on paper work than their specific occupation.
"Sometimes I feel I am not a doctor but some bookmaker or finance analyst," Adruliene says. "We are on the verge of a serious crisis. It would be better if patients and not doctors went on strike, since they are the ones suffering from this situation the most. Patients blame the doctors for the chaos and don't understand that we all suffer from this healthcare system."
It was rather difficult for Rolandas Burkauskas, a surgeon and president of the Siauliai Doctor's Union, to agree to an interview. Not because he did not want to speak, but because the doctor was constantly running from one corridor to another to assist patients.
Burkauskas, 39, is one of the youngest doctors in the Siauliai hospital. The medic works full time as a surgeon, part-time as an echoscopes specialist and takes up night shifts in the hospital. In addition to that, he works part time in two other private clinics. As long as his health is strong, he says, he can continue the marathon. But Burkauskas admits that he faces a greater chance of committing mistakes.
However, Burkauskas' main concern was not the work load, but aging. As the medical staff at Siauliai grows older, there is almost nobody out there to replace them. "Young medical school graduates who speak foreign languages don't have any other ideas on their mind but to go abroad. All their long-term educational or working plans are associated with foreign countries," Burkauskas said. "If the salary situation doesn't change I will have to consider this as well."
In 1995 Lithuania's medical university admission count was cut nearly in half. Foreign experts argued that the country had too many doctors at the time. Later, however, the situation swung the opposite direction. Noticing this sudden lack of students, educational institutions adopted their old policies. In 2002, student admission increased from 250 to 400. The increase, however, was of little help, as only some graduates decided to stay within the country.
National dailies are overloaded with advertisements from across the country alerting "doctors needed." After EU accession on May 1, 2004, there were nearly as many Lithuanian doctors fleeing the country as there were medical students graduating from Vilnius and Kaunas universities per year.
Unofficial data shows that some 200 doctors from various fields emigrated over the past six months. In 2004, the Health Ministry issued 390 certificates that are needed to practice medicine abroad. Most of those planning to pack up and leave are specialists in anesthesiology, gynecology and surgery. Also, over the same period 73 certificates for foreign practice were issued to odontologists and 79 to nurses.
While the certificates do not necessarily mean that doctors will actually pack their bags and move, the numbers testify to the precarious state of the profession.
The state invests 43,906 litas in one doctor's education. Only a slightly smaller sum goes toward a nurse's training. Having invested so many millions, it could easily be argued that the state is gifting other countries with its medical professionals.
The Lithuanian Doctor's Union recently conducted a poll asking whether those doctors that are now considering leaving the country would change their minds if the salaries were doubled. Most of the respondents gave an affirmative answer. The Doctor's Union confirmed that the mass emigration was a result of abysmally low salaries. The experience of the Czech Republic, union officials say, where PhDs fled en masse to Austria, shows that once salaries are increased to reasonable levels, the brain drain will all but end.
When asked what is being done to prevent a brain drain to the West, health minister Zilvinas Padaiga claimed that the problem was being tackled at a pan-European level in Brussels. While implementing EU funds, the government is not only seeking to improve the general healthcare system but also to sort out salary matters and to diminish work burdens. In general, old EU countries do not permit their doctors to work extra hours.
Some 14,000 doctors and 28,000 nurses now work in Lithuania's healthcare system, which means there are some 200 inhabitants per doctor. The situation is not yet critical, especially when compared to other European countries where the ratio is one doctor per 300-400 inhabitants. The health minister, however, expressed worries that if the salary crisis is not immediately solved, the situation could get worse.
The Lithuanian Labor Exchange registered 169 unoccupied general practitioner positions and 30 available jobs for deontologists in 2004. By the end of the year, 75 medical positions were categorized as "unoccupied for a long time," most of them being in regional hospitals. In January alone, another 14 vacant positions in various medical fields were registered in the national labor pool.
Fed up with promises for a better life in the future, Lithuanian doctors ran out of patience in January and threatened to stage a nation-wide strike. More than 20 medical organizations presented a demand for top state officials to immediately double their salaries. "At this point, we can still provide all necessary medical services, but perhaps this will not be possible soon," explains Liutauras Labanauskas, president of the Lithuanian Doctor's Union. However Health Minister Zilvinas Padaiga says that he cannot work miracles. "We will increase [salaries] as much as we can, and if doctors want to go on strike, it is up to them."
The general demand is for the government to implement its promise to allocate at least 5 percent of GDP to the healthcare system and to double salaries. Otherwise, doctors claim they would be forced to start a nation-wide strike in May.
And their demand has been heard. Starting in May, salaries in the medical sector will be increased by 20 percent, the minister of health and the finance minister agreed. However, doctors say this still does not dissuade them from staging a strike, arguing that the average monthly wage should be at least 4,000 litas.
On Feb. 23, the minister of health and medical representatives met with President Valdas Adamkus to discuss the situation. "The medical staff demands are grounded. For the hard work they do, they receive a truly meager salary. When speaking about a pay-raise, it shouldn't increase by 20 percent, not even 50 percent, but considerably more so that people don't have to go abroad for extra money. However, the budget at the moment is short to provide all the money needed to increase salaries for medical staff," Adamkus said.
Labanauskas said he got the impression that Adamkus was a keener revolutionist than himself. He added that although he understood the government could not immediately double salaries, the demands of the medical staff still remain.
If the salaries were doubled as demanded, another 250 million litas would have to be found in the budget, government calculations show. Meanwhile, Labanauskas asserted that medical staff is not asking for additional spending. The problem, he says, could be easily solved if the existing money allocated to the healthcare system were redistributed for other priorities.