North Macedonia could soon face an alarming shortage of medical staff

After graduating as a physiotherapist at the High Medical School at the “St. Kliment Ohridski” in the city of Bitola, and completing her compulsory internship, work opportunities for 35-year old Ivana Grujoska were few and hard to come by. She either needed to be a member of a political party, or she had to know people who would recommend her to get a job at private clinics across North Macedonia. And the physical therapy licensure law in the country didn’t help her case, too.

“Apart from volunteering and internships, I do not hold any official work experience in the country. And you cannot start your own practice as a physiotherapist, because the law states that a graduated physiotherapist cannot independently provide medical services. So this is why I set out to look for my luck elsewhere.” Ivana says.

The only option that was left for her was to work in hotels and spa salons — quite underpaid jobs that require serious engagement and working on weekends. So, Ivana considered her options, and soon after she started learning German language. There were many job postings from Germany, looking for all kinds of medical staff — doctors, nurses, physiotherapists.

Ivana decided that this is an opportunity that she needs to grab, and to emigrate there together with her family. At the moment, she is a trainee at a physiotherapy studio in the city of Aachen, while waiting for her papers to be transferred to a state clinic in the German state of North Rhine-Westphalia.

And it is not an easy procedure to do, the recognition of a foreign diploma, especially if you are coming from a non-EU country like North Macedonia. “As a country, Germany has an individual approach to the recognition of foreign diplomas, which varies from region to a region. On paper yes — anyone with a degree from an EU or a non-EU country can work there, but in practice it is not so easy. They have to go through a diploma evaluation process, which is individual. The documents are sent to the appropriate state institution responsible for the recognition of foreign diplomas in the field in which you wish to work, then you go through some 4–5 months of comparing qualifications with the German ones and then you receive an official response whether or not your diploma is fully recognized.” she explains.

Many health professionals in North Macedonia decide to go on the same path, in order to ensure a better future for themselves and their families. In the last eight years, more than 1,200 doctors have left the country. Most of them are specialists doctors, and this is an additional burden for the health system of the country.

Twenty-five year old MD Daniela Toshevska graduated last year from the Faculty of Medical Sciences in the city of Shtip. Most young doctors are unsatisfied with the salaries that they are being offered, she explains. “Young doctors can rarely prosper in a country like ours because they rarely find a job right after graduation, and if they do find a job, the salaries are usually low and doctors themselves are unhappy.” she says.

Most of these young doctors then choose Germany as their next destination, Daniela says. “Not only doctors, but also other medical staff, such as nurses, physiotherapists — but most of the doctors go to Germany. There are fewer cases with states such as the United States, because the standards and the educational system there is slightly different than the Europe.” she adds.

North Macedonia is also facing a severe nursing shortage, as most nurses also looking to find their luck abroad. According to Gordana Beshliovska, President of the Union of Association of Medical Nurses, it is alarming that lately, apart from the younger and inexperienced nurses, a lot of nurses with a work experience of 15–20 years are also looking to leave the country.

“During the year, we had about 40 such requests, but there are many who emigrate without seeking those confirmations, and I think that the number is much higher. The shortage in the hospitals is a testimony of that outflow, as all of these numerous job postings in the hospitals are in fact a retrograde number for the departed nurses. It is very difficult when you lose staff which are trained, such as nurses in operating rooms. All of the nurses are very important, but I am talking about nurses from critical units, where we need to provide the staff with a longer education. Basically, the ready-made staff is the one that is going away.” Beshliovska says.

According to her, health authorities in the country also face another risk when it comes to keeping qualified nurses in the country. “I am afraid that we will come to a situation where the nurses will become so scarce, that even pay increases won’t be enough to keep them here. This is because when they go overseas, in those countries they see standards, principles, see competencies and interventions, and sometimes the satisfaction is not only in the personal income, but satisfaction is in the recognition of one’s work, too.” Beshliovska points out.

Macedonian health authorities claim that they are doing everything they can in order to keep the medical professionals in the country. “Since February 2020, the salaries of specialist doctors will increase by 25%, while that of nurses will increase by 10%. Cumulatively, together with all the increases, we increased the basic salary of specialist doctors by 40%, and that of nurses by between 20% and 23%. By increasing the salaries, we provide dignified working conditions for the health workers, so that they can work in our country, and not go abroad.” the Ministry of Health says.

Authorities also note that over the past two years, they have given more than 5,000 employment approvals, and invested a billion of denars (more than 16 million Euros) in the heath workers salaries. “All of these measures help keep our health care workers in our country and provide them with decent work.” Ministry authorities point out.



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