Districts are in big trouble: and 5 thousand. doctors are no longer tempted by euros “in their hands”.

Although the name of the Joniškis hospital was recently inflected as an example of a district hospital that found the key to success, where by concentrating day services for patients, they managed to successfully attract a group of doctors, today the mood here is gloomy.

He spins as he knows how

Due to the retirement of 3 out of 4 doctors of the Department of Internal Medicine, the hospital will no longer provide 24/7 emergency medical services. However, the head of the hospital does not dramatize the situation and claims that the problem with internal medicine doctors has always existed.

“Nothing has changed, for three years we said we were looking for doctors who would live here or somewhere around, and they didn’t appear. That time is coming and the situation is what it is. But we are doing relatively well. The specifics of the provided services have not changed. However, it is rather strange to me that when such working conditions are offered, there are not many people who want to come here. This means that the districts are in trouble,” said Martynas Gedminas, head of the medical facility.

According to him, formally the Department of Internal Medicine will remain, but in reality the services here have been reduced – already by 10-15 percent. more patients are transferred to Šiauliai.

“Formally, the department will remain – in Lithuania, regulation is very underdeveloped, there are departments such as nursing and then internal medicine, we now have an inpatient department left, where we admit low-risk patients. About 10-15 percent we have to transfer patients to Šiauliai, whom we did not transfer before. These are patients in serious condition. And for those who have had a stroke and need active treatment just for the sake of rehabilitation, there is Radviliškis. I wouldn’t mention other hospitals in the region, I wouldn’t sleep there myself…

Indeed, with nurses, telemedicine, we turn from that situation as best we can. And we had to provide emergency care 24/7 simply because with the Department of Internal Medicine, any patient can be brought in at any time, and now we have reduced resources in order to be able to offer those 4-5 thousand. “in hand” so that we can attract doctors who can work during the day and not just come,” said the head of the Joniškis hospital.

The municipality offers not only solid salaries, but also compensation for housing rent or travel expenses.

Hospitals have to pull the sheet

However, it turns out that Joniškis district is not unique. Aušra Čiūdarienė, the director of Radviliškis Hospital, assured the tv3.lt portal that the current situation of the institution she manages is worrying – the activities of the Department of Internal Medicine are also hanging in the balance.

“There is a lack of doctors who want to come to work in the regions, so we have to look for them with a light. One therapist is already of a respectable age, but still working, in good health, and the other doctor is younger. This is all we have.

“However, it is rather strange to me that when such working conditions are offered, there are not many people who want to come here. This means that the districts are in trouble,” said M. Gedminas.

Therefore, the question of the survival of Internal Medicine also hangs in the balance, but we are still talking, I am trying to find therapists through all channels. It would be great fun to attract a younger therapist, because now we have to live in uncertainty and fear, lest any doctor “fall out” or get sick, because that’s all then – one doctor will not do anything,” she was afraid.

The interviewer said that, on the one hand, in half of the cases, the doctors of this specialty are generally not well trained, and others do not want to go to the region. “So all district hospitals have to pull the sheet when trying to invite them”, stated A. Čiūdarienė.

She said that the work of the Emergency Department is still managed 24 hours a day in the hospital, but as everywhere there is a shortage of cardiologists and endocrinologists.

“And we have resuscitation 24 hours a day, there are no such problems in reception, young people, residents want to wake up. But there are problems with therapy, and the number of patients is increasing. There are also many lonely people – their children have left or it is simply difficult for them to work and look after their elderly parents, they need to contact other social care institutions as well”, stated the head of the Radviliškis hospital.

Although it is constantly noted that hospitals are particularly short of nursing staff, A. Čiūdarienė indicated that the situation here is not critical either: “The situation with nurses in the hospital is quite good. There are enough nursing assistants, of course, we would need a few nurses, but we are trying.”

Some municipalities are saved by a good geographical position in attracting doctors. “Good communication is very important. Near us are Panevėžys and Šiauliai, it is easy to go to Kaunas and Vilnius. At that time, the road to the same Joniškis is very ungrateful, narrow, I really wouldn’t want to drive every day, especially in winter,” she added.

In 30 years, not a single doctor came to live

According to M. Gedmins, the residents have not yet felt that anything would have changed after closing the Department of Internal Medicine, but the question is what will happen in 2-3 years.

“It’s like we haven’t dealt with a problem for 20 years now and suddenly we gasp when it comes up.” Here Zarasai started and completely closed the departments, like other hospitals. We are spinning, people have not felt that there are changes. But the question is what will happen in 2-3 years. When the appointments ended, no doctor had come to live in Joniškis for about 30 years. This is a big problem,” emphasized the director of the Joniškis hospital.

When asked if now is the time to talk about forced “appointments”, the interlocutor said that it is necessary to do something.

“I don’t know, some kind of system should be thought of. If the state guarantees free education so that a doctor can get a license, a doctor who has worked in the area for 3 years, I think, would not lose a lot.

But basically, I think the solution is to revise residency studies so that people come here during residency. Because there is a problem that young doctors buy houses, find second partners and stay in the big city. And we offer a salary that is two or three times higher than in Kaunas, but people stay for other reasons, this is a chronic problem.

There is nothing to give up on working in the district, but decision makers should pay close attention to such situations. I think that public medicine is very neglected and there is either a collapse that has to happen or radical solutions that apparently will not happen because people are afraid to take them. In the end, it will all end with the arrival of private medicine with its own solutions,” he thought.

He sees the deplorable politics of the regions

The chairwoman of the Lithuanian Medical Movement (LMS) Auristida Gerliakienė stated that the hospital examples discussed are systemic and the result of many unmanageable problems.

“It is not the case that if there is cancer somewhere in the body, all the other organs are working well. And that the whole system is shaken and has been for a long time, the medical movement has been talking for many years. We are talking about the lack of specialists, as well as working conditions, different salaries, insufficient payment for services – everything is related here.

How can someone from somewhere “steal” doctors? If there are no conditions, they are there, and they are not there because there is no funding, and they are not there because there is a monopoly, and they are there because there are political decisions. This is how we hit the wall of political incompetence,” she stated.

According to the interlocutor, regional policy in Lithuania is basically deplorable – nothing is done to make people want to live in the regions.

“Nothing is being done to make people return to the regions, there would be normal schools, good living conditions, so that people would want to be there. No one invests in it.

Conditions could perhaps be eased for those people who work in the regions, for companies that set up businesses. This has not been the case for a long time, doctors suffer from it and do not want to go there,” said A. Gerliakienė.

Such “explosions” are predicted everywhere

According to the chairman of the board of LMS, no reforms, apparently aimed only at absorbing money, will help.

“We have to calculate what resources we have and analyze what we do next based on that. Because there are four resources – human resources, money, medical qualifications and the time that doctors can devote to the patient.

There must be a reduction of the administrative burden and a normal e-health, so that doctors have to work with it as little as possible. Our other proposal is to introduce health secretaries who would be engaged in non-medical work, but this again requires funding”, said A. Gerliakienė.

According to her interpretation, the recruitment of employees should take place by specifying clear criteria for how they will work – workloads, conditions, salaries:

“Now it can be very different from one hospital to another, because the municipalities also contribute or the administrations go overboard in order to be able to pay high salaries. But again, some specialists are paid high salaries, while others are paid lower salaries. Therefore, there should be a clear systematic approach with a systematic analysis carried out beforehand.

Therefore, I think such “explosions” will be everywhere in the system. You can nominate some leaders, show off, shake hands with politicians when they arrive, but these are demonstrative things.”

Already see the benefits of the reform

For her part, the head of the Radviliškis hospital, when asked whether the health reform will help save small hospitals, said that everything is in the hands of the municipalities.

“Everything depends on the municipal administration, if it supports it, it is possible to combine everything and find solutions with joint efforts. I think we will really successfully survive, but if the administration itself decides to close its eyes and close, then you are powerless to do something”, stated A. Čiūdarienė.

“Such “explosions” in the system, I think, will be everywhere. You can nominate some leaders, show them, shake hands with politicians when they arrive, but these are demonstrative things,” said A. Gerliakienė.

She said that after the establishment of the Radviliškis health center, there are no problems in cooperation so far, European funds have been successfully shared, and the patients have already felt the benefits. “For example, a dentist at the primary center gets sick, then another doctor who belongs to the center is notified to cover emergency patients,” she noted, already seeing the benefits.

Sejonienė: young doctors would emigrate if they felt coercion

When asked whether the health reform can solve the long-standing problems of lack of doctors in the regions, Seimas member Jurgita Sejonienė said that certain decisions have already been taken.

“It’s an old problem that all doctors want to stay in big cities after graduating and don’t want to return to smaller towns. It has already been decided on residency that at least 30% its time doctors will have to perform in the regions. But the result cannot be in a week, month or year.

This would be one way to develop working relationships – if the conditions were attractive, young people could return. But the districts themselves also have to put in a lot of work: there are many career fairs, it is very important to keep in touch with the people of that district so that they know that there will definitely be a guaranteed job and good conditions,” she commented.

According to the MP, there is no other civilized and non-violent way to try to attract specialists.

“We decided that the coercive method is very inappropriate, the doctors themselves, especially the young doctors, expressed dissatisfaction with it. I don’t know if we would have achieved anything by force. People would simply emigrate then,” said J. Sejonienė.

Responding to the words of the LMS representative, she also stated that raising the qualifications of doctors is one of the goals of the reform.

“But again, it depends on how each institution decides where to invest.” On the other hand, although there was a lot of opposition to the reform, now I don’t hear from any district that they feel bad,” she said.