Hungarian radiology has become trapped in a vicious circle: A combination of low prestige, long hours, and, most especially, low wages is driving a brain drain of the most experienced specialists to find work abroad, in particular to the Republic of Ireland, Scandinavia, the U.K. and now Germany, according to one of the country's leading practitioners.
Gábor Forrai, PhD, heads Hungary's biggest radiology department in one of its newest, best equipped establishments, the ÁEK military hospital in Budapest. Trainee doctors want to work there; the environment is good, its reputation high, and the cases interesting. Last year a call to fill two trainee posts resulted in 24 applicants. The problem lies in finding qualified staff. Up to four senior posts have been open in the same department for two years, without a single applicant. The situation is mirrored in every hospital in the country, Forrai said.
"Because of the shortage of experienced specialists, the workload is heavy. Every doctor who goes abroad compounds the problem, and the trend is getting worse," he said. He himself has lost seven radiologists to other countries in the EU in the past three years. A university hospital department head recently told him that of seven residents now in their second year, four had said they were leaving to work abroad. "From my department in the last four months, three doctors have left: one young, just after specializing, two over 50. It is tragic," he said.
Doctors have always been attracted by the opportunities of working abroad, of course. In the mid '90s, Forrai spent time in France and Germany. But prior to the EU's accession of Hungary, taking up a permanent position would have required complete retraining, lasting six years. "That's not so funny when you are in your 30s and have already qualified once," he said.
Since 2004, when Hungary became an EU member, its qualifications have been recognized in the rest of the union, as have the quality of its training and the skills of its specialists -- and that has fueled the growing exodus. Forrai is a board member of the Hungarian Society of Radiologists. A country with a population of 10 million has an estimated 900 active registered radiologists, but between 100 and 150 of those work abroad. Three years ago, the figure was 53. "Last year, there were 18 radiology specialists who applied to the medical chamber for the documentation they need to work abroad," he said. Even that doesn't paint the full picture, though, because the growing trend of teleradiology is sucking yet more from the system -- specialists who live in Hungary but spend their time remotely reporting on MR and CT scans for the Republic of Ireland, the U.K., and other nations.
"I know five to 10 Hungarian doctors who will earn two or three times as much working for a few hours reporting CTs via the Internet than they will in a six- or eight-hour day at the hospital," Forrai said.
Nor is the brain drain unique to radiology; it affects all three pillars of diagnostic medicine, with pathologists and laboratory specialists also in increasingly short supply. "There is a hospital in Sweden where the entire pathology department, six or seven doctors, is Hungarian, and team meetings are held in Hungarian," he reported.
Norway, in particular, has embraced the fruits of Hungarian medical training. It is not uncommon to find Norwegian students in this country's university hospitals. While Norway's four oldest universities (Bergen, Oslo, Tromsø, and Trondheim) all have faculties or schools of medicine, there is no specialized university dedicated to medicine alone. "It is easier and cheaper to recruit our specialists," Forrai added.
The Hungarian Medical Chamber appears to welcome foreign headhunters to the country (recruiting conferences are held in the capital, and language courses are offered for those who need them), he said. Forrai believes the chamber passes on contact details for direct mailing. "I get three or four letters every year. I'm not against people working abroad; I've done it myself. I'm quite open-minded, and my son is studying in France now, but I don't think it's our job to help recruit for other countries."
Such is the mess of the country's healthcare system that there can be no quick fix. By law social security contributions to healthcare funds do not cover amortization or replacement of equipment, but running costs only. Every state hospital owes millions of forints (the Hungarian currency) to its medical suppliers. Partly as a consequence, doctors here are near the bottom of EU salary scales.
The average salary for a young qualified radiologist will be in the region of 565 euros (around $810 U.S.) per month before tax, Forrai said. An experienced radiologist in his or her 40s would be doing well to pull down 940 euros (around $1,350 U.S.) while doctors in their 50s earn 1,120 euros (around $1,600 U.S.) per month.
Two-thirds of medical students want to leave Hungary for Western countries where they can earn up to 10 times as much, according to a survey by the increasingly vocal Hungarian Residents' Association, which represents junior doctors. Magor Papp, the head of the association, told state news agency MTI earlier this year that a resident doctor's average monthly take-home pay for 60 to 70 hours of work per week is no more than 300 euros (around $430 U.S.) -- a sum he said was equivalent to the pay of a street sweeper.
A radiologist will attract a bigger salary than an average general practitioner, of course, but not by much, and that isn't the whole story. For the past 50 years, Hungarian healthcare has operated on a "pocket money" system. Healthcare is free at the point of service, but patients are expected to pay all clinical medical workers a gratuity. As it isn't declared, no tax is paid, but everyone seems to accept this situation. Since radiologists rarely have a personal relationship with their patients, it is an extra channel of income that isn't available to them. Experienced specialists, even the heads of Hungary's university hospital departments, routinely hold down second or third jobs. "In Hungary, a vet is better paid than a doctor," Forrai remarked.