Why these health workers left or stayed in their home country Romania

The below interviews were conducted by Janneke Juffermans. Read her article about migration and recruitment of health workers in the EU on Vrij Nederland (Dutch).

Flavius – Cardiologist in training in the Netherlands

“The Romanian health system must be structurally redesigned”

“I work as a basic physician to become a cardiologist in Leeuwarden. Seven years ago, I came here to study medicine and after that I never left. I graduated last June, and I’ve been working at the hospital since October. 

What motivated you to become a doctor? 

When I was a teenager, I didn’t have a fixed or romantic idea of ​​what I wanted as a profession. First, I thought of geography. But since I liked chemistry and biology very much, I thought of studying medicine. And when I did an internship at a hospital, I knew this was what I wanted. There are several things I like about cardiology. I can really mean something to people who are in a vulnerable situation. Cardiologists often deal with very acute situations, with vulnerable people and miserable illnesses. It’s nice to really help people and offer support to their loved ones. Sometimes a good conversation can really do wonders. Another part is the medical puzzle. Making the diagnosis, and doing research to determine the diagnosis.  

And then you decided to leave… 

Yes, I also wanted to study abroad, since I figured then I would get a better education. I also liked the idea of ​​being in a multicultural environment. In Romania, studying medicine is very theoretical. Books are as old as forty to fifty years and are not very up-to-date. I liked the practical focus of the medical studies in the Netherlands. I am the only one in my class who ended up in the Netherlands. Most went to England, but also to Spain, Italy, and other countries. There was a lot of talk in my class about England in particular. I knew that in England it is very difficult to get admitted. Two classmates studied in Groningen and recommended the course, so I applied.  

What differences do you see between the Netherlands and Romania? 

Not only the medical training, but also the health care system is different here in the Netherlands. There is no scarcity of resources or instruments and there is less corruption. In Romania, corruption exists at all levels of society. In addition, generally speaking, doctors in Western Europe earn much more than those in Romania.  

Romania is now part of the EU, which makes it very easy to come here. Since the Schengen visas expired in the 1990s, many doctors came to the Netherlands or to other countries in Western Europe. I don’t have the exact figures, but I think half of the Romanian doctors went abroad. The recognition of diplomas, for example, went very smoothly. I applied and was able to start right away. 

How did that go? 

It took me some time to adapt. I found the Dutch language very difficult. But I quickly picked up phrases and learned the language. Now I can express myself very well. I found it difficult to integrate culturally. The Netherlands is a very individualistic country and Romania is much more collectivistic. People live closer together and the group comes first. Everyone also has hobbies here, with which people confirm their identity. Things that make a person unique. In Romania, group feeling and spending time with the family are more important than your self-development. That’s why I felt lonely in the beginning. I have made good friends, but the Dutch like to be in their own group. I find it a disadvantage that I cannot speak my own language. My culture remains there. I do know some Romanian doctors here, but we don’t have that much contact. 

Do you think there are gender differences for doctors in Romania? 

Although there are more and more female doctors in Romania, you do have an advantage there as a man. Especially regarding the managerial roles such as manager or director of a hospital.  

Do you ever consider going back? 

Some other Romanian doctors would like to return to Romania to revamp the health care system. 

I wouldn’t do that so quickly; it feels a bit like being Don Quixote. Besides, it doesn’t fit with who I am, there. I feel more free to be myself here. 

The world just experienced the COVID-19 crisis. How did it affect you as a doctor and how did it go in Romania? 

During the COVID-19 pandemic I worked at home a lot, contributing in various ways. I also assisted with the triage and administered vaccines as a doctor. This way I gained a lot of experience and was able to help people. Cardiological and acute care continued, of course.  

But in Romania it was different. It was much more heavily overrun with patients. The country’s vaccination rates are the lowest in the EU. People are impressionable and not well-informed. It was reported in the news that you would get brain damage from the oxygen mask. In the Netherlands, at a certain point, more trust was needed in the health care system, but in Romania much more than only trust is needed.  

Such as? 

Such as better financing of the healthcare system so that people can be taken care of and helped. And investments in infrastructure and good remuneration and managers. In fact, the entire Romanian health care system should be reformed and restructured. In Romania you get a job via contacts, in the Netherlands you have to apply and therefore you have an equal chance. But the health workforce shortage is an issue almost everywhere in Europe. If at EU level the salary of nurses and doctors could be increased or at least more equalized so that it wouldn’t be so tempting to leave, that would be very good.” 

*At the time of the interview, Flavius was officially a basic physician (Dutch: ‘basisarts’), and he was enrolled in cardiology training (Dutch: ‘co-schappen’) to become specialised in cardiology.  

Dana – Psychologist in the Netherlands

“Romania has more to offer now than when I left in the ‘80s. And so have I, so I intend to go back“

What motivated you to study psychology in the Netherlands? 

“I always wanted to do something with people. I am interested in their stories. In Romania, when I was in high school in the ‘80s, I worked in children’s homes. I developed an interest in psychology. After high school I came to the Netherlands. Studying psychology was not possible in Romania. There were very few educational opportunities. I saw no opportunities to develop myself in Romania. Psychotherapy was a completely new profession worldwide, but it was not until the 1990s that it started to take shape in Romania. So, I left six months after the fall of the Berlin wall in 1989. I was 21 years of age and wanted to settle here in the Netherlands.  

How did your start in the Netherlands go? 

It was very difficult then. I first lived in an asylum-seekers’ center and had to start a procedure. I met people with so many cultural backgrounds and found it interesting. After that I lived for a while with a Dutch family. I wanted to work and to study, but for work I needed a residence permit and for a residence permit I needed work. And I had only finished high school. So, every day I worked as a volunteer with disabled people. I was also able to get training there, and things started rolling for me. I became a healthcare manager. But I still wanted to learn to become a therapist. I was especially interested in family counseling. And finally, in 2002, I enrolled in a course: transcultural therapy in Amsterdam.  

What has changed since you came to the Netherlands? 

In the 1990s, Romania was rudderless, in a dark post-communist time. We didn’t know where it was going. We had to go through such a big transition. Later, I did a lot for Romania, setting up foundations. I wanted to contribute. I will always feel connected to the country. You see the struggle over there, but you can also give something back.  

I think it took me five years to get my Dutch nationality. I got my work permit after three years. It was a couple of years of thorough searching and keeping and filing records. But since Romania entered the EU, everything has been aligned. In the entire EU. Now it’s very different. 

Coming to this country has become very attractive. You are invited. A friend was on LinkedIn, and she was asked to come to the Netherlands. That was settled within three months. Financially, it has also become attractive to come here. In the beginning, you don’t have to pay taxes and your children are welcome to come too. All kinds of favorable arrangements are put in place for healthcare personnel from abroad. 

What differences do you see with the health care system in Romania? 

Health care is much more centralized here. Decisions are also controlled much more centrally. In Romania, healthcare is much more isolated. Every hospital in Romania works for itself. As a patient, you walk from one doctor to another, with your own file under your arm. Here, more transfer is done by doctors themselves, and there are also more consultations between doctors, sometimes even with entire teams. That is now also happening in Romania, but the way it used to be was that every doctor is there for his own patient.  

On the other side, in Romania there is much more one-on-one contact between doctors and patients, and the relationship is much more intimate and warmer. As a patient, you will also be asked about your family and relatives. Doctors in Romania see you as a total package.  

Another difference: in Romania there are more private clinics. There are also many state clinics, where waiting times are longer. Private clinics often have the latest gadgets and instruments, but of course it’s more costly for patients. Romanian organizations and hospitals are organized in a much more hierarchical way, but this is less so in new companies. Old hospitals in particular are much more traditional. 

You can set up a private practice there, but you must invest a lot of money. Not every doctor can afford that. Although doctors are now paid much better, better than a few years ago. Over the past five to ten years, salaries have steadily increased. 

What cultural differences do you see? 

In Romania, doctors quickly become friends with each other. Not acquaintances; I’m talking about deep friendships. Going out for dinner together, going on holiday together, etc. For example, before you know it, you are sitting with five families while the children also get together, and you find yourself chatting until five o’clock in the morning. If you meet up one-on-one with people in Romania, it’s often because you must tell each other something personal.  

In the Netherlands, you make an appointment with everyone separately. And people are used to going on holiday with the family. In Romania, you go on holiday with friends. 

This is quite difficult for newcomers, who want to connect quickly. And you are sometimes left with a certain uncertainty as a professional from Romania. You don’t have the same background, so you must prove right away that you’re good enough, that – in your case – they didn’t buy a pig in a poke. For example, if someone says that something isn’t such a good idea, you don’t know what would have been a good idea. They also said that I was ambitious, while I did not experience it that way. In Romania, you must prove that you know something. You must be ready, with a lot of knowledge. That was seen as an ambition here in the Netherlands, as showing off. 

Do you see differences between female and male doctors in the Netherlands and Romania? 

In the communist era, you didn’t have to distinguish between men and women. Women were encouraged to study.  

As a result, in Romania more women are in high-level positions than in the Netherlands. Yet, as a woman, you are viewed differently. Here in the Netherlands, it is more difficult for women to reach a high position, as a minister, or CEO. In the Netherlands it is almost impossible for a woman with children to work 40 hours a week. In some respects, I think Romania is more emancipated. Women can be found in the IT sector, they go to universities, and do dental training. In Romania, women are more emancipated in society, but have little to say at home. She must work very hard to be heard and supported by her husband. 

Do you ever consider going back? 

Most people who come to work in healthcare here do so because they can develop themselves here and want to have a better salary and higher standard of living. But Romania is still such a lovely country. It is wonderful to be there, and I would love to take care of people that I love there more than I can do from the Netherlands. I already work online now with clients from Romania. The weather is fantastic, the nature is very beautiful. In a few years, I think I want to go back.” 

Claudia – General-practitioner in Romania

“We need less administration and more contact among GPs and specialists in Romania“

You work in Romania, did you ever work abroad? 

“Yes, I’ve worked as a doctor in Ireland over the course of several summers, as part of a European exchange programme. I learned many things from the doctors there. They perform many medical procedures! In Romania, a general practitioner will refer patients to a specialist, in most cases. Procedures such as IUD insertion or wart removal are done by a specialist here in Romania, while in other countries, they are also done by general practitioners.  

But the doctors in Ireland also learned from me. I was one of few female doctors in Ireland, so many people, especially women, were happy to come to my office.  

Why do you think other doctors leave Romania permanently? 

I understand when young doctors go abroad to broaden their horizons. A veritable exodus took place especially after Romania’s accession to the EU, and it never stopped. But it’s also a pity, because it’s exactly Romania that needs good examples of experienced doctors who can share their expertise. Many young doctors now must miss those role models.  

The medical training in Romania is good, but very theoretical, and I remember how much I learned from the more experienced doctors once I entered the practice. You really need such examples as an entry level doctor. And since there are few of those, also for other reasons, young doctors are even more interested in moving abroad, and the problem becomes a vicious circle.  

Why do you choose not to go? 

Fortunately, the salaries and working conditions are improving here in Romania. I feel that I am needed here. I don’t want to abandon my patients either. As a general practitioner, I put effort in investing in my relationships with my patients. I have known many for years. And I am in close contact with the other GPs in this practice. I consider them as my friends. One of them has gone abroad. Our personalities are different, she is better at settling elsewhere. I think I will always feel homesick for Romania. 

What do you think can be improved in Romania besides the salaries? 

Well, I have little contact with the specialists I refer to. I know that the hospitals, for example, had a very hard time during the COVID-19 crisis, and that many people have died. 

For me personally, that was all quite far away, although of course I sometimes had to refer patients to hospitals. And of course, as general-practitioners we also had to work harder, but I think it would have been nice if there’d been more coordination and cooperation. The general-practitioners who do still work in the practice, just like me, work extremely hard. This brings me to another thing that I encounter in Romania: the increasing amount of paperwork and accountability that I must comply with. I must justify everything that I do and discuss with a patient, which is super time-consuming.

When it comes to what the government can do for me, I think: please address the unnecessary bureaucracy and mistrust. I also sometimes find it stressful, as I think: have I justified everything sufficiently? What if I am charged for this? It’s different now as compared to the past, everything is much more analyzed from a cost-benefit perspective, and if our performance is subpar, it’s held against us. I always stay in Romania because I really feel that I am needed here. But I still go to Ireland in summers to work there. As a result, I still feel that I’m connected with other countries. This is very important if you want to reflect on or enrich your profession. In a European context, I hope that these collaborations will continue to be stimulated, but I also hope that people will choose to stay in Romania. To achieve this, not only the salaries, but also the government’s trust in our doctors must be increased. Fewer rules and bureaucracy, more room for support staff. If you were to ask me now what I’d want most, then it would be a secretary or a doctor’s assistant.”