I must admit that over the years I have developed a somewhat negative attitude toward what Hungarians call the “orvostársadalom,” that is, the members of the medical profession, especially its leading lights. In the last 25 years they managed to thwart all attempts at reforming the whole rotten system. The hysteria that surrounded the suggestions of the ministry of health under the leadership of Lajos Molnár was outright disgusting. Hospital directors refused to collect minimal co-payments even if the money would have benefited their hospitals. So did the Fidesz-infatuated family doctors, although the money would have helped keep their own chronically underfinanced practices afloat.
I don’t know what these people expected from Viktor Orbán, but what they got must have been a bitter pill to swallow. The state of Hungarian healthcare is worse than ever. The old directors with few exceptions were dismissed and in their stead came doctors who in the past had expressed loyalty to Fidesz. For the most part these people are now quiet. Some of them even try to defend the current situation. At the government level, undersecretaries in charge of healthcare come and go. Gábor Zombor, the great hope, threw in the towel after a year or so, and the new one, Zoltán Ónodi-Szűcs, seems to be hiding somewhere. Meanwhile, István Éger, president of the Hungarian Medical Association, gives the occasional interview in which he complains that doctors don’t get enough money.
And what are the physicians doing? Emigrating. Between 2003 and 2011, 12% of Hungarian doctors left the country, most of them after 2010. Sixteen percent of MDs simply abandon their profession and work in the pharmaceutical industry or in fields completely unrelated to medicine. According to some calculations, if the salaries of doctors were raised by 40-50%, the outflow of Hungarian doctors could be stopped. I’m sorry, but I don’t believe this optimistic prediction when physicians in Western Europe can earn seven to ten times more than physicians in Hungary. Moreover, the problem is not only financial: there are not enough nurses, many of the buildings are in terrible shape, hospitals don’t have enough money to replace instruments critical to the work of the staff, and often the attitude of superiors toward people of a lower rank in the hierarchy is outrageous. I read about one maniac who writes weekly instructions to his staff demanding, for example, to be greeted first. If not, there is punishment.
Given the miserable working conditions, the amazing thing is that neither the doctors nor the nurses have been speaking out. Yes, Mária Sándor, the nurse in black, has been fighting for her fellow nurses ever since May, but she is unable to gather sizable crowds for her demonstrations. Since she is considered to be a troublemaker, she is unemployed at the moment. Although there is incredible shortage of nurses, she can’t get a job. The doctors don’t rally behind the nurses, who cannot live on their salaries and who often have to take second or third jobs to make ends meet. Mária Sándor asked the Hungarian public to support their cause. But although most Hungarians constantly complain about the state of Hungarian healthcare, no one paid the slightest attention to her.
In the last month or so, however, there are some signs that dissatisfaction is rising to the surface. Doctors are so fed up that they now openly talk about the deplorable situation that exists in Hungarian hospitals. First came the revolt of six anesthesiologists who gave notice to the administration of the Saint Imre Hospital in Budapest. Their complaints were manifold: shortage of nurses, low salaries, too long hours. They no longer felt that they could do a decent job under the circumstances. Sixteen doctors gave an ultimatum to Jenő Rácz, director of the Ferenc Csolnoky Hospital in Veszprém: either the woman doctor under whom they have to work goes or they will. But as Index correctly remarked, in each of these cases the directors defended the correctness of their decisions while the doctors remained quiet.
This situation is changing, it seems. Sixty-four doctors gathered and organized a Facebook group called “1,001 doctors without gratuity.” For those of you who are not familiar with “hálapénz,” perhaps I should say a few words about it. The habit of slipping a few forints into the pockets of doctors became widespread during the Rákosi regime when doctors became state employees who worked for a pittance. The Kádár regime continued underpaying physicians because the party leaders knew that the gratuity payments were amply supplementing physicians’ salaries. Or at least it was supplementing the salaries of certain doctors, like surgeons and obstetricians. And the tradition continues. The poor anesthesiologists normally receive nothing. So they have to work 300-400 hours a month to have a salary that befits their station in life.
These 64 men and women want to make gratuities illegal, arguing that maintaining the system serves only the interest of the government, which can point to these gratuities as a justification for not raising salaries. The new undersecretary, in one of the few interviews he gave, expressed his hope that with time gratuities will simply disappear from the system, no intervention necessary. Well, that’s unlikely given current salaries. Here is one example. A specialist receives an hourly net wage of 1,000 ft or €3.00.
The open letter they wrote to the undersecretary is an indictment of the present state of Hungarian healthcare. The Hungarian text is available online. The reaction from the ministry is not encouraging. Zoltán Balog said that “we pay as much as we can” while Bence Rétvári, the parliamentary undersecretary of the ministry, insisted that doctors make good money.
But there are other problems as well. The doctors claim that there are not enough professors in the medical schools, whose accreditation might be in jeopardy. Nurses who are being humiliated either leave the profession or the country. They talk about the falling plaster, the mildewy walls, and the inedible food in the hospitals. They bring up the inadequacy of medical care in general. For example, among cancer patients Hungary has the highest death rate in the European Union. The number of CT and MRI machines per 100,000 people is half that of Slovakia or the Czech Republic. These doctors want clear answers to their questions and demands from the ministry.
Suddenly the Hungarian Medical Association woke up from its years of slumber and is urging doctors to sign the petition. Moreover, Éger promised to stand behind the doctors’ demands.
What is the reaction in the ministry? Not very promising. The claim is that they have been regularly consulting with the profession, that the government is ready to listen to all opinions and is committed to high standards and the betterment of working conditions. The undersecretary insists that the exodus of doctors has slowed lately. The answer included references to higher wages for 43,000 nurses and 18,000 doctors in addition to extra pay for residents and specialists.
Today the government switched into high gear. MTI reported that the hospital in Siófok received 3 billion forints, the Pécs hospital 20 billion, and the Mohács hospital 1.1 billion. Yesterday Bence Rétvári called attention to the fact that in the last five years the government spent over 500 billion forints on healthcare which sounds terrific until you compare it, for example, to expenditures on sports and specifically on football.
The problems of Hungarian healthcare are so massive that I don’t expect any discernible change in the near future. The government is highly unlikely to embark, two years before the beginning of the election campaign for 2018, on any reform of the healthcare system. They’ll just let the whole thing rot for as many years as the Hungarian public allows it because, as everybody knows by now, touching healthcare can be political suicide.