Getting a job as a doctor from abroad is hell. It costs thousands of euros and takes months

Thousands of doctors leave Slovakia each year for better conditions, but replacements from other countries do not come. The healthcare system is short of over 15,000 nurses, hundreds of pediatricians, and general practitioners. They could be replaced by specialists from countries that cannot offer doctors good living or working conditions. Although Slovakia might seem like an attractive destination for work and life, they face bureaucracy, high fees, and strict regulations. As a result, they often choose the same path as Slovak doctors and also go abroad to work.

The statistics are clear: Slovakia has been exporting medical faculty graduates and experienced healthcare professionals abroad for years. Data from the Organisation for Economic Co-operation and Development (OECD) shows that the number of medical students in Slovakia is above average. In this regard, we surpass not only neighboring Czechia but also most Scandinavian countries. However, after completing their studies, healthcare workers do not stay in Slovakia and instead leave for work abroad. Doctors most often go to Czechia, with over two thousand Slovak doctors relocating there every year, according to OECD statistics.

Several governments have tried to solve the problem. Four years ago, current Prime Minister Robert Fico (Smer) even proposed the idea of issuing a bill for education to young doctors who wanted to leave Slovakia for work abroad. This has not yet happened, but neither has the outflow of healthcare workers been successfully stopped. The latest expectation is for a new wave of doctors leaving for neighboring countries, as the government aims to significantly cut costs on salary increases as part of its consolidation efforts.

Partially addressing the shortage of healthcare workers could be achieved by bringing doctors and nurses from other countries to Slovakia. However, the process of their adaptation is often lengthy and challenging, with language barriers also being an issue. During the pandemic, the government tried to attract doctors from non-EU countries, such as Ukraine, Russia, Serbia, and Moldova. Heger's government approved a document allowing for the accelerated issuance of national visas for highly qualified workers from these countries, including doctors. After the start of Russia's invasion of Ukraine, another law was passed to facilitate the arrival and integration of Ukrainian doctors and nurses into the Slovak healthcare system.

The government made a good move, according to Boris Janíček from the organization 'Doctors and Nurses,' which provides guidance to foreign healthcare professionals interested in working in Slovakia. 'The legislation is good and sufficient, but the real problems lie mainly at the consular departments and the offices of the foreign police,' Janíček explains.

The entire process begins with Ukrainians needing to legalize their stay in Slovakia—either by obtaining refugee status or a residence permit. Waiting times for an appointment at the foreign police can take several months, he says. Only after this can they proceed with the process of recognizing their diploma from their home country. 'The nostrification takes about two to three months,' Janíček clarifies. During the nostrification process, doctors are not allowed to work and must wait several months. In total, the process of coming to Slovakia takes about half a year.

Another issue for foreign doctors is the cost of recognizing their qualifications and language courses, with fees amounting to thousands of euros. 'For a foreigner to learn Slovak at a B1-B2 level, they need 800 hours of study. It's a year-long course, which can cost up to 4,000 euros per year,' explained Alena Kurotová from the International Association of Doctors and Healthcare Workers in Slovakia (MALnS) to Pravda. Fees for recognizing diplomas and taking professional exams are also not low.

'It costs 140 euros to recognize a diploma. Exam fees are 200 euros for nurses, 500 euros for doctors, and 620 euros for pharmacists. For pediatricians, it's even more expensive, by 200 euros,' she added. On top of that, there are everyday costs for rent and food, and since doctors are not allowed to work while waiting for exams and documents, they have no income during this time.

Even when a healthcare professional has all their documents translated, recognized, and approved, they face another round of bureaucracy—the employer, typically a hospital, must secure a work permit for them. According to Janíček, hospitals often don’t understand the process well or know how long it takes. 'On the employer's side, there is a lack of understanding of the issue, especially in terms of creating their own adaptation and integration processes for staff who eventually join us,' he said.

The World Health Organization (WHO) has developed guidelines that serve as a legal framework for countries to more easily attract and employ international healthcare personnel, explained Kurotová. However, these recommendations have not been implemented in Slovakia. 'This creates room for inconsistency in the approach to recruiting healthcare personnel and insufficient consideration of international standards,' she added.

As a result, fewer foreign doctors work in Slovakia than in neighboring countries. According to OECD statistics, more than 3,600 foreign doctors work in the Czech healthcare system, around 4,000 in Poland, while Slovakia has only 1,200 foreign doctors. The number of foreign nurses is even lower. Out of a total of 32,000 nurses, only 200 come from other countries.

Boris Janíček states that Slovakia has the worst conditions for accepting foreign healthcare workers among all V4 countries. 'The Czechs do it purposefully and systematically, involving multiple ministries, the government, and even the employers themselves,' he emphasized for Pravda. 'It's a neighboring country with a similar healthcare system but better experience in integrating foreign healthcare workers,' Kurotová agreed.

Germany could also serve as an inspiration for Slovakia, as it began making changes early, effectively, and inclusively. By doing so, it managed to attract both young and experienced healthcare workers from abroad. 'Foreign professionals benefit from a comprehensive free (or state-funded) support system, which includes language courses through an e-learning platform and advice on adapting to the work environment,' Kurotová highlighted. She believes that improving the situation in Slovakia could involve support for specialized language training for foreign healthcare workers, removing certain bureaucratic obligations when submitting documents, and significantly reducing some fees.

"Nursing can increasingly be described as a mobile profession. Thousands of nurses, the vast majority of whom are women, migrate every year in search of better wages, working conditions, career mobility, professional development, a better quality of life, personal safety, or sometimes just for novelty and adventure," stated Lukáš Kober, Vice President of the Slovak Chamber of Nurses and Midwives (SKSaPA) for Pravda.

Countries like the United Kingdom, Australia, and Switzerland, during periods of critical shortages, have placed nurses on their preferential worker lists, simplifying the immigration process for them. However, Slovakia lags significantly behind in this regard. "If we cannot retain our own workforce, we cannot expect to attract foreign workers who could help fill the more than 14,000-nurse deficit in our healthcare system," Kober added.

He emphasized that foreign healthcare workers must meet the same conditions to work as their Slovak counterparts. Nurses and midwives need higher professional education in the field of certified nursing from the relevant vocational school or a bachelor's degree in nursing. Both programs must comply with EU directive requirements. "Healthcare workers who obtained their education abroad must go through the so-called nostrification of education," Kober said. The Ministry of Education and, in the case of healthcare professions, the Ministry of Health, recognize foreign qualifications.

"Another requirement is registration with the relevant chamber. For nurses and midwives, this is the Slovak Chamber of Nurses and Midwives," Kober explained. Healthcare professionals must also engage in lifelong learning. "This is mandatory and is based on the need for continuous information acquisition in line with the pace of technological changes and scientific advancements in medicine, nursing, and midwifery," he said.

According to Kober, the process could be simplified by reducing the bureaucratic and financial burden on applicants seeking recognition of their education. Additionally, providing sufficient opportunities for supplementary education, in case any discrepancies are found in the applicant’s education, would also help.