“Anaesthesiologists in Serbia can make 1,500 euros a month tops if they keep their nose to the grindstone and have non-stop night shifts. In Croatia and Slovenia, the salaries go as high as 5,000 euros, whereas in Norway, Sweden, and Switzerland they can go up to 50,000 euros a month, but never below 10,000! In the US, they can become millionaires in a year – if they work and have an academic title, they make a million dollars a year! The financial status is especially important for young doctors, and it should be much better in Serbia, but that’s not enough,” Professor Radmilo Janković, the new President of the Association of Anaesthesiologists and Intensivists of Serbia (AAIS), Deputy General Manager of the Niš University Medical Centre, Chief Physician of the Clinic for Anaesthesia and Intensive Therapy at NUMC, and the Secretary of the European Society of Anaesthesiology, says in his interview with Kurir.
Serbia has a shortage of as many as 200 anaesthesiologists. Does it seem unattainable given what the salaries are?
“It is estimated that there are about 1,000 of us, with the majority working at state-owned institutions, but over 100 have in recent years got permanent employment at privately-owned hospitals in Belgrade and Novi Sad, even in Niš. The exact number is difficult to determine because a great many of them have gone abroad, mostly to Western Europe. State-owned hospitals have a shortage of no fewer than 200 anaesthesiologists, who are needed to sort out the problem of very long waiting lists, primarily in orthopaedic surgery. However, small hospitals, which have surgery departments and maternity wards, have only a few, and some of them no more than one or two anaesthesiologists, which makes the entire process highly risky. On top of this, the salaries aren’t the only problem.”
SOME OF THE BIGGEST NAMES IN THE WORLD ARE COMING TO NIŠ
At long last, after a pause due to the pandemic, you are once again organizing a Spring Anaesthesia and Intensive Therapy Conference in Niš, to be held between 21 and 23 April.
“These professional gatherings are an excellent opportunity for continued education, which is the basis for the safety of our patients. This year will see 10th anniversary conference, which has become one of the 10 most prominent anaesthesia and intensive therapy gatherings in Europe. It started in 2009 as a local theme-based gathering and has grown to become of the most significant gatherings. We invite all anaesthesiologists, as well as medical doctors in related speciality areas, because a wide variety of topics in internal medicine, emergency medicine, infectious disease medicine, and paediatrics will be covered. We expect nearly 1,000 participants and nearly 100 lecturers in over 20 theme-based sessions. This will be an extraordinary opportunity for doctors from Serbia to hear some of the biggest names in anaesthesia and intensive therapy without having to go to expensive international conferences and faraway destinations. This speaks to the fact that the AAIS and the Clinic for Anaesthesia and Intensive Therapy at NUMC, of which I am the head, are recognized as a centre of excellence.”
What can motivate young medical doctors to go into anaesthesiology?
“Being acknowledged and having the healthcare system pay attention to permanent education, because our job largely depends on medical technology, which is changing almost daily. That is key in keeping the current anaesthesiologists and getting new ones. And this is why we are proud of our Spring Anaesthesia and Intensive Therapy Conference, which will have its 10th anniversary in Niš.”
Could the fact that anaesthesiology is on the list of the Ministry of Health’s deficit specialities be of any help?
“The deficit of anaesthesiologists is seen across the world, above all due to the demanding nature of the specialization and the so-called burn-out syndrome at work, the great pressure in operating rooms and additional pressure in intensive care units (ICUs), where the most severely ill patients are treated, often those that everyone else has given up on. Everywhere in the world the mortality rate at ICUs exceeds 20 percent, which causes an emotional and psychological burnout. Also, some other specialities actually come with much higher salaries.”
Many are vying for positions in plastic surgery and dermatology.
“Yes, they can easily start a private practice, earn a lot of money, and do the kind of work where they don’t face such a great potential danger of patient death. As for anaesthesiologists, they top the list of 11 deficit specialities precisely because the demands of the system in post-Covid times are truly great and the waiting lists are long, primarily in orthopaedic elective surgery. Unfortunately, I’m not sure that this deficit will result in an increase of interest in anaesthesiology.”
SPECIALIZATION SHOULD LAST FIVE YEARS, AS IN EUROPE
Doesn’t our training to become an anaesthesiologist boil down to preparing to go abroad?
“They do go abroad, but there are obstacles there as well – our specialization lasts four years, whereas it lasts five years in many countries, so in practical terms, there is no complementarity of the educational programmes. This is why young doctors mostly leave after they finish their medical studies and find it much easier to get a specialization in anaesthesiology there.”
Are we lagging behind the West in terms of education?
“This specialization lasts five years in almost the entire world, and I see no reason why this shouldn’t be the case in Serbia as well. At any rate, one day this country will be in the EU, and perhaps anaesthesiologists from other countries will come here.”
Isn’t the designation of being “deficit” a form of forced recruitment of medical doctors? Do you fear that you will not be getting the best and most motivated personnel?
“The fact that those specializing at state-owned hospitals will no longer be able to choose their specialization, but will rather be assigned one depending on the needs of the hospital, and the deficit that the Ministry of Health has pointed out can certainly mean that our young colleagues will be forced to accept this specialization, even though they are actually not inclined towards it. Anaesthesiology, and especially intensive therapy, is highly demanding, as it requires the knowledge of clinical as well as basic medicine, which includes pathophysiology, pharmacology, the basic areas of surgery. You also have to have an inclination towards manual skills – od course, not to the same extent as surgeons. I don’t think this will seriously decrease the quality of the personnel, but we need to work on motivating the young, as they need to understand that anaesthesiology is the queen of medicine. The social acknowledgment of anaesthesiologists is much higher everywhere else compared to Serbia, as are the salaries, as I have already pointed out.”
COVID DOESN’T HELP, IT TURNS PEOPLE AWAY FROM ANAESTHESIOLOGY
Has Covid finally made you visible?
“However much we may think that Covid has brought anaesthesiologists to the fore because we have finally become visible and got an aura of national heroes, that hasn’t helped us. On the contrary. The young doctors ask themselves the following question: ‘Will I have to do such a difficult job?’ After Covid, many anaesthesiologists have gone to privately-owned hospitals, and a great many doctors from my clinic, who met one of the conditions for retirement, but they weren’t 65, have retired nonetheless. We have about 80 anaesthesiologists, and we’re the youngest clinic at NUMC in terms of average age – a tad over 40.”
ATTENTION GOES DOWN WITH AGE
You cannot be an anaesthesiologist forever – you need to switch to a similar discipline as you age in order not to make mistakes in the operating room.
“That’s a very good observation on your part – aging results in an anaesthesiologist’s decreased capacity for attention and some physical activities that are necessary for the patient to go through the post-operative period safely. While the patient is under, the anaesthesiologist must be adept enough to find the peripheral or central vein pulse, to place the dialysis catheter, sometimes also the urinary one as well, or to block the peripheral nerves using the spinal or epidural anaesthesia. Their attention must be meticulous in order to be able to monitor the vital signs from one minute to the next, and these signs can vary in major surgeries. The capacity to do your job isn’t the same at age 60 or more and at the beginning of your career. Unfortunately, doctors in Serbia are on shifts until the last day before retirement because in some places they’re the only anaesthesiologists. Due to the shortage of personnel, we’re often unable to spare our oldest colleagues even at the biggest hospitals.”
Are patients in Serbia at risk?
“Patients in Serbia are not at risk, but the anaesthesiologists are overburdened. Many overtime hours, the constant pressure – in operating rooms, reanimations, and especially in ICUs. No one is that interested in treating the most severely ill patients anymore.”
WE EDUCATE INTENSIVISTS TOO
What is the difference between an anaesthesiologist and an intensivist, and where in Serbia do you have new specializations?
“Only three European countries have separate specializations in intensive medicine – Spain, Portugal, and France. In the others it is a subspeciality, which can be chosen by other specialists. They last two or three years. Since last September, the medical schools in Belgrade and Novi Sad have subspecialist education in intensive medicine, and the classes last two semesters. Those who have registered are mostly anaesthesiologists, but there are some who come from internal medicine, as well as a small number of neurologists and infectious disease specialists. In Europe, anaesthesiologists are in charge of over 80 percent of all hospital beds in ICUs, and in some Central and Eastern Europe countries, the number stands at 100 percent. In Serbia, anaesthesiologists are in charge of nearly 100 percent of hospital beds in surgery ICUs, and they have extensive engagements either as consultants or doctors in charge of severe neurological conditions that require artificial ventilation.”
Kurir.rs/J. S. Spasić
