Pauperised Serbia pays exuberant amounts for educating doctors who end up a number in the Bureau of Labour registers or find employment in the West; affluent Germany systematically educates fewer doctors than it needs because it will always be able to recruit them from countries that “have not made it” in their transition to capitalism.
The trick of globalisation lies in the fact that it ends immediately after its four famous pillars, upon which today’s EU is also built — free flows of people, goods, capital and services. The final sum in this game amounts to nothing but zero, which means that the goods someone exports have to be imported by someone else, or that labour force that is somewhere welcomed with open arms probably leaves an empty hole where it comes from. While migration of unemployed or unqualified masses from the periphery to the centre of capitalist system can at least theoretically be justified as export of unemployment, when these masses comprise of experts whose education is both expensive and long – lasting, then we are dealing with a more complex situation.
We can make two hypotheses based on the analysis of the state of affairs in Serbian and German healthcare systems: pauperised Serbia pays enormous amounts for educating doctors who end up either in the Bureau of Labour registers or find employment in the West, most often in Germany; affluent Germany systematically educates fewer doctors than its new demographic structure really needs because it will always be able to recruit them from countries that “have not made it” in their transition.
Standing conference of German Medical schools, it was estimated that German universities offer only nine to ten thousand places for medical students, even though six times more candidates apply each year. Admission is reserved only for the best high school students with grades between 1 and 1.2 (the highest grade in Germany being 1 and the lowest 5). According to the OECD, Germany has only 11,3 medical graduates per 100,000 of its residents—by far fewer than Serbia (17). When university places are concerned — let us use the neoliberal discourse so widely adopted in Germany — the supply is significantly lower than the demand.
What advice would we be given by an economist or a demographer in any other case? To enhance capacities, of course. Some of the like voices can indeed be heard and are strengthened by occasional students’ protests and doctors’ appeals.1 We are still no witnesses of significant changes in that regard because, at the same time, there are 288 doctors per 100,000 residents of Serbia, but 410 per 100,000 in Germany. Nevertheless, unlike in Serbia, doctors in Germany can work part-time if they want to.
The conclusion we can make from all that is more than obvious — Germany’s healthcare system’s shortages are compensated by recruiting doctors from the periphery of the capitalist system or even from the countries with ongoing war exoduses. According to the German Medical Association, 46,721 doctors working in Germany are holders of foreign passports (excluding those who have meanwhile gotten German citizenship). Among those who started working only last year are 218 doctors from Serbia.2
German taxpayers, i.e. potential patients, pay 200,000 EUR for educating a single doctor at a public university, where tuition fees are not covered by students, but by the State. Bringing doctors from abroad is, thus, an exercise in austerity — favourite German discipline.
Even though there are some systematic qualities to it, the recruitment of the necessary medical professionals from abroad is carried out neither openly nor according to a strict plan. The ruling Christian Democratic Union of Angela Merkel (CDU/CSU) has impeded passing a so-called immigration law for years, which would clearly define the needs of the labour market, reduce barriers and introduce a points-based system for potential immigrants, such as CRS in Canada, for instance. Within the conservative circles, it is rather unpopular to pass such a law and thus admit that Germany has been an immigration country for a long time, even though it started its Wirtschaftswunder in the fifties with millions of gastarbeiters (eng. guest workers).
Even without that kind of law, passive recruitment of medical professionals can be observed from numerous sources — unemployment statistics, salaries in both countries have long been subjects of countless forums and Facebook groups where Serbian medical professional seek and exchange information on living conditions in the “promised land.” Regardless of the growing gap between the rich and the poor and precarisation of some jobs, when we look at the salaries in the medical sector in Germany, we can see that the Article 1 of its Basic Law (i.e. constitutional law) holds its ground — human dignity is inviolable.3
Salaries of medical staff in Germany are five to six times higher than those in Serbia, meaning that they offer them three to four times greater purchasing power. Doctors working in public healthcare system in Serbia earn between 500 and 700 EUR per month (net), and nurses around 250 EUR — these are the sums that do not provide one with a minimum needed to satisfy basic human needs, just like most other jobs in Serbia. The very possibility for one to have normal living and working conditions and the opportunity to earn enough money seem to be crucial for many. As put by a medical technician who moved from Niš to Rostock: “I feel like a human being in Germany.”
Enough reasons to depart
According to the study carried out by Healthgrouper in 2015, three–quarters of doctors in Serbia thoroughly considered or are still considering leaving the country. Around 60% of participants in the survey cite working conditions and salary amounts as potential reasons for emigration, the first one being more prevalent than the other, interestingly. A smaller proportion of them states they would pack their suitcases because of the political situation in the country and partocracy which, nota bene, Berlin and other Western capitals proverbially support up to the point that this phenomenon has gotten its own name: stabilocracy. Civilians in Balkan stabilocracies may not be sent to war anymore, but they sit on their suitcases or talk to their children on Skype.
Healthcare sector — as a system of unquestionable public interest that has not been totally privatised and completely left out of State control even in capitalist Meccas — is by far more susceptible to migrations than education or security system sectors, for instance. A biology teacher from Požarevac cannot simply go and teach in Wuppertal — even though Germany lacks teachers, especially in the field of natural sciences — nor can a policeman from Leskovac simply put on a German uniform and patrol Nuremberg.
At the same time, medical workers can do all that with just basic knowledge of German language and will moreover be offered free language courses by intermediary agencies in order to improve it. Furthermore, employers in German clinics and nursing homes praise Serbian education for medical professionals because it resembles their own.4
What does the white coat exodus leave in Serbia? According to the National Employment Service, there are almost 3,000 unemployed doctors in Serbia, among which only 98 specialists. Media sometimes report on dramatic lack of specialists in certain fields, most often in anesthesiology and radiology. Anyone who has had the misfortune of needing to consult a specialist or undergo a surgery knows quite well that sometimes death can come quicker than the waiting list can reach its end. For that we can only thank insane restriction in awarding doctors specialisation certificates as well as to barriers to getting employment — which can be bypassed, as is widely known, with party membership.
Obviously, funding education of doctors with public money is not in the best interest of citizens of Serbia — if these doctors end up treating Germans, the Swiss or Norwegians. Clearly do the wealthier countries draw human resources from poorer ones in the same way as they take away mineral resources with the help of imposed land concessions. Moreover, we obviously cannot resent those that pack their stethoscopes and leave for having given up — their experience shows them that the crisis on the periphery is permanent, that it can only be ended individually by moving to the centre. Rather than becoming old waiting for the world revolution to come, they go to Germany where shift handovers are already being carried out in Serbian.
Translation from Serbian: Ivana Anđelković
This article was originally published in Serbian on December 12, 2017.
- “Germany must not rely on foreign workforce to cover its medical needs. That is not in line with the responsibility we have as a wealthy country”, said Ulrich Montgomery, chair of German Medical Association in conversation with Die Welt. These kinds of attitudes are seldom heard in Germany.
- In the year 2016, the largest number of medical professionals came to Germany from Syria (746), then Romania (223), Serbia (218), Ukraine (160), Russia (109) and Azerbaijan (108). The most foreign doctors working in Germany are those coming from Romania (4,285), Greece (3,118), Syria (2,895) and Austria (2,600).
- Average salaries in private clinics in Germany are impossible to determine because doctors employed in that sector are entrepreneurs taking all risks and possibilities for extra profit-making. On the other hand, public and university hospitals have strict collective agreements. Hence a trainee earns around 4,300 EUR gross per month, a specialist earns 5,800 EUR, and head of ward earns 7,300 EUR—without paid overtime, or weekend and public holiday hours. Nurses can get a starting salary of around 2,000 EUR gross (tax rates in Germany depend on income, tax class and family status).
- “What nurses do in Serbia is similar to what they do in Germany, and their cultural matrices are similar. If we take Spain or Italy as examples, we can see that patient’s family and relatives bring food to the hospital, they bathe their sick relatives, feed them. When nurses come from those countries they are shocked to discover they are expected to aid their patients in bathing or showering. On the other hand, Serbian education is really good, it provides students with a lot of theoretical knowledge. Even though they get less practical training than in Germany, the jobs themselves are similar, so that is easily compensated”, said Annette Labahn, the Chairwoman of Board of Medical Personnel of Rostock University Medical Centre in conversation with Deutsche Welle.