As a Hungarian from Transylvania, now a Swedish citizen, Lídia Bartha helps many doctors find a job in Scandinavia. Her Swedish company based in Helsingborg, which is present in several countries, is now being contacted by hospitals themselves to help them recruit an international team of professionals. Növekedés.hu interviewed her.
Do you personally feel that you are taking away doctors from countries where they would also be needed?
Undoubtedly, we are often accused of brain drain. First of all, people must understand that everyone in Europe works where they want to.
There is free movement of labour in the labour market, and companies and healthcare institutions take advantage of this opportunity.
But it is important that as a last year high school student I also helped my young friends in Hungary to come over here and take a temporary job. So then, why not now? Everything is in motion now, but the strongest movement started in 2008, when the global crisis broke.
Landscape and space – Lídia Bartha and her daughter
Where did most foreign doctors come from at that time?
Romania was at the forefront of this process. As soon as the financial crisis broke, more and more acquaintances from Transylvania, where I come from, approached me to help them find a job abroad.
The healthcare system there worked so badly that nearly half of all doctors ended up working abroad. This process lasted until 2016, making the system almost unworkable.
It was not hard to find a job for them.
What was Hungary’s position in the ranking list?
Romania was followed by Germany, Greece, Italy, Poland, and then Hungary, at least according to reports by Politico. So now to answer your first question: I expect my own “business” from the many private inquiries. The great turning point in my life began during this period. The “adventure”, as you put it, has been going on ever since.
It is not clear why it was you who was contacted by those in need of help.
Because they knew I had worked in HR before, for example at Adecco IT & Engineering, where we recruited IT development engineers worldwide for Ericson, for example. Plus, I come from a family of doctors and nurses; I grew up in this environment, so I knew how they felt.
In the end, I received so many inquiries that I had to start my own business.
I was also approached by people who wanted to join the business, mainly from Spain, Italy and Croatia. In recent years, people have been able to move from almost the entire EU to Scandinavia through my company.
The biggest wave from Hungary was around 2008-2009 and 2013. The situation always depends on geopolitical conditions.
Where there is a crisis, doctors and other professionals in Europe are fleeing mainly to Scandinavia, with its freedom-loving, life-affirming attitude; a region that offers good quality of life. Of course, there are also those who arrive because of private reasons: they need a change, or have family or friends living in Sweden.
Tell us about this famous Swedish life. What motivates foreign doctors besides money?
This is a complex question, not easy to answer. Most people get in touch with me because they are keen to do research, want to do more complex scientific work, or wish to leave their country behind.
Here, professional development is possible during working hours, unlike in many other places where you need to sacrifice your own spare time for this.
In addition, in Hungary this is only possible in university hospitals, while here in every hospital. There are more opportunities for doctors. They can attend more conferences, where their attendance is not paid for by pharmaceutical companies or sponsors, but by their employers. So the whole healthcare system works differently.
Can you give some examples?
For example, groups of 10-15 GPs work in clinics that resemble small hospitals; and they perform more complex tasks. Although they treat fewer patients, they spend more time with each of them.
80 percent of patients get treated in GP surgeries.
General practitioners have to take a special examination, for which the training period is five years. Therefore, they are able to treat patients themselves and only refer them to consultants if their own competence is not sufficient. This way, resources are freed up and this leads to better organization. Everyone is a winner: patients and doctors, as well.
Are these relationships based on trust?
Our human relationships are different. They are strong and fundamentally based on trust. Money is not the only motivating factor, although of course it’s also important. The truth is that Swedes used to be very conscientious, until society got diluted. Don’t get me wrong, even today they are conscientious; mostly in the north everything is unchanged, but in the south they have become less so. The country is still among the first in the world in terms of family friendliness, but the mood index is also good. Neither fathers nor mothers have to worry about overworking.
How has the selection process changed over the years?
Today, the system is different from that in 2010-11. At that time, knowledge of the Swedish language was not a requirement, today it is. I select according to the needs of hospitals.
How long after the application can a doctor or a college degree nurse start working?
Due to safety reasons, this time is long.
It takes at least one year from the application until the candidate can start working due to the long selection and preparation process.
Does the demand meet the supply?
I receive inquiries from every medical specialty. I have a contract with more than half of the hospitals in the 21 regions of Sweden, and today the institutions themselves approach me with their specific needs. Last year, I received a request from one of the regions to find ten qualified GPs at once. It was impossible, as I would have had to present at least twenty candidates, which would have meant finding at least fifty people. I’m talking about such big numbers because not everyone is able to learn a foreign language, and many applicants only realize what it really takes when they face the facts. Then they often withdraw their application.
Many internists, general practitioners and psychiatrists are, or more precisely, would be needed.
Unfortunately, I have to reject psychologists against psychiatrists with medical qualifications, just like dentists. I can’t help those who are about to retire in a few years, either, although they are interested in coming, too.
Why is that so?
Each hospital invests huge amounts of money into the training a foreign doctors with specialist qualifications, so the costs of the courses and procedures would never pay off. A minimum of three years are needed to return these costs, so if someone comes at the age of sixty, that can no longer work. Older people tend to find it harder to adopt a totally new way of working, as they would rather work as they are used to and also have more difficulty learning the language. There are exceptions, of course, but most people around sixty are no longer as flexible as younger colleagues.
The hospitals here use funding to pay for the recruitment, training and relocation of foreign doctors and nurses.
The problem, however, is that there are fewer doctors in the region closer to the North Pole, and it is not proportionate to the number of patients / cases. There are fewer inhabitants there, so the catchment area is also much larger. This also means that patients have to travel more to get to the hospital. In such cases, consultants tend to commute, as northern hospitals are willing to pay staff hired from the southern regions very well.
If I apply to you as a doctor, will I have a long hard journey?
If I find that you meet the criteria, then everything is done at the expense of the hospital; you don’t have to pay. All the costs are covered by the hospital, the language course, retraining, everything; in return, however, candidates must devote all their time to their studies.
As for the language, they have a maximum of one year to reach the C1 level, which means becoming a fluent speaker. This is a very intensive course that not everyone can complete. Therefore, it is important for us select those who have the potential to learn the language.
We are talking about six hours of course work five times a week - plus a few hours of home assignments - as foreign doctors and nurses have to pass the compulsory language exam. Husbands / wives may also take advantage of these courses, as they may be available for partners as well.
Are the courses run locally?
No. At this stage candidates are still at home; the training is done digitally, especially now because of the epidemic. There are maximum five students in these virtual classrooms.
How do participants make a living during the course?
During the course, participants receive a net salary of one thousand euros, as a grant. Plus, if they have kids, they get a benefit of about seventy euros per child. After all, during the course applicants can only work in their home country, not in Scandinavia. Although our experience is that the language training takes up all the time.
If someone has successfully passed the language requirement, what happens next?
By the time you have passed the Swedish language exam, I will have taken care of the administrative tasks which are needed in order that you can move.
You mentioned that all my costs are covered by the host hospital. How much do I cost the institution without having ever worked for them?
This is confidential information. All I can say is that the hospital pays for the whole package, which includes not only the course, but also the relocation and finding a place to live. I need to know exactly when applicants are planning to move, because finding property here takes time.
I guess we can talk about doctors’ salaries…
I can see that you are interested in the financial aspects, although we treat these things with greater prudence. The financial conditions are determined by each of the 21 regions of Sweden separately; only the minimum wages are set by the trade unions. All qualified doctors or nurses should be paid at least this amount. Minimum wages change annually as salaries are adjusted for inflation every year.
A newly trained doctor will earn about five thousand euros, while a newly trained nurse about 2,800 euros a month, plus additional remuneration such as on-call fees.
This is the minimum amount determined by the unions, so it can only be more than that.
What about the cost of living? How expensive is life in Sweden?
As rental housing is in short supply, housing is the most expensive part. On average, the monthly rent for a three-room flat is between 800-1300 euros, depending on the city and the location, of course. The rent includes everything except electricity; the electricity bill is around thirty euros for every three months.
In Sweden, people spend an average of three hundred euros / adult a month on food. This means cooking at home, not eating in restaurants.
Education is free. Clothing is the same as in Hungary, but cars are cheaper, just like electronic devices, at least that's what Hungarians say. Fuel is available at roughly the same price everywhere in Europe, and we do not have to pay for motorways, except for the newly built shorter sections around Gothenburg and Stockholm.
After all this the question is how the salary of foreign specialists can increase.
Experience, dexterity, and popularity set the price of each professional.
Leaders are loyal. A negotiation related to pay rise may take hours.
You mentioned the “boss”: what is a Swedish boss like?
Anyone who arrives here will find it strange at first that managers are not following you and checking on you all the time. You don't have to hide if you want to have a cup of coffee, either. Everybody is treated as a partner; everybody has a lot of independence. This can be an advantage, but it can also be a disadvantage. There is trust, which prevails until it is broken. However, once a Swedish person loses trust in someone, there is a long way back. Therefore, honesty and communication are crucial.
On the other hand, it is unfortunate if a newly arrived doctor – e.g. from Hungary - expects special treatment. Thinking too much of yourself is not acceptable here.
It’s possible to get used to the work culture and hierarchy here, but I’m not saying it’s easy. However, if someone succeeds, they will have nothing to complain about. It has happened already that foreign professionals could not or did not want to get to know the Swedish medical procedures adequately. It is something that needs learning, just like the handling of tools and machines. This affects all specialists from pathologists to psychiatrists to gynaecologists.
The problem is not new. A few decades ago, only a low number of doctors were trained here at Medical Universities, and many of them have already retired. For example, the number of young doctors graduating at Stockholm University each year is around 70-80, which is less than half of those graduating at Semmelweis University in Budapest.
The situation is made worse by the fact that many of the newly graduated doctors move on, for example to Norway, where salaries are even higher.
There is no shortage, however, of orthopaedic, cardiac and neurosurgeons.
Do they earn more? Are these the most popular specialties?
The interesting thing is that this is not typical. Salaries are pretty much the same. GPs, who are always in short supply, are given even higher salaries than heart surgeons, for example. It’s the exact opposite of the situation in Hungary.
To what extent has the coronavirus caused a setback in applications?
From a business perspective, I can feel the impact like anyone else in the world. There are those who do not have the courage to set off now, but there are also some who are being forced to make a move precisely by the current situation. Many people are giving their decision a thought now.
Do you have any candidates now?
Yes, there are several, but it is still more about visiting the city, the hospital, etc.
Because of the pandemic?
Yes. No candidate can be expected to accept a job unless they can see the hospital, meet prospective colleagues, get to know the city. There is now a psychiatrist from Croatia who is hesitating because he does not dare to go to the hospital without wearing a facemask. I don’t know if he’ll come to the job interview. There are hospitals that don’t even do job interviews in person now, just online, which is not the same thing.
It’s obvious that applicants are more cautious. We don’t usually use a facemask and this fact alone can scare some people.
We only wear the mask when we are seeing infected patients.
This is strange to hear from a professional who has a good insight into healthcare.
I agree with the Swedish model of virus control if we look at the long term effects and take society as a whole into account. I know our virus control strategy is one of the most divisive in the world. However, I do not agree with the way we have handled nursing homes here in Sweden, but that is another question.
You have to understand that we don’t live on top of each other; there are huge free areas here.
My office is in Helsingborg, the seventh largest city with 112,000 inhabitants. I commute every day, as we live in a small settlement, with only a few hundred families living there. Everyone has become fed up with all the controversial news; I would go crazy browsing the statistics every day. Panic only breaks out if we induce it.
You must be familiar with the number of deaths, though.
Yes, I am. There was a week during the first wave of the epidemic when there were 64 deaths. So far, the total death toll here is around 5,900. What the second wave will bring, if there is a second wave here in Sweden, remains to be seen. For the time being, the situation is calm. I'm not worried.