ZAGREB, 12 June 2022 - The number of doctors in primary health care in Croatia will drop by 24% in the next five years, which will make work in the sector impossible, while the number of nurses will drop by an additional 25% due to retirement and lack of new staff, the medical and nursing chambers have said.

On the other hand, projections for the next five years show that the number of hospital doctors will increase by 23% considering data on those who will go into retirement in that period and the number of doctors entering the system.

Number of hospital doctors growing, number of primary health care doctors falling

As in other matters, the profession expects the imminent health system reform, announced by Minister Vili Beroš, to provide solutions.

A total of 15,668 doctors work currently in the public and private health sectors, and their number is 9.1% higher compared to 2017. Their average age is 51, and 63% are women.

Hospitals currently employ 9,170 doctors, their average age being 43. Of them, 995 are above the age of 60 and currently 127 pensioners work part-time in the system.

Among the hospital doctors are 6,276 specialists, whose number has increased by about 300 since 2017. Considering that 2,558 are residents, the Croatian Medical Chamber (HLK) estimates that the number of specialists in hospitals will grow by 23% in the next five years.

The situation is quite different in primary health care, where the number of doctors is expected to fall by 24% in the next five years considering the current number of only 236 residents.

The situation is particularly critical in family medicine, with only 131 doctors being trained for family doctors, including 122 who are already team leaders. The number of doctors in that area of medicine is estimated to fall by 27% in the next five years.

There are currently 2,213 family doctors and there is a shortage of 150 doctors in that branch of medicine; 733 of those 2,213 doctors are above 60 so if something is not done, the situation will be unbearable in five years' time, HLK head Krešimir Luetić said at the MedMed conference in Grožnjan.

One-third of 248 pediatricians, who are already in short supply, will retire in the next five years, and their number will drop by 13% while the number of gynecologists will fall by 10%, it was said.

A total of 1,021 doctors, aged 36 on average, have left Croatia so far even though the numbers have been stagnating in the last two years due to the coronavirus pandemic. Most of those who have left today work in Germany, Great Britain, Switzerland, Sweden, Ireland and Austria. Another 839 doctors have sought documents required for employment abroad.

Croatia lacks a system of human resources management in the health system, Luetić says, noting that the HLK has been demanding for years a collective branch agreement for the profession, a law on wages and comprehensive reorganisation of specialist training. The shortage of physicians is also evidenced by three million hours of overtime work annually, he says.

Nurses in short supply

There is a shortage of more than 4,000 nurses, and in the next five years between 5,500 and 7,000 will meet retirement conditions, according to the Croatian Nursing Council.

A total of 38,500 nurses work currently in the health and social welfare system.

The Council calls for urgently increasing enrolment quotas for nurses by at least 50% and encouraging the employment of carers to help cope with a constant, 25% shortage of nurses, as well as for increasing their wages and securing benefits related to professions in short supply.

"In five years' time the number of nurses will drop by an additional 25%. The interest in the profession is great but enrolment quotas are too small and we have asked the Education Ministry to increase them," Council head Mario Gazdić said.

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February 11th, 2022 - Primary care providers are not responding lightly to the accusations of being unavailable to their patients. At the same time, they are being reprimanded by the HZZO for the sick leave rate increase, despite it largely being caused by COVID-19

The pandemic has led to a significant increase in the number of workers taking sick leave. More than a million citizens have been infected with the coronavirus in the last two years, and as of yesterday, 21,865 people were in isolation.

Although some of them only have mild symptoms and continue to work from home, a good number of people are forced to take sick leave. However, although it is clear to auditors from the Croatian Health Insurance Fund (HZZO) that taking time off for this reason is justified, GPs are being reprimanded for the amount of sick leave they’ve been approving, reports Vecernji list/Romana Kovačević Barišić.

‘My allowed rate of sick leave is 2.8%, and I had 5.5%. The [HZZO] audit did not find any irregularities, but I received a warning for exceeding the rate nonetheless. I didn’t want to sign it, but I was informed that I was putting my contract in jeopardy. I filed a complaint. It was accepted, but it was also confirmed that my exceeding the sick leave rate was unjustified as I signed a contract with the HZZO stating that I would adhere to the stated rate as a contractual obligation. And the pandemic isn’t mentioned anywhere in the contract’, said Marija Gluhak MD, a family doctor from Međimurje, describing her case from November last year.

In case of repeated warnings, the practitioners are first subject to a fine, followed by a possible termination of their contract with the HZZO.

Dr. Vesna Potočki Rukavina MD has seen her contractual sick leave rate of 2.5% increase to 4.9% in the last two months.

‘Omicron has caused a considerable increase in acute sick leave. It mostly affects the younger part of the workforce and inevitably excludes them from work obligations, and HZZO does not look at the situation in the field objectively, so they reprimanded some of my colleagues’, said Dr. Potočki Rukavina. She hasn’t received a warning despite having exceeded the mentioned contractual rate, which only points to the absurdity of a dry bureaucratic approach which is devoid of logic and uneven across the board.

The HZZO point out that they have an obligation to monitor and control the Temporary Incapacity for Work (TIW) of the insured to see whether the status is justified, and to do so both on a regular basis and in exceptional circumstances.

‘Temporary incapacity for work caused by isolation and illness related to COVID-19 is determined and managed in accordance with the epidemiological measures and guidelines recommended by the Croatian Institute for Public Health and the Civil Protection Headquarters, and cannot be considerably affected by audit. In January 2022, there were 11,303 recorded new cases of isolation or self-isolation due to COVID-19. We can say with certainty that the number is even higher in reality, but many who are isolating or self-isolating in agreement with their employers avail of the option of working from home, take vacation days or paid leave without exercising the right to request the TIW status, so the HZZO doesn’t have them in their records.

Regular audits of TIW leave are intended to monitor long-term TIWs and those TIWs that are determined to last too long given the medical diagnosis on which they are based’, stated HZZO and also brought up the fact that keeping the sick leave rate within the strategic parametres contributes to the rational spending of limited resources of the health care system.

Health Minister Vili Beroš recently again encouraged patients to report it if they cannot get hold of their GPs. Between November 2020 when the email address This email address is being protected from spambots. You need JavaScript enabled to view it. was introduced and the end of January 2022, HZZO received a total of 2697 emails from the insured, 928 of which were determined to be justified complaints.

In 2021, they received 1682 complaints, and between January 1st 2022 and February 9th 2022 there were 457 complaints.

According to the HZZO, the majority of received complaints focused on inaccessibility of service, namely the inability of patients to establish timely contact with primary health care practitioners.

The way this is handled is the HZZO employees immediately look into the allegations listed in the complaints, get in touch with primary care clinics (by phone or e-mail), inform the doctor who supervises the team about the need for a call back to the insured person in question, and get back to the insured persons to inform them of the outcome, stated the HZZO.

The overworked doctors are not taking these accusations lightly. ‘If all clinics have a problem with inaccessibility, we obviously have a bug in the system’, commented Dr. Ivana Babić MD.

Dr. Potočki Rukavina agrees with her colleague. ‘The situation is absurd. If all 2,200 of us combined received a total of ten million calls and e-mails in the first three quarters of last year, I don't know if this is a question of unavailability as much as it’s a problem of over-availability! Always being available to this extent is a danger to our work. Is it possible to do comprehensive, quality work in the two or three minutes that you have for each patient?! And if you process 150 of them, you’ll most likely be unavailable for the 151st’, said the doctor.

ZAGREB, Aug 12, 2020 - An average primary care physician in Croatia is in their fifties, some of them are already opting for early retirement and around 160 who still work are older than 65 and can close their practices any time, the Wednesday issue of the Vecernji List daily says.

According to data from the Croatian Medical Chamber, there are 2,215 family doctors in Croatia, but that figure is disputable, says Vikica Krolo, who heads the KOHOM association of family doctors.

"Around 160 active doctors are older than 65, 200 primary care teams do not include a doctor, and around 660 doctors are about to retire," she says.

The situation with primary gynecology and pediatrics is also unfavourable, the average age of a gynecologist or pediatrician is 54 and 55 respectively, with 30% of active gynecologists being older than 60 and as many as 38% of primary care pediatricians being above that age.

The state has been trying to make up for the lack of young specialists with a specialisation plan that focuses on primary health care in the next five years, Krolo says, but warns that one should provide good work conditions, notably salaries, to attract young doctors to those branches of medicine.

She warns that family doctors opt for early retirement also because they lack motivation.

The administrative part of the job, phone calls, patients' emails, etc. are a daily routine that will become more demanding in the autumn, while patients will have more difficulty accessing primary health care, KOHOM has warned, noting that in addition to work related to the coronavirus epidemic, tourists and refugees, the health system will also have to deal with flu season in the autumn as well as with new prevention programmes.