site.btaInstitute for Market Economics Proposes Doubling Nurses’ Pay to Tackle Staff Shortage

To address the shortage of nurses in Bulgaria, the Institute for Market Economics (IME) proposed a significant increase in nurses’ salaries, along with a funding mechanism to ensure the money directly reaches the nurses, the IME reported on Thursday. The proposals were presented during a discussion hosted by IME in Sofia under the title “Nurse Shortage: Economic Perspectives and Practical Solutions.”

According to IME, doubling nurses’ pay within one to two years is an ambitious but necessary goal.

Among the ten proposals, the IME also suggests shortening the duration of nursing education in Bulgaria by two semesters to meet the minimum standards of the relevant European directive, as well as launching a targeted programme to improve student retention in nursing programmes. Another recommendation involves attracting nurses from third countries, with IME advocating for active recruitment and incentives to bring non-EU nurses to Bulgaria.

The Institute further proposes granting nurses the right to operate private practices and to independently contract with the National Health Insurance Fund (NHIF).

Presenting key data, Petya Georgieva, Senior Economist at the IME, highlighted that the current nurse-to-doctor ratio in Bulgaria is approximately 1.4 to 1. In some healthcare facilities, the ratio is even less favorable, with doctors outnumbering nurses. In specialized hospitals, the situation is more critical, with some nurses caring for as many as 30 patients. The national average in general hospitals is one nurse per 6.5 patients.

Georgieva also commented on recent income trends. Based on National Revenue Agency data, nurses’ gross monthly earnings increased from about BGN 1,960 in early 2023 to over BGN 2,600 by the end of 2024. These figures include earnings from multiple jobs and night shifts. Despite rising incomes, the number of practicing nurses has slightly decreased, from around 29,600 to just under 29,000 in the same period - indicating a negative trend in workforce participation.

The NHIF’s budget continues to grow, Georgieva noted, with about BGN 4 billion allocated for hospital care in 2025 and a total NHIF budget increase of over BGN 1.3 billion. “There is no shortage of funds, yet their final allocation remains unclear,” Georgieva added.

Georgieva also cited Health Ministry data showing a decline in the number of nurses applying for certificates to work abroad, as there were around around 63 such applications in 2023. Approximately 1,000 spots are available annually in nursing programmes, with 92–93% enrollment and 630–650 graduates per year. Roughly 10% emigrate shortly after graduation.

Meanwhile, 173 doctors and nurses from EU countries applied for permission to work in Bulgaria in 2023. Georgieva emphasized the importance of attracting medical staff from third countries, offering them proper working conditions and support to validate their qualifications. Bulgaria’s entry into the Eurozone could serve as a competitive advantage, she added.

IME Chief Economist Latchezar Bogdanov cited Organisation for Economic Co-operation and Development’s data showing that Bulgaria, alongside Cyprus, ranks last in the EU in the nurse-to-doctor ratio. While Bulgaria’s ratio is 1:1, the EU average is 2.2:1, and some countries exceed 3:1. He also pointed out that Bulgaria has about 9 nursing graduates per 100,000 population, compared to an EU average of nearly 40.

Bogdanov stressed the need for substantial change, noting that only 0.5% of Bulgarian 15-year-olds see themselves working as nurses by the age of 30. While this career choice typically ranks low across EU countries, the figure is especially low in Eastern Europe, and in Bulgaria, it is exceptionally so, he added.