site.btaCommittee on Health in Parliament and Medical Residents Debate Pay Rise Proposals

Medical residents and MPs discussed proposals from healthcare professionals to raise their salaries at a roundtable in the National Assembly on Wednesday. 

Political parties represented in parliament have until July 14 to submit their proposals to the Committee on Health, after which each suggestion will be reviewed in detail before a final draft is submitted by July 28, Committee on Health Chair Kostadin Angelov said following the meeting.

Until July 14, parliamentary parties are expected to submit their proposals to the Committee on Health, after which they will discuss them article by article before submitting final drafts by the 28th, Angelov said after the roundtable.

Commenting on There Is Such a People (TISP) Floor Leader Toshko Yordanov’s recent remarks about medical residents, Angelov said that every adult is responsible for their words and actions, and believes that Yordanov understands the implications of what he said. Angelov added that he offered his apologies.

BTA notes that on Tuesday Yordanov told medical residents: "I urge you once more: go to Italy, cover your own expenses, work for five years in a Sicilian village, and then return if you are truly satisfied. If you believe foreign medical institutions are waiting for you, I wish you well. Health systems do not maintain unfilled positions. If you refuse to work here, we will need to recruit specialists from other countries who would be happy and willing to work for five hundred dollars—the maximum our state can provide."

Yordanov later apologized. "If, nevertheless, I have offended anyone, I most sincerely ask to be forgiven. I hold deep respect for all medical professionals in Bulgaria. I say this with the utmost respect and with all my heart," he said.

Committee on Health Chair Angelov continued and explained that, in the Committee, the tone seen yesterday has always prevailed, and as chair he is obliged to give every group the chance to speak, thus ensuring pluralism and freedom of speech. He also said that during the discussion there are also more emotional opinions, and he cannot intervene or take away the floor. “No one who wished to speak was denied the opportunity; it has always been that way and will remain so as long as I am chair,” Angelov said.

Speaking about differing opinions on whether pay should be linked to the collective bargaining agreement or to the Medical Establishments Act, Angelov commented that a lack of consensus among healthcare professional communities on the desired outcome makes agreement impossible. The representatives of the medical residents’ initiative committee want their basic salary to be 150% of the average gross wage, as do the representatives of the professional nurses. Angelov said, however, that the base salaries for these two communities cannot be the same, so further effort will be needed to find a compromise.

On the issue of whether a salary increase could be funded by raising the health insurance contribution, Angelov said that this had not been discussed, and at present, there is no risk of an increase. “Reform could be addressed if it is not tied to party politics,” he added when asked whether GERB might initiate such a discussion this year. He said the ruling coalition is discussing reforms to improve demographic indicators such as morbidity and mortality. If such a direction is taken, the entire system would need to be shifted from hospital-based treatment towards prevention and screening. Results, he noted, would only be seen in 20 years even if reforms began today.

Continue the Change (CC) Chair told journalists that CC supports the bill put forward by young medical residents and would push for it to be adopted promptly before the parliamentary recess. Regarding the availability of funds, he said, “There are funds; it’s a question of priorities.” Calculations based on lower previous amounts from the Ministry of Finance and the Ministry of Health show that achieving 125%, not 150%, would require some BGN 60 million from a BGN 9.3 billion NHIF budget. The mechanism exists, Vassilev added, with dedicated funds available in the NHIF budget for regional and municipal hospitals to support staff salaries, so it is ultimately a political decision—and the will to act is there, he said.

On the divergence between demands for salaries to be stipulated in law rather than in the collective bargaining agreement (CBA), as some MPs propose, Vassilev said the CBA has previously been blocked by hospital directors, who then failed to comply, and fines have never come into force. At present, there is no active CBA. Including salaries in the Medical Establishments Act ensures a more stable solution, but either route is possible. However, if the CBA route is chosen, automatic indexation will be needed to protect salaries. He proposed that, should there be no active CBA, salaries could be based on the previous one, indexed for inflation, for young medical residents.

“There is no lack of funds in the healthcare system,” Vassilev said. He pointed out that Bulgaria provides access to costly, innovative treatments that are unavailable in many other European countries. The real problem, he said, is the system’s imbalance, aggravated by the Constitutional Court's decision to remove limits on payment for excess activity, putting NHIF’s budget under pressure. “It is not normal for a doctor in Bulgaria to earn half of what a city bus driver does. Politically, we cannot claim that such funds cannot be found—they can; it is a question of priorities.” Access to specialists is prompt, but for people in small settlements, there are difficulties, especially in emergencies. A true healthcare map is needed, with well-funded regional hospitals and guarantees that patients can reach care within the golden hour. The fact that students are drafting legislation reflects the failure of attempts to resolve problems through the CBA to secure adequate pay, Vassilev added.

Health Minister Silvi Kirilov said in the discussion that even with his experience, he needed time to read and compare the proposed bill to current law and conditions. He added that raising pay for night work among secondary budget holders would require an extra BGN 30 million, and reserved his right to provide a judgment later. Many problems have accumulated in Bulgarian healthcare over at least 50 years. Bulgarian doctors are distinguished professionals with strong knowledge and paths, deserving of worthy remuneration, but because of these pay imbalances, every action must be carefully argued, as it risks worsening the disparities. Kirilov assured participants he would continue to work for fair, adequate and sustainable pay for Bulgarian doctors.

Committee on Health Chair Angelov said the healthcare system faces serious problems with funding, regulation and quality—though the quality often exceeds the average level, it does not deliver the added value that society expects. The debate has focused on wage regulation for doctors and healthcare professionals, but staffing is a significant issue especially among professional nurses, with a shortfall of some 30,000, a problem set to worsen over the next 5-10 years as the workforce ages. Many medical establishments could be forced to close due to a lack of nurses. Angelov emphasised that healthcare policy should focus on professional nurses. Bulgaria generally does not have a shortage of doctors except at the primary care level, where some regions lack general practitioners.

Angelov noted a general deficiency in the residents’ draft bill: it does not address the problems of all healthcare staff, since hospitals employ not only doctors and nurses. Regulating everything as requested would mean a step back towards planned economy and government-set salary ranges, leading to a potential exodus of top specialists due to pay ceilings. He said he does not want hospital directors to earn vast sums, but it is necessary to see what share of their pay comes from actual treatment activity. The base salaries by category should be contracted through the CBA, benefiting all staff. If the law only lists doctors and nurses, others will be left out. He insisted funding sources must be identified, and a fiscal impact assessment must be completed by July 14. Health insurance payments cannot be used for pay, as that would revive socialist-era thinking and discourage capable doctors from working. State intervention in setting pay ceilings is a mistake, Angelov said.

Velichie MP Lyubisha Blazhevski declared full support for the medical residents’ proposals. He argued that the first step must be removing hospital commercial status; only then can salaries rise, because commercial companies cannot have salaries imposed on them. He reported that colleagues reacted to Yordanov’s comments by urging him to try to find foreign doctors willing to work for USD 500.

Angelov dismissed the idea that hospitals should not be commercial entities as a populist ploy with no real impact on pay. Regardless of structure, if hospitals are not commercial, the State must step in as paymaster, but the best doctors would leave for higher wages abroad. Hospitals have no unrelated commercial activity or excessive profits. The link between legal registration and staff pay is, he said, spurious and misleading. He added that proposals to ban private hospitals from using public funds would require constitutional reform, as current law treats public and private work equally. Every citizen should have access to quality healthcare, so there should not be confrontation between State and private hospitals.

Desislav Taskov of BSP – United Left said they had committed to reviewing all submitted proposals by July 14 so that an overall bill could be prepared by July 28.

Elvan Gyurkash of the Movement for Rights and Freedoms (MRF) – New Beginning group said simply being present confirmed there is a problem. A deep analysis is needed, and her party believes everyone who works should be paid fairly, no matter the sector. There should be no division; healthcare quality is vital, and every Bulgarian should receive it, Gyurkash added, stressing that full analysis is required before making changes.

The parliamentary group of MECh also voiced support for the proposed amendments, with Aleksandar Todorov hoping the changes will bring stability.

Vazrazhdane MP Margarita Mahaeva attributed the shortage of nurses to poor funding and strained relations with doctors but endorsed the bill in principle.

“There Is Such a People (TISP)” will participate actively in discussions and supports fair pay reflecting everyone’s contribution, TISP MP Ivan Klisurski said.

The draft was also backed by head of the Bulgarian Union of Physician Assistants and Feldshers Aleksandar Aleksandrov, who argued for a methodology for setting basic pay, proposing 85% of the average gross salary for physician assistants.

The head of the Bulgarian Association of Healthcare Professionals, Diana Georgieva, insisted their members' pay should also be set at 150% of the average gross salary.

Lilyana Petrova, chair of the Bulgarian Association of Assistant Pharmacists, noted their recognition as a separate profession raises questions over whether legislators see them as healthcare professionals, since the measure targets medical establishments and thus applies to pharmacists in hospitals.

The Bulgarian Pharmaceutical Union supports the bill, said chair Dimitar Marinov, but questioned extra pay for further qualification.

“Funds exist but are mismanaged. Opening new hospitals undermines municipal and State hospitals, which mostly treated Covid-19 patients,” said Penka Georgieva, head of the patient advocacy group Together With You. If private hospitals want public funding, they must accept the healthcare map, she said, and if the State covers full insurance for its employees, that generates more funds for the system.

“Your demands are fair, but it’s unclear how or from where the money will be found,” commented Nikolay Branzalov, Chair of the Board of the Bulgarian Medical Association. Chronic underfunding, the dismal value of user fees, and the low share of GDP devoted to healthcare are long-standing problems, he added.

“There are two approaches—top-down or bottom-up—but we need to focus on where we’re headed,” said Borislav Milanov, head of the Bulgarian Dental Association, stressing his views are personal. He warned against further divisions among healthcare professions: “Healthcare is not political, nor should it be divided. If we want improvements and better working conditions for residents, we must identify the path forward. I am ready to share any expertise and experience I have, selflessly,” Milanov concluded.