site.btaAging Nurses, Fewer GPs and Patchy Access: Continue the Change Hosts Expert Discussion on Health Care

An expert discussion on the challenges in Bulgarian health care organized by the Continue the Change party Tuesday, drew a picture where medical establishments are understaffed, nurses are ageing, general practitioners are not enough access to services is patchy. "If we don't solve the real issues, there will never be a normal healthcare system in this country," said Assen Vassilev, leader of Continue the Change. He was speaking at the opening of the discussion titled "Healthcare: Restoring Trust and a New Social Contract".

Among the attendees were representatives of the Bulgarian Medical Association, the dentists' union, the association of health care professionals who are not doctors, the union of pharmacists, hospital associations, patient organizations and young doctor associations. 

Vassilev added that one of the problems is that the healthcare system is highly politicized and dominated by lobbies. Half of the nursing positions in healthcare facilities, schools and nurseries are unfilled and the average age of nurses is over 50. 

Petya Georgieva from the Institute for Market Economics (IME) said that Austria and Germany have a high number of doctors relative to their population, while Finland and Latvia have almost half the number of doctors that Bulgaria has. She said that the problem in Bulgaria lies in the number of nurses. Greece and Romania have fewer nurses than Bulgaria, while Finland and Germany have the most. Data from the Ministry of Health shows that in state and municipal hospitals, one doctor cares for 10-11 patients per month and one non-doctor healthcare specialist cares for seven, with more patients in specialized hospitals. She added that the shortage of nurses is severe, with a shortfall of around 17,000 nurses. Data from the National Revenue Agency for the first months of 2025 shows that doctors earn around BGN 3,000 (EUR 1,533.88) while nurses and midwives earn around BGN 2,700 (EUR 1,380.49).

The average salary in Bulgaria in June 2025 was BGN 2,547 (EUR 1302,26).

According to the Bulgarian Association of Healthcare Professionals, the average age of nurses is 57.8. Diana Georgieva, Chair of the Association, said that until last year, there were 22,800 nurses and as of February 2, 2026, this number had fallen to 21,830 and continues to decline. She believes that no one will want to study this profession due to the enormous responsibility and the need to provide round-the-clock care for patients. Nurses are also burdened with other duties, such as data entry. Another issue, she says, is that nurses work at more than one hospital and rarely take time off. Georgieva also drew attention to the large number of hospitals that are opening without considering who will provide care for patients, pointing out that there are only 3,347 midwives and about 1,500 X-ray technicians in the whole country.

Dimitar Marinov, chairman of the Bulgarian Pharmaceutical Union said that there have been over 7,700 pharmacists for the last 10 years, mainly in regional cities with university hospitals. He added that there are already six pharmaceutical faculties, and the latest one, which opened in Burgas, is completely unnecessary. According to Marinov, only Spain, Greece and Cyprus have more master's degree pharmacists and pharmacies per capita than Bulgaria. According to him, there are too many pharmacies in the country but they are poorly stocked and this does not improve access to medicines for the population. 

Dr Gergana Nikolova, vice-chair of the National Association of General Practitioners in Bulgaria stated that there were around 4,300 family doctors in outpatient care a few years ago, but now there are fewer than 3,800, many of whom are approaching retirement age. She pointed out that Petrich has not had a single new general practitioner for 25 years and that, when a doctor dies, their patients are distributed among the remaining colleagues. She added that serious attention should also be paid to the administrative burden in outpatient care. Neglecting outpatient care is very costly for the system, taxpayers, and the public purse, she said.

Kalina Bozhilova, representative of the Future in Bulgaria Initiative Committee, which represents young doctors, said that after long protests and many discussions, they have seen that the government lacks the necessary will and consensus to implement reforms. According to Bozhilova, medical education and training needs a thorough reform, and political pressure needs to be applied to the minister to ensure that the necessary reforms are made. Bozhilova believes that there should be a minimum basic salary for all specialty trainees, as they are not paid on the basis of clinical pathways as other doctors are, and their pay depends on the head of the clinic. Regarding the competitions for specialty training, Bozhilova said that enrolment in a specialty is not transparent. She added that competitions are announced for specialties for which a specialist has been selected in advance. 

Dr Vassislav Petrov, Chair of the Association of Regional Hospitals suggested that specialists should go to receive their specialty training in smaller towns. According to him, emergency care in hospitals over the past 10 years has indeed relied on specialists in training. 

According to Dr. Borislav Milanov, Chair of the Bulgarian Dental Association, favoring one specialty or another in the state policy is the wrong approach. He noted that dental doctors take care of their own dental practices, and that the state regulations concerning the career development of dentists and specialty training have been unchanged for 15 years. He pointed out that Bulgaria ranks third in Europe in terms of dentists per capita, and there practically almost no settlements without a dentist. 

Assoc. Prof. Anton Tonev, representative of the medical colleagues in Varna said that nurses are not well paid, that patchwork solutions are being offered, and probably the time has come to realize that there is a need to rebuild the healthcare pyramid from scratch. He believes that one of the worst problems is the rising average age of doctors and nurses.