Prof. Mircea Cinteză, Ph.D., a prominent cardiologist with extensive experience, is a professor of Cardiology and Internal Medicine with the Cardiology and Internal Medicine Department of the “Carol Davila” Medical and Pharmacy University in Bucharest; head of the Cardiology Ward of the Bucharest University Emergency Hospital; since 1996 he has been a member of the “Carol Davila” Medical and Pharmacy University Board of Professors; between 1997 and 2007 he was the chairman of the Romanian College of Physicians; in 2004-2008 he was the dean of the “Carol Davila” Medical and Pharmacy University; in 2004-2005 he was the public health minister; in 2004-2011 he was a member of the Senate of Romania.
Professor Cinteză, what links politics to healthcare, considering that great personalities of the Romanian medicine, from I.C. Parhon to yourself, embraced political careers, one way or another?
Medicine in itself has a social element. Through the nature of their profession, physicians find out about people’s lives, and if they are interested enough, they also find out about the solutions people have in mind. Solutions and ideas emerge in the most unexpected places, and so is a sound, grassroots judgement, so I believe no other profession enables one to research the human society so deeply, in its most profound levels.
As a physician, in order to be able to be involved in politics you need a political environment in which your ideas are taken into account and promoted so as to make the system work better. At present, in Romania, on the one hand because of a history that has disorganised society and on the other hand because of chronic under-financing, most politicians in top positions fail to see the system as a whole. Instead, they focus on temporary opportunities that can be completed during a term in office and within the slim budget they have available. This is why there are few moments when a far-sighted leader or party try to develop a system. I entered politics hoping that I would be able to influence the healthcare system, but most of the times I was told, “This is not a good moment, we have other, acute priorities.” Since my time away from medicine was getting longer, and the results fell short of my expectations, I chose to return to the medical world, to make my contribution to medical education and to remain always available in case our advice will be requested by future leaders of the system or of the medical education system. Let me just add, briefly, that in my opinion the Romanian medical education is organised in a quite valuable manner, which should not be altered and disturbed too much. One of the prevailing slogans in politics is “we want to reform things,” but “reform” is just a buzzword. The changes proposed by this or that leader are in fact opportunities to get some publicity, rather than necessary changes. So far we’ve had mere replacements of political power groups from one term in office to the next, sometimes even before the end of their term in office, and newcomers never carry on the ideas of their predecessors. Moreover, when they return to power after an electoral cycle, they have long forgotten what they had started to build six or eight years before. Our only important chance was that the European Union forced us to adopt a number of fundamental rules that we had not thought about, and that brought some order in various fields. Unfortunately, the medical field is so complex that the EU motto in healthcare is “we stay away, each country should do what it sees fit.” Given that we have to make do with the smallest budget in the European Union, our difficulties in building a competitive healthcare system are both understandable and manifest in all circumstances.
How long would it take to create the necessary conditions to keep healthcare professionals from leaving Romania, if the government wanted it?
Physicians obviously leave the country because of the small incomes, figures speak for themselves. Specialist physicians make 400 euro, with nightshift bonuses they get 500-600 euro a month. In contrast, in the older EU member countries the income of this category is 4,000 euro a month. Secondly, in those countries they get to do their job as they have learned from textbooks and practice guidelines, whereas in Romania shortages of all kinds force them to always improvise a solution. These shortages are frequent and diverse, and physicians are forced to practice some pseudo-medicine. Another relevant aspect is that no new hospital has been opened in Romania for the past 50 years. We all know the scandal around the dismantling of those hospitals that had turned into shelters for the poor. On the other hand, the first generation of emigrants will have a hard time adapting to any country they might choose. Because, after they get a warm welcome to the lower levels of medical practice, hardly any of these thousands of physicians are accepted to higher positions in either the healthcare system or in medical education, where the local physicians make up the overwhelming majority. Locals prevail in the professional and cultural elite of these countries, otherwise their national identity would be altered. So the first generation of physicians who leave Romania must be aware of the fact that they will have to settle for mediocre positions. In addition, their cultural roots and their friends, who are more often than not members of the same ethnic community, prompt many of these emigrants, 20 years after they left the country, to think about returning, although things have not changed too much back home during this period. What is to be done to keep these physicians in Romania? First of all, the dignity of the medical profession must be reconsidered. The prevailing perception of physicians in Romania is that they are poor professionals and bribe-takers. Most liberal professions charge a fee for their services, but this does not happen in public healthcare, which continues to make up the largest part of the Romanian healthcare system. A young physician is able to practice medicine starting at the age of 30; until the age of 35, when women should have one or two children, if they want, they have to live on 500 euro a month. So they obviously need an additional income source, just as lawyers have their fees. Definitely, making medical care conditional on receiving undue benefits, whether directly or indirectly, is unacceptable. However, it often happens that a patient wants to be seen by a particular physician, he/she wants more than what public healthcare can provide, he/she wishes a particular, safer procedure which is only available in a few centres in the country. In such cases, that patient should pay a fee for what he/she wants in addition to the cheaper, more uncomfortable services, which sometimes may have more serious adverse effects, but which are the only services that the minuscule public healthcare budget of Romania can finance for its citizens. In other words, a reform of the healthcare system should ensure a set of basic services, permanently available from the existing budget, plus additional payments for those physicians, procedures or institutions that provide higher-quality services. This money does not have to be paid by patients themselves: if this principle was officially promoted, it would be quickly covered by special insurance polices that would address those needs. Such attempts have been initiated by several ministers, but they failed to come up with a viable model, first of all because this is a very complex task, and secondly because none of them had the political support needed in order to take such projects to completion. There was a time when the Romanian public health minister was replaced more frequently than any other minister in any other country. Then came Mr. Nicolaescu’s term in office, which was a little longer but equally ineffective in terms of this particular issue. And after he left, the rate of minister replacements skyrocketed again.
In short, physicians should be legally allowed to increase their incomes. In fact, their incomes should be three times higher than the average salary in the country, because the responsibilities of this profession are not matched by those of any other civilian profession in times of peace. To be able to work independently, a physician needs an average training of 11 years: 6 years in university and 5 years of internship. This long training period is also unique, as compared to other professions, and this is why most countries offer incomes three times higher than the national average wages, to offset these difficulties. In Romania, physicians make a just little more than the national average salary. So the only way to persuade young physicians to stay in the country and to thus address the tragedy of rural areas and of small and medium-sized towns that no longer have medical professionals, is to officially enable those who provide additional quality to earn three times the average national salary. The Romanian society must also acknowledge the heroism of those doctors that cure or preserve the health of their patients through all sorts of “innovations” that make up for the current shortage of medicines and technical equipment.
Was there a moment in your career when you thought about leaving the country?
In the early 1980s I was offered a job in California. At that time, a group of elite American physicians delivered conference series in Eastern European countries, followed by talks with those participants they believed to be worthy. Further to these informal talks, they were discreetly invited to work in the USA, and were obviously helped to get a visa. I decided not to leave Romania, having in mind all the things I’ve told you earlier.
What would you advise the young Romanian physicians?
The young physicians who leave must keep in mid that they will lose their roots, and any person with a conscience is aware that a life without roots and without friends is a barren life. No matter how much money you make, it could never make up for that. I would also tell them that at this point Romania is struggling with such a shortage of medical staff, that with not very substantial efforts and in a short time they may climb to important positions in their field, with a lot of professional satisfactions. Step by step, financial satisfactions will also follow. They may not be substantial, but when coming in a friendly environment they may well be worth significantly more than a life that is easier in economic terms, but more sterile in terms of human emotions.
Interview by Virginia MIRCEA
