Интервю с д-р Ралица Панчева

Cardiologist Dr. Ralitsa Pancheva on Choosing a Career in Bulgaria and the Drawbacks of the Healthcare System

In 2023, six more young cardiologists obtained European certification in their specialty exams, bringing the total number of these specialists who passed the challenging test to seven. How difficult is it to obtain a European education, and what does a young doctor with European credentials think about our healthcare system and education? The health portal Clinica.bg asked Dr. Ralitsa Pancheva, the first cardiologist in Bulgaria to receive a European certification in her specialty and a member of the Medical Center Hera team.

– Dr. Pancheva, is it difficult to obtain a European certification in cardiology?

– The European exam in cardiology covers all areas of the field and requires an in-depth understanding of the subject matter. I believe that this knowledge is necessary for every doctor to practice their profession effectively. Successfully passing this exam is an indicator of a high level of competence.

– What did the preparation cost you?

– The preparation for the exam was long but fruitful. For me, this exam was an opportunity to deepen my knowledge of the specialty, assess my level, and identify areas that needed more focus.

– What opportunities does this certificate provide you?

– This certificate offers the opportunity to practice the specialty abroad.

– Would you continue working in Bulgaria?

– At this stage, I plan to continue practicing in Bulgaria because from the beginning of my medical studies, I knew that I would dedicate my life to treating Bulgarian patients.

– Do you see opportunities for career development here?

– The truth is that there are opportunities for career development in Bulgaria, but the respective development depends both on the individual capabilities and ambition of the doctor, as well as on the institution where they work and train.

– Why did you choose to become a cardiologist?

– I chose this specialty after spending two years as a volunteer in a cardiology department, where I had the opportunity to be actively involved in the work process and get an idea of what to expect if I chose this specialty.

– Are you satisfied with your medical education?

– I completed my education at Medical University Varna and I believe I received a very good level of medical education. In my opinion, the level of theoretical training in Bulgaria is very good, but there is room for improvement in the practical training of students.

– And what about your experience with the healthcare system?

– My experience with the healthcare system was not easy. During the time I have been working I have encountered many injustices, both administrative and personal which I still find difficult to accept.

– What are the pros and cons of our healthcare system?

– A plus is the easy and quick access to medical services, while the drawbacks of the healthcare system are not just one or two. They are related both to the quality of medical care that patients receive, the working conditions and salary of those involved in the healthcare sector. In many places the living conditions are critically low. On the other hand, in places with good living conditions, additional payments are required from the patient. Moreover, there is an excessively high level of additional payments usually by the patient for both medicines and medical supplies.

– Are our hospitals overcrowded, and should measures be taken to address this issue?

– Yes, measures should be taken. Hospitals and hospital beds need to be regulated in accordance with the so-called national health map, which has not been actively implemented or is being circumvented by administrative manoeuvres.

– Do you believe that the patient is placed at the center of the healthcare system and why do you think so?

– By presumption, yes, they are. There are many specialists who provide services at a very high level but there are also quite a few deviations from good medical practices.

– Are you afraid of aggression shown by patients on regular basis?

– Honestly, I haven’t encountered aggressive patients myself, but there are quite a few cases among colleagues, especially those working in emergency care. However, I have encountered patients who behave disrespectfully towards doctors and their prescriptions.

– How do you explain it?

– Probably with the easy access to medical care in Bulgaria. In Western countries people wait for months for an appointment but in our country, if someone decides they can see several specialists in a short time. Another huge issue can be seen the easily accessible medical information on the internet. A large part of this information is not reliable and apart from this a person without adequate medical education cannot understand it correctly. Many Bulgarian patients believe that by reading for 10 minutes on non-medical websites like Google they become more competent than doctors. Constant coverage in the media of “possible” medical errors further contributes to the loss of trust in doctors. Ultimately, in 99% of cases there was no mistake on behalf of the doctor. The blame here lies with the media in the way they present information and the fact that they report cases before they are clarified. On the other hand, information about achievements in medicine is rarely published.

– Do you think the rules under which the NHIF works with doctors and hospitals are good?

– In my opinion, the methodology of payment needs to be changed both towards hospitals and doctors. First and foremost, there should be a change in the payment model focusing not on quantity but on the quality of the provided medical service. It is appropriate to increasingly focus on disease prevention rather than treating the complicated severe forms in hospitals. Especially for modern cardiology, there are many innovative procedures used for precise diagnosis but as of today they are not financed by the NHIF. There is a significant portion of procedures performed in hospital conditions that could be carried out in outpatient settings.

– Do you think there is a need for a change in the system? In what direction?

– There is a need not only for better funding but also for better quality of healthcare services. In my opinion, it is necessary to focus on continuous medical education and additional qualifications for medical specialists in order for Bulgarian patients to receive accurate diagnosis and the most modern treatment.

– And what about the ethical values within the guild?

– There has been a growing trend in recent years of disrespect and derogatory comments among doctors towards each other or towards patients. The reasons for this are probably found both in the increasing competition and in the extremely busy schedules of colleagues.

– How do you explain the lack of promised changes in the system in recent years?

– Unfortunately, you’re right. The promised changes in the healthcare system have indeed not materialized. The reason for this may be related to the lack of consistency in healthcare policies. The frequent changes in governments, along with frequent changes in the leadership of the healthcare system, represented by health ministers, lead to inconsistency and failure to implement priority directions in healthcare.

– Who are the people that according to you determine the future of healthcare?

– It depends on all participants in the healthcare system including patients, doctors, and healthcare professionals.

– What would you tell them?

– Health is the most important thing but people only truly appreciate it when they lose it. That’s why I urge patients to try to improve their health literacy to trust their doctors and to follow their guidance. To doctors and healthcare professionals, I would advise them not to forget that the patient always comes first regardless of the working conditions and compensation they receive for their services.

Source: clinica.bg