4.2 Human resources
4.2.1 Health workforce trends
The number of active physicians has risen consistently over the past years reaching a current total of 2444 physicians (Cyprus Medical Association, 2011); 70% (1704 physicians) are employed by the private sector. These numbers include trainee physicians who are in the specialization process. Physicians are predominantly male (64%, 1563 physicians). More than half the physicians are over 45 years old. The total number of practising physicians per 100 000 inhabitants (287 in 2008) is well below the EU average (326 in 2008) (Fig4.3).
Over the last decade most of the newly qualified physicians have pursued careers in non-primary care specialties. As a result there has been a decrease of 20% in the number of GPs between 1995 and 2000 (Samoutis, Samoutis & Tedeschi, 2010). Since patients have direct access to specialist care in the public sector, public primary care physicians mainly treat minor illnesses, provide prescriptions and order laboratory tests. There is currently no government policy to increase the number of GPs. A primary care workforce plan is imperative in the near future in order to secure a sufficient number of trained GPs for the anticipated GHIS, which is planned as a primary care driven system that will include gate-keeping in some capacity.
Cyprus has had a fairly constant supply of nurses since 1990, although significantly fewer per 100 000 population than the overall EU average (Fig4.4). There are approximately 1.6 nurses for every physician in Cyprus, which is among the lower nurse-to-physician ratios in Europe (Fig4.5). Although the private sector employs the most doctors, the overwhelming majority of nursing staff is employed in the public sector. In 1980, of 1707 total nurses, 1427 (84%) were employed in the public sector. In 2008, 3710 nurses were employed by the public sector, an increase of nearly 260% (Table4.3). Recently created nursing programmes at four local universities (one public and three private) have also contributed to increases in the nursing supply. The increase in nursing school graduates in the last few years may have led to difficulties in absorption by the labour market.
Compared to other Mediterranean countries, Cyprus has a fairly high density of dentists, which has generally increased over time (Fig4.6). The pharmacist-to-population ratio, however, is much lower than the EU average (21.19 per 100 000 population in Cyprus compared to 74.72 per 100 000 population in the EU) and has remained reasonably constant over time (Fig4.7). Most pharmacists work in the private sector.
4.2.2 Professional mobility of health workers
Most health workers are Cypriot, although the number of physicians from the EU has increased over the last few years mostly due to immigration from Greece, which has increased during the last year due to the severe economic crisis. Until a few years ago there was a lack of Cypriot nurses that led to recruitment from other countries, especially Greece and eastern European countries. A substantial number of health care professionals, especially physicians, prefer not to return to Cyprus after their studies abroad (especially those studying in Greece, the United Kingdom, Germany and the United States of America), either because of better working terms or because of the lack of high-quality tertiary medical education in Cyprus. This “brain drain” can potentially be addressed by establishing tertiary medical and pharmacy education, independent biomedical research centres and more research funding.
4.2.3 Training of health workers
Cyprus has historically not had a medical school, which is why the majority of physicians have been trained abroad (mainly in Greece and the United Kingdom). However, medical specialization training has been available in Cyprus public hospitals for the last decade, and thus a small number of medical school graduates has completed their specialist training in Cyprus. The requirements for medical specialist training in Cyprus include registration with the Cyprus General Medical Council (GMC) and passing written and oral examinations. There is a need to update and improve the specialization programme and the Ministry of Health has recently decided to designate a committee to this task. The main body responsible for approving specialties and medical training in Cyprus is the GMC. Presently, there is no process in place for the revalidation of qualifications. Additionally, although a significant number of CPD activities take place each year, mostly in conferences, CPD has not received adequate attention by the Cyprus Medical Association or the Ministry of Health.
Recently the Ministerial Council has approved governing rules for the School of Medicine, which will come into existence in 2013. The Cyprus University of Technology has also announced plans for the establishment of a School of Pharmacy and a Rehabilitation Department in the next few years. In parallel, legislation on franchising tertiary education programmes has changed the education map in Cyprus. UK universities have created branches in Cyprus that offer “mirror programmes” that are similar to those taught in the UK.
A nursing and midwifery school has been in operation for more than 50 years under the Ministry of Health. After the establishment of the Cyprus University of Technology, the Nursing School was upgraded to university status.
4.2.4 Doctors’ career paths
The health care professional recruitment process in the public health sector is the same for all types of health care professional. Every position offered in the public sector is publicized by a government publication, which lists the full qualifications necessary for an applicant to be a valid candidate. Selection and recruitment is carried out by the Civil Service Committee after a draft selection and recommendations from intradepartmental committees of the Ministry of Health. As a result, hospital managers cannot easily encourage employee motivation because managers lack hiring authority. All public sector health care professionals are salaried employees of the government. They belong to a centralized civil service staffing system that assigns them to different positions on the basis of defined needs. In the planned GHIS, hospitals will have more managerial control over health worker recruitment.
There are no specific procedures or policies followed for the recruitment of physicians or other health professionals in the private sector. The vast majority of physicians in private hospitals are hospital shareholders. The majority of pharmacists have their own private pharmacies, and some work in pharmaceutical companies.
In order to address the acute problem of long waiting lists the Ministry of Health has decided to allocate €182,580 for overtime work in order to serve 352 patients who have been on waiting lists for hernia surgery, cataract and total knee replacement for a long time.
Alongside this, in an effort to attract new doctors in public hospitals, the MoH has announced that specialist doctors' salaries will be upgraded by giving them an extra bonus. Additionally, 50 more doctors will be hired during 2017 to increase public sector productivity.
For three weeks, half of the nursing personnel working at public hospitals were on strike, demanding recognition of their academic qualifications as well as an increase in their salaries. As a result, 644 patients were referred to the private sector for either emergency care or for surgeries that were postponed due to the strike.
The government will cover these costs using the savings accrued by not paying salaries of personnel during the time they were on strike (around €450,000).
Nurses ended their strike after being assured that these issues will be addressed in discussions regarding making the public hospitals more autonomous.