European Observatory on Health Systems and Policies


Health Systems in Transition (HiT) profile of Hungary

4.2 Human resources

4.2.1 Health workforce trends

As can be seen in Fig4.5, Hungary had 3.1 active physicians per 1000 population in 2008. This was higher than the figure for Poland and the EU12 average, but below those for the EU27, EU15, the Czech Republic and Austria. Although the per capita number of physicians in Hungary in 2008 appears in the figure to be no higher than it was a decade earlier, frequent changes in data collection methodology and in the organization responsible for updating the registration database make it difficult to analyse trends with any precision. Between 2000 and 2007, the task of collecting and maintaining data on physician registrations was the responsibility of the Hungarian Medical Chamber. Since then, the task has fallen within the remit of the OHAAP.

Other sources of data help provide a clearer picture. Using payroll data from 44 089 individuals working in 130 public institutions to estimate the number of health professionals, the quarterly report of the NISHR from 2011 found that the absolute number of physicians working in inpatient and outpatient care had dropped substantially between 2003 and 2010, falling from 19 503 to 16 913 (NISHR, 2011a). Here it is important to note that this source did not take account of physicians who may have switched from the status of a public employee to that of a private entrepreneur while continuing to work in the same hospital. Because private entrepreneurs do not appear on the hospital payroll, a large number of switches to the status of private entrepreneur could make a decline in the total number of physicians appear artificially large. Another factor to consider is that increased professional mobility may contribute to the overall decline in the numbers of physicians in the near future (see section 4.2.2).

Physicians in Hungary are unevenly distributed, both in terms of geography and specialties. Excluding counties with medical universities, the average number of practising physicians was lowest in Békés County, with 1.5 physicians per 1000 population in 2008. Five additional counties also had fewer than 2.0 physicians per 1000 population that year (Ministry of Health, 2009c). Out of a total of 35 169 medical posts in 2008, some 4% were unfilled, implying both regional disparities and differences among specialties. For instance, there was not only a shortage of public health physicians (19% of available posts vacant), but also of physicians working in acute inpatient care (13% of available posts vacant) (Ministry of Health, 2009c). In contrast, traditionally there have been very few persistent vacancies in family physician and family paediatrician posts in primary care districts. In 1999 about 99% of these posts were filled (HCSO, 1999), and unpublished data from the NHIFA indicate that this percentage was roughly the same in 2007.

The share of jobs occupied by physicians working as private entrepreneurs in all sectors was 43.4% in 2009 (Table4.4), which was a substantial increase from the 36.5% figure reported for 2005 (HCSO, 2010d).

The number of nurses per 1000 population in Hungary has increased steadily, rising from 5.3 in 2000 to 6.2 in 2008. This latter figure was slightly higher than the EU12 average, but far below the averages for the EU15 and even EU27 (Fig4.6). In total, some 4% of posts for nurses and other ancillary health professionals were unfilled in 2008 (Ministry of Health, 2009c). It is important to note that the number of nurses graduating each year in Hungary has dropped from almost 6000 in 1993 to less than 4000 in 2008 (WHO Regional Office for Europe, 2011).

In contrast to physicians, the per capita number of dentists in Hungary increased by 56% from 2000 to 2008, a phenomenon attributable to the far better remuneration possibilities in private business. In 2008, Hungary had 0.5 dentists per 1000 population, which was about the same as in the EU12 as a whole, but far below averages for the EU15 and EU27 (Fig4.7).

The per capita number of pharmacists rose 20% between 2000 and 2008. In 2008, Hungary had 0.6 pharmacists per 1000 population, which was higher than the EU12, but much lower than EU27 and EU15 (Fig4.8).

The salaries of health workers, especially of physicians, have remained low compared to those in other sectors of the economy and in western Europe, even after the change from the Semashko-style health system in place during the communist era (see also section 3.7.2). The practice of informal payments was and has continued to be widespread, but these are not evenly distributed among health professions or medical specialties. As a result, well-paying specialties such as surgery or gynaecology became particularly attractive to new entrants, while other specialties, such as diagnostics, public health and the paramedical professions began to exhibit general shortages well before Hungary joined the EU in 2004. The shortage of nurses and health care support personnel has forced physicians, including specialists and family doctors, to carry out nursing and administrative duties in addition to their regular responsibilities (Gál et al., 2003; Orosz & Holló, 2001). Moreover, low salaries and informal payments have kept medical doctors working well after the age of retirement because state pensions have been too low to enable decent living standards. Altogether 8.2% of practising physicians were over the age of 61 in 2007 (Ministry of Health, 2009c).

Successive governments have failed to formulate effective policies to tackle these problems. Although the share of physicians working as private entrepreneurs has been increasing steadily, public employees with low salaries still form the majority. The health workforce is ageing, affecting physicians and nurses alike, and Hungary is a net donor country regarding health care worker migration (see section 4.2.2). Together, these factors have created a human resource crisis in health care, which requires increased attention by the government to avoid the collapse of the single-payer health insurance system.

By December 1, 2018, the number of permanently vacant GP practices increased to 334, according to the National Healthcare Service Centre, despite the fact that government spent 2.34 billion HUF (7.44 million EUR) in one year to increase the attractiveness of the vacant practices. Based on research from the Centre in 2015, the average age of GP practitioners was 57 years and more than 42% of them were over 60 years. The growing number of abandoned practices can be justified by their retirement.


All of the medical faculties in Hungary featured in  the ranking list of the Times Higher Education (THE) for their popularity among foreign students. According to data of the Educational Authority, 8000 foreign student studied additionally to the already enrolled foreign students in higher educational institutes in Hungary over the last 5 years. When looking only at the medical faculties more than 10 thousand students are not Hungarian citizens, who pay more than 10 billion educational fee a year. 


Although salaries have been increasing in the public-sector, the average salary remain the lowest in the health and social sector.

According to the Hungarian Central Statistical Office the average gross salary stood at 290 600 HUF (or roughly 900 EUR) between January and August 2017, which translates into an increase by 12,7 % compared to 2016. This average salary was determined by all private sector employers with at least 5 employees, all governmental agencies and all non-governmental organizations into account. Employees from the financial and insurance sector, for instance, earn on average 564 400 HUF a month (or 1750 EUR).  Although the increase slowly reaches the health  and social sector as well, on average only 180 800 HUF (or 560 EUR) a month were paid.

Source: Hungarian Central Statistical Office

Despite the wage increase, the mobility of health professionals from Hungary did not decrease in the first part of 2012. It was in fact reported that the number of professionals who asked for diploma certifications by the Office of Health Authorization and Administrative Procedures increased by 15% (from 469 to 542) among medical doctors and by 80% (from 135 to 244) among nurses, compared to the same period in 2011. The number of health workers applying for diploma certification is considered a proxy for the scale of migration. This is based on the assumption that only those, who have a strong intention to leave the country would apply, since the administrative charge of issuing the certificate is quite high given the average salary of health workers.

On July 6th, Miklós Szócska, State Minister for Health signed a contract on the development of a human resources monitoring system for the health sector. Hungary is struggling with a substantial human resources deficit in the health sector and in order to ensure a sustainable high-quality health care system, it is essential to monitor and follow-up on the characteristics and trends of the workforce and create problem-solving action plans based on reliable statistics.
The main objective of the project is to provide support in solving HR problems considering the careers and work-life balance of health professionals, predicting their medium- and long term training needs and linking Hungary to the international information- and data exchange flow.  The newly signed contract foresees that HUF 500 million (≈ USD 2.16 million) of non-refundable support be provided from the new Széchenyi Plan to map possible solutions to the human resources shortage.

4.2.2 Professional mobility of health workers

Health professionals who intend to leave the country to work abroad must have their diploma certified by the OHAAP. The process is lengthy, and applicants must pay a fee. Because data on the actual number of health professionals leaving Hungary are lacking, the number of certification requests can be used to estimate outflow. Of all health professionals applying for certification in Hungary between 1 May 2004 and 31 December 2009, an estimated 4901 were physicians, 1316 were nurses, 749 were dentists and 226 were pharmacists (Eke, Girasek & Szócska, 2011). Here it should be noted that these numbers include both applicants who were residing in Hungary during this period and those who were not. Of those not resident in Hungary, the vast majority are likely to have been individuals who were already living and working in another EU Member State and required retrospective certification from their employer after Hungary joined the EU in 2004 (Eke, Girasek & Szócska, 2011). Altogether 43.6% of applicants between 1 May 2004 and 31 December 2009 held a general medical degree only and 56.4% were specialists. Salary levels (see sections 3.7.2 and 4.2.1) were the main push factor for mobility (Eke, Girasek & Szócska, 2011).

In terms of inflow, a total of 639 foreign physicians, 1585 foreign nurses and 82 foreign dentists registered with the OHAAP between 2004 and 2008 to practise in Hungary. The majority of these individuals were members of Hungarian minorities from neighbouring countries (Eke, Girasek & Szócska, 2011).

In short, there has been a net inflow of nurses and a net outflow of physicians and dentists since 2004. It is important to note that whereas the outflow appears to be increasing substantially, the inflow is diminishing. For example, the number of foreign nurses who registered to practise in Hungary in 2008 was only 45% of the number in 2005 (Eke, Girasek & Szócska, 2011).

Free movement of persons is a basic principle of the EU, and health professionals’ mobility was expected to increase after the accession of Hungary to the EU in 2004. Capturing health professionals’ mobility, however, is challenging. On the basis of international professional debates, the outflow indicator most frequently used for measurement is the number of requested good-standing certifications, which is required when a health professional wants to work abroad. Requesting this certificate indicates only an intention to work abroad, and does not necessarily mean that the person will in fact leave the country. Despite this methodological limitation, the indicator is considered to be a good- enough proxy to monitor migration trends.

Since 2004, the outflow of medical doctors from Hungary showed a significant increase and peaked in 2011. In 2012 still more than 1100 persons requested the certificate, which decreased to 823 in 2016. It is also important to note that this number includes those foreign medical graduates, who obtained their diploma in Hungary and intend to return home, and also not corrects for repeated certificate requests. Excluding the cases of freshly graduated foreign medical doctors and repeated requests, the figures still show a decrease from 831 in 2011 to 398 in 2016. Nevertheless, no data are available on the duration and/or parallel jobs in foreign countries.

Previous research emphasized the financial opportunities as the most important key driver and motivation factor of Hungarian medical doctors to work abroad (Eke et al, 2011). Health policy recognized this and intervened into the system with various financial measures, including scholarship programs for medical residents (graduated medical doctors, who are in a professional training program and work to obtain a medical specialisation) and salary increases (for more details see also log from 30/12/2016).

It seems that these programmes had a measurable impact on the outflow of medical doctors, but latest figures are still high. In 2015, 492 doctors requested the good-standing certificate out of which 329 apparently do not work at home (estimated by inactivities in the Hungarian health system as not filling a prescription), which still constituted around 40% of the new Hungarian medical graduates in that year. Further monitoring and interventions are needed to mitigate the influence of the continuous outflow and the shortages of certain specialties in the Hungarian health system.



Eke E, Girasek E, Szócska M: From melting pot to change lab central Europe: Health workforce migration in Hungary. In: Wismar M, Maier C B, Glinos I A, Dussault G, Figueras J (eds.) Health professional mobility and health systems: Evidence from 17 European countries. p.595. Copenhagen: World Health Organization; European Observatory on Health Systems and Policies (Observatory Studies Series: 23), 2011, pp.365-394

Government Resolution No. 1248/2011. (VII. 18.) Korm.

Government Decree No. 162/2015. (VI.30.) Korm.

MÉRTÉK health system performance report for 2013-2015.


A special thanks goes to Edmond Girasek and Eszter Kovacs, which contributed  a great deal to this report.

As of January 2016 a new decree has come into effect to raise the salary of young specialists. The measure, which increases the average net monthly salary of young specialists to HUF 270 000 (appr. EUR 900), aims at decreasing the tension created by the so-called Markusovszky-scholarship. This was a measure introduced by the government in 2010 to prevent the emigration of medical graduates by offering an additional HUF 100 000 per month for medical residents (previous average salary: 170 000 HUF, appr. EUR 550). While this program has been successful in meeting its goal, it also created the so-called "Markusovszky-generation", i.e. physicians who would suffer a massive wage reduction after passing the specialist exams. The new decree has mitigated this tension: young specialists are entitled to receive HUF 151 000 in additional support per month for a maximum of five years. This money is paid by the National Health Insurance Fund Administration on the basis of applications from the health care providers employing eligible young specialists.


4.2.3 Training of health care personnel

Health care professionals can be trained at the secondary, post-secondary and higher education levels, supervised by the State Secretariat for Education, and by means of professional training supervised by the State Secretariat for Healthcare. Physicians and pharmacists are trained at four universities, into which the faculties of the previously five medical universities have been integrated (Medinfo, 2000). Undergraduate education takes six years for physicians, five years for dentists, and four and a half years for pharmacists. In addition, universities can offer postgraduate and continuing education courses. Postgraduate professional training of medical doctors is carried out under the so-called central trainee system, which is a centrally determined residency programme supervised and financed by the Ministry of National Resources.

Non-medical health professionals, such as nurses and assistants, are trained at several levels. Practising nurses used to be trained for four years at secondary-level vocational schools, but nurse training has been harmonized with EU requirements and elevated to the post-secondary level, where a three-year training course leads to a diploma in nursing. This basic nursing education can be followed by clinical specialization courses in the form of on-the-job training in various nursing specialties, such as oncology. Nine colleges of nursing offer a four-year baccalaureate diploma in nursing, and graduates can continue in postgraduate programmes (Ministry of Health, Social and Family Affairs, 2002). There are qualified health workers who enter directly into higher education courses, including highly qualified nurses with diplomas, MCH nurses, midwives, emergency ambulance officers, dieticians, physiotherapists, sanitary inspectors and optometrists. Further training of qualified health workers is offered by health faculties of universities and in the two training institutions of the State Secretariat for Healthcare, which is part of the Ministry of National Resources. One of these training institutions, the Institute for Basic and Continuing Education of Health Workers, operates the registration system for non-medical health professionals (1998/12).

Before 1989, Hungary had no training courses in public health or health services management. Later, the Ministry of Health16 supported the establishment of the School of Public Health at the University of Debrecen and the Health Services Management Training Centre at Semmelweis University. Both schools offer Master of Science training curricula for medical graduates and other professionals. The Health Services Management Training Centre offers continuing education programmes for hospital managers. As a regional partner of the World Bank Institute, the Centre also offers an international course on Health Sector Reform and Sustainable Financing, designed to provide an intensive training opportunity for senior decision-makers in the region.

16 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.

4.2.4 Doctors’ career paths

The careers of physicians in Hungary follow three main paths: professional, academic or managerial. Generally, these paths are separate, but for some practising physicians they are not. For instance, in a county hospital, a head of department who both treats patients and directs the work of subordinate physicians can be involved in the teaching of medical students and medical residents (and be granted an honorary academic title for doing so) (2005/7).

The professional, the managerial and, to a certain extent, the academic career paths have a general regulatory framework based on Act XXXIII of 1992 on the Legal Status of Public Employees. This framework applies equally to all public employees, including physicians and other health workers, and there is a related governmental decree for implementing the provisions of the Act in health care institutions (1992/5, 2008/12). The Act defines the public employee career path in relation to a guaranteed minimum salary (Articles 60–80). The pay scale has 10 categories, numbered from A to J, and in each category there are 14 grades. Public employees are classified in the lettered categories according to qualifications, educational and academic attainment (highest level of education, specializations, doctoral and other academic degrees, as well as membership in the Hungarian Academy of Science) (1992/5). Category A requires either an elementary education or vocational training, whereas Category J requires either a university degree plus a specialization and a doctoral degree, or membership of the Hungarian Academy of Science (Article 61). In each category, the grade level is determined by the years of service (Articles 62 and 64). The public employee is upgraded by one grade for every three years in service (Article 65). In 2010 the guaranteed minimum salary in grade 1 of category J was HUF 154 000 (about €555) per month, and in grade 14 this is multiplied by 1.8725 (2009/6). Special rules apply to heads of organizational units and organizations (managerial path), and to teachers and researchers at institutions of higher education and at research institutes (academic path). Since 2009 managers have been divided into two groups: (1) appointed directors (kinevezett vezető), who are full-time managers, and (2) acting managers (megbízott vezető), who carry out their managerial duties part-time in addition to their regular professional work (1992/5, 2008/5). In a health care service delivery organization, this means that acting managers (for example, heads of departments) are allowed to treat patients whereas appointed directors are not. Individuals in the former category receive a so-called managerial allowance, which supplements the basic public employee salary, and managers in the latter category have an entirely different pay scale, which consists of two levels (manager and higher-level manager) in three categories (secondary education, higher education 1 and higher education 2). In 2010 the base salary was HUF 120 000 (about €433) per month, the highest category had a multiplier of 2.4, and the base managerial allowance was HUF 20 000 (about €72) (2008/5, 2009/6).

The governmental decree mentioned above regulates only the amount of managerial allowances in the various managerial positions of health care organizations (2008/12). The highest allowance, which is 300% of the base managerial allowance, is for the directors working for providers of health care services at the national level and members of their governing bodies (2010/2). There are no higher-level managerial positions specified by the decree, however, for which the rules of the appointed directors must be applied. Health care delivery organizations that provide publicly funded health services must have a four-member top management team, including the chief executive officer and three deputies, the medical director, the nursing director and the financial director. Outpatient providers do not have a nursing director, and long-term or nursing care providers do not have a medical director (2003/11). Applicants for the top management positions of publicly funded health service delivery organizations, including the chief executive officer and the medical and nursing directors, are required to hold a degree in health services management and have a minimum of five years’ experience to be eligible for the chief executive officer (CEO) post or three years’ experience to be eligible for either of the other two posts. Applicants whose degree course is in progress or who commit themselves to obtain the degree within five years are exempted. Exemptions can also be granted by the owner of a health care delivery organization (2002/4), but this has to be approved by the professional governing body of the institution in question. The members of this professional governing body include the medical director, the nursing director (or senior assistant) and the heads of medical departments or the senior consultants in a matrix hospital (2003/11).

The academic career path is regulated in detail in Act CXXXIX of 2005 on Higher Education, but the pay scale of the various positions is contained in Annex 2 of Act XXXIII of 1992 on the Legal Status of Public Employees. There are two to three grades in each category, and the salary is determined relative to the university professor grade 1 (100%). An assistant professor (university trainee) grade 1 earns 37% of this salary, whereas a university professor grade 3 earns 106%. The base salary in 2010 was HUF 437 300 (about €1576) per month (2009/6). Aside from general university positions, there is a separate career path for academics who work mainly on research projects. Positions consisting of at least 90% research must be defined as scientific research positions, but individuals in these positions have to take part in teaching activities as well. The starting position is the junior scientific assistant, and the most senior position is the research professor with a guaranteed salary 40% and 100% of the university professor grade 1 respectively (2005/7).

The professional career path for physicians and other health care professionals is not regulated in detail by the aforementioned acts or decrees. Act XXXIII of 1992 on the Legal Status of Public Employees has no provisions specific to health care, and the related governmental decree, which regulates the health care-specific implementation of the provisions of the Act, deals only with the classification of various health professionals (physicians, paramedical workers, nurses and assistants, and non-medical jobs) into the various categories of the public employee pay scale; the categorization of managerial positions and the extent of managerial allowance as described above; and the definition and extent of health care-specific supplementary allowance (diagnostic, assistant, traumatology, intensive therapy, infectology, psychiatric and nursing allowances). For instance, recent graduates of medicine, dentistry and pharmacy are classified into category H; medical doctors, dentists or pharmacists who recently qualified in their specialization are classified into category I; clinical specialist psychologists are classified into category I; and dieticians, diploma nurses or physiotherapists are classified into category F (2010/2).

In general, the career path of a physician working in a general hospital begins with the residency period and, after passing their specialization exam, the new specialist becomes a so-called departmental or ward doctor (2009/2). After several years of medical practice, the physician can be promoted to the position of an adjunct doctor (adjunktus), who is the deputy of chief doctors, and finally to a chief doctor. The chief doctor title is recognized by law and can be granted to specialists who have at least 10 years of medical practice and have received an evaluation of “excellent” in accordance with the rules of performance assessment, described by Article 40 of Act XXXIII of 1992 on the Legal Status of Public Employees. Chief medical doctors receive what is known as a “titular allowance”, which was 50% of the base allowance in 2010 (2008/5). Chief medical doctors can be promoted further along the managerial career path, as described above. Physicians in general hospitals may also participate in the teaching of medical students and medical residents. Universities are allowed to acknowledge their educational activity by granting honorary academic titles, including the title of “titular associate professor” and of “titular professor” (2005/7).

The general principle underlying Act XXXIII of 1992 on the Legal Status of Public Employees is that, for the various groups of public employees, a guaranteed minimum salary is defined, and employers are able to exceed this minimum. As of early 2009, these deviations are allowed only if the performance of the public employee is evaluated and found excellent or very good (2008/5).

The career paths of other health care staff are regulated within the same legal framework and according to the same principles as the career paths of physicians.

The number of doctors working in Hungary has increased to 39,132 in 2017 compared to 33,943 in 2010, according to the Ministry of Human Capacities. In addition to favourable migration trends, higher enrolment in universities through additional publicly funded student placements contribute to the rising numbers of doctors: the four medical universities issued 1040 diplomas in 2010, compared to 1521 in 2017.


According to the Hungarian Central Statistical Office salaries were increased most significantly in the health sector. On average, gross salaries increased by 30-40 thousand HUF (92- 124 EUR) in May compared to the previous year, while in the health sector the average salary increased by 110 thousand HUF (340 EUR), a never seen 19.4% increase. While the average gross salary was about 270 thousand HUF (835 EUR) in May last year, this year it has increased to 323 thousand HUF (1000 EUR).

However, according to the data sent voluntarily to the HR portal (, the average gross salary of a healthcare nurse is still only 180 200 HUF (557 EUR) per month. Many Hungarian hospitals would not be able to meet the statutory minimum conditions without hired nurses who are being provided by external companies.

Though from general and supplementary salaries hundreds of thousands HUF could be earned, there is a serious price: besides the three or four jobs there is no time for the compulsory rest period, which increases the risk of malpractice and can cause burnout.

It is not surprising that HR related scandals still dominate the news in the health sector. A famous ER doctor of a big Budapest hospital has resigned on the grounds that he was not able to meet the minimum staffing standards for the department, and the nurses of a whole department quitted on one day to the other at a municipal hospital in Northern Transdanubia region.


As part of the efforts to contain the emigration of young doctors, the government introduced the Markusovszky Scholarship Program in 2011, which provided an additional monthly net income of HUF 100,000 (EUR 320) to make medical residents stay and work in Hungary for 10 years. During the previous years the program was extended and became a complex scholarship scheme covering the residents of various specialisations including the Markusovszky Scholarship for medical specialisations in general (EUR 320 per month), the Than Károly Scholarship for pharmacy (EUR 320 per month), the Méhes Károly Scholarship for paediatrics (EUR 640 per month), the Gábor Aurél Scholarship for oxyology and emergency medicine (EUR 640 per month) and in 2016 a new program was introduced for specialisations in shortage with a monthly scholarship of EUR 480.

Since February 2017 young medical doctors can also apply for the Flór Ferenc Scholarship, which is offered for the candidates of military, catastrophe and law enforcement medicine.

By the end of 2016 close to 3,500 medical doctors applied for and received one of the scholarships.

Source: National Healthcare Service Centre (ÁEEK)

As of 1st September 2016, salaries of around 100,000 health workers are raised according to professional categories. The salary of specialists and hospital pharmacists will increase by 107,000 HUF (approx. 350 EUR) a month, other health professionals will receive a pay rise ranging from 6,660 (approx. 20 EUR) to 61,670 HUF (approx. 200 EUR) a month, depending on their qualifications and work experience. The required funding, which amounts to 19.2 billion HUF in 2016 in addition to the 12 billion HUF allocated to primary care, is covered from the central government budget.