MEDICAL EDUCATION IN BULGARIA NEEDS A RADICAL CHANGE

Prof. Dr. Krassimir Ivanov, MD, was born in Varna in 1960. He graduated from the Varna University of Medical Sciences in 1986 and then worked as a general practitioner in Varna. He worked as a general practitioner in Devnya. He specialized in Surgery (1990-1993), Oncology (2002-2005) and Health Care Management (2003-2005). In 2005 he obtained a second master's degree in "Economic Management". In 1996 he defended his PhD thesis on "Diagnosis and surgical treatment of rectal cancer" and in 2008 he defended his thesis for the degree of Doctor of Medical Sciences. In 2009 he was elected Professor of Surgery.

From 2004 to 2012 he was Head of the Department of General and Operative Surgery at the Medical University - Varna. Between 2001 and 2010 he was the Executive Director of the University Hospital "St. Marina" - Varna. From 2012 to 2020 he was Rector of Medical University - Varna.

In 2020 he was elected President of the Association of University Hospitals in Bulgaria.

He is an active member of several Bulgarian and international scientific organizations - Bulgarian Surgical Society, German Surgical Society, Romanian Surgical Society, Union of Scientists in Bulgaria, Bulgarian Medical Association, International Association of Surgeons, Gastroenterologists, and Oncologists (IASGO), International Society of University Colon and Rectal Surgeons (ISUCRS), etc.

He has won numerous awards including: Order of St. Cyril and Methodius with necklace (2020), Order “Apostle Andrew the First-Called” of the Metropolis of Varna and Veliko-Preslav (2019), Gold Badge of Honour "For Merits to Varna" (2015), Gold Badge for Special Merits in the Development of Mini-Invasive Surgery, "Manager of the Year" of the Varna newspaper "Forum Medicus",, Gold Medal of the Bulgarian Red Cross (2016), the award "For unique contribution to university education in health care" from the Bulgarian Association of Health Care Professionals (2017). He was awarded the honorary citizenship of the town of Sliven (2017) and the honorary citizenship of the city of Plovdiv (2017). In 2019 he was awarded the title of Doctor Honoris Causa of the Nikola Vaptsarov Military University.

***

Prof. Ivanov, health care was highlighted as a priority in the agreement of the regular government. In your opinion, what are the main priorities that will contribute to improving the quality of medical care?

In my opinion, things should start with education and upbringing from a very early age that health is the greatest wealth and it should be taken care of. Secondly, we should put healthy lifestyles, food and nutrition. Third is medical education in Bulgaria, which needs a radical change, including:

• - Updating and modernizing outdated uniform state requirements;
• - investing in medical universities to build state-of-the-art simulation centres for AI deployment;
• - investment in university hospitals to upgrade the facilities where medical professionals are trained;
• - increasing the capacity of medical universities to attract foreign students to study for a fee;
• - prevention and early diagnosis of socially important diseases.

It is increasingly discussed by politicians and managers of municipal and state hospitals that medical institutions should not be commercial companies. Do you share their opinion?

Absolutely not. State psychiatric hospitals are not for-profit companies, and we are not aware of any thriving ones. The form of ownership does not in any way affect the physical and value performance of the hospitals.

After the decision of the Constitutional Court, a complicated situation is created: on the one hand, the law restricts hospitals to work within the budget of the NHIF, on the other hand, there are no restrictions if they exceed it - where is the solution?

There are two solutions. The first one is to implement blockchain technology on the basis of which to develop electronic health records of the citizens of the Republic of Bulgaria - from birth to death. The same should be implemented in the National Health Insurance Fund, respectively - for the contractors of medical activities. Secondly, but not least, payments by the NHIF should be made by validation by the patient.

Do you support the practice of the NHIF or the Ministry of Health to make a single tender and to negotiate the most favourable prices, volumes and terms for the supply of oncology drugs on the basis of advance orders of hospitals?

My answer here is an absolute no! Medical institutions should not procure medicines under the current Public Procurement Act (PPA). I believe that it is best to have an electronic marketplace, the writing of which in the PPA will solve all problems. There will be transparency, the market will regulate prices, the bureaucracy of all the schemes and machinations, the endless appeals will be removed.

Should the National Framework Contract set salary levels, or is this the responsibility of the management of the medical institutions?

The determination of salary levels in the National Framework Contract (NFC) is a legal absurdity, so we urgently demand that the Health Insurance Act be changed in this part and, accordingly, that the text be removed from the NFC. Neither the NHIF nor the BMA are employers in medical institutions, so they have absolutely no right to set wages. They can set such wages for their own employees.

In the draft for a new Collective Labour Agreement, the unions set a 20 per cent wage increase. Is it possible for state hospitals to implement this?

Of course, it can. We insist on a 100% increase in salaries, which can happen if the NHIF budget is increased by 100%. We believe that this 20% is not worthy of the work of Bulgarian doctors and specialists, so our demands are in line with those of the trade unions, even more. It is strange why the trade unions are making these demands of us, when we should be demanding them jointly from the institutions that determine the state budget.

Should young cadres whose education has been confounded by the state be bound by a commitment to work for a period in the country?

In my view, this is not a workable measure. The people have said that "beauty is not made by force". Of course, it could be made possible for students who have been admitted (who have passed the entrance examinations) but do not have the financial means to enter into a contract with the state, for the state to pay for their training and subsequent specialisation, and for them to work in a state-designated medical institution for the same period for which the state has paid for their training.