In the last decade, 1,214 doctors have emigrated from Croatia, driven primarily by poor management and organisation of the healthcare system, according to a research by Croatian sociologists published in the journal "Migration and Ethnic Topics".

Sociologists Ljiljana Pintarić from the Faculty of Humanities and Social Sciences in Osijek and Drago Župarić-Iljić from the Faculty of Humanities and Social Sciences in Zagreb interviewed 18 doctors who already emigrated to gain deeper insights into the key motives behind their leaving.

The emigration of doctors from Croatia is shaped by many interconnected factors and is primarily fueled by various organisational problems within the public healthcare system, especially difficult working conditions and a high level of perceived corruption both in the system and the country as a whole.

Poor organisation as the primary motive, followed by doctors’ aspirations

Poor management and organisation of the system are the primary reasons for leaving, even before the professional aspirations of doctors, which are the second motive.

The broader social and political context provides a general framework in which various negative institutional practices such as clientelism and corruption occur, contributing to the overall dissatisfaction with the working environment and conditions.

A significant number of emigrated doctors cited poor interpersonal relationships as one of the most important reasons for leaving, often linked to excessive politicisation of the profession and the formation of opposing groups.

In terms of interpersonal relationships, they mentioned mobbing, mostly in relationships between superiors and subordinates, but sometimes also among colleagues at the same hierarchical level.

Two types of mobbing emerge: individual cases of power abuse, which are somewhat embedded in the system, especially towards younger doctors, particularly specialists. There is also systemic mobbing in the form of gender-discriminatory abusive behaviour and the use of power positions for the harassment of subordinates.

Nepotism is also an inevitable topic, as favouritism towards certain colleagues at the expense of others, along with the absence of meritocratic principles, characterises the relationships within work collectives divided into “ours” and “theirs.”

That aspect is linked to the high level of competitiveness in career advancement, especially in clinical hospitals where there is also the aspect of scientific work and teaching at faculties.

Policy changes needed to help retain doctors

The overall picture points to an organisational climate that tolerates, even encourages, and mostly ignores problems in functioning, fails to address them, and lacks adequate mechanisms to sanction unacceptable behaviour.

The authors emphasise the importance of using public health and educational policy measures to mitigate the consequences of weakening professional institutions and the entire healthcare system. By losing doctors through emigration, Croatia loses valuable resources, both material and human, that have been invested in their education and training.

From 2013 to 2024, 1,214 doctors left Croatia, with an average age of 36 and an average of eight years of work experience, among whom 57% are female. The highest number left in 2023, a total of 158.

We are facing a problem of sustainability in the healthcare system and of the ability to continue providing adequate healthcare and treatment. Without investing in education and training, and subsequently retaining the medical staff, we risk a potential collapse in the standard of treatment services due to a lack of professionals, conclude Pintarić and Župarić-Iljić.