Changes to doctors’ pay splits health care sector in Macedonia


Efforts to reward hard-working doctors are being disputed by the health care sector.

By Aleksandar Pavlevski for Southeast European Times in Skopje -- 11/09/12


About 90 percent of the Skopje Clinical Centres staff said they will strike against the plan. [Aleksandar Pavlevski/SETimes]

A proposed payment system for Macedonian doctors that would give bonuses to those who meet a monthly quota – and dock the pay for those who do not – is the latest effort in the region to modify physician salaries.

The Macedonian Health Ministry’s performance-based pay system gives doctors a 20 percent monthly bonus if they meet a required number of patients. Those who do not meet the quota would have their pay cut by 20 percent.

"The concept is to empower the workers and to reward them, and to demotivate or punish those who do not work their job," Macedonia Health Minister Nikola Todorov told SETimes.

Some doctors object to the plan and have given the ministry until September 24th to retract the new provision.

Dr Dejan Stavrikj, president of the Independent Trade Union, said the changes violate the legal provisions on wages.

"Our work cannot be treated as someone who works in a factory. We believe that there should be a payment under performance and rewarding with additionally provided money, [but] not to change the basic salary," Stavrikj told SETimes.

According to the union, 90 percent of the staff at the Skopje Clinical Centres backs a proposed strike if the conditions are not removed.

"Patients are not numbers. Each has its own difficulty, its own story. I am offended if a patient should be treated as a number. My colleague and I [do not] have the same number [of patients] because they all have different difficulty," Snezhana Georgieva, president of the board of doctors in the Independent Union Clinical Centre Skopje, told SETimes.

However, not all workers disagree with the proposal. "I think this system will finally highlight those who really invest labour from those who hide behind the good workers," Juliana Spasevska, a public hospital employee, told SETimes.

"It is true that in our hospitals are so many doctors that do a lot of work, but there are also many doctors that are constantly on break. There is much less work in smaller cities than in Skopje. I believe that if everyone takes a pay-as-work, it will contribute to greater efficiency of doctors. Those who avoid the workplace would normally receive smaller salary," said Skopje City Hospital patient DS from Veles.

The state of healthcare wages is an issue in other countries in the region.

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In April, about 10,000 health workers, members of the Trade Union of Doctors and Pharmacists, staged a strike to protest the Serbian government's decision to reduce salaries in the sector by 10 percent.

Doctors from 22 hospitals went on strike in Belgrade, Nis and Kragujevac. The average salary in the health sector in Serbia is 360 euros. Physician salaries are between 585-630 euros, and about 80,000 employees that have lower level of education receive wages starting around 225 euros.

In Bulgaria, dissatisfaction in wages is paramount among doctors. In March, an international Internet project -- -- announced the results of a survey conducted among staff physicians in Bulgaria.

When asked "How much are you satisfied with the ongoing reforms in the health sector and reflect on your work as a doctor?" more than 87 percent of those surveyed said they are dissatisfied.

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