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21 July 2025 | Country Update
Draft regulation on dual practice open for public consultation -
14 February 2025 | Policy Analysis
Proposal for a new regulation on dual practice -
25 November 2024 | Country Update
Health workers’ strike: agreement reached with the Ministry of Health -
22 July 2024 | Policy Analysis
Introduction of specializations for emergency medicine nurses and technicians -
22 July 2024 | Country Update
Abolition of “slave contracts” for medical residents -
01 May 2023 | Country Update
Agreement on higher salaries and improved working conditions for doctors -
17 February 2023 | Country Update
Consultation on the Draft Decision on the adoption of the Supplement to the National Plan for the Specialist Training of Health Workers for the five-year period 2020–2024
4.2. Human resources
The geographical distribution of human resources is uneven, with an oversupply in urban areas and a shortage in rural areas and the country’s islands off the Adriatic coast (Box4.2). In May 2015 the Government adopted the Strategic Plan for Human Resources in Healthcare for 2015–2020, which aims to establish a human resources management system. During the COVID-19 pandemic Croatia took a number of measures to increase the number of staff where needed and ensure the retention of existing health workers. Measures to increase the number of staff included the redeployment of doctors and nurses to COVID-19 duties, as well as the inclusion of young doctors. Measures to support the health workforce included benefits in the form of funding or the provision of accommodation for doctors working with COVID-19 patients (OECD/European Observatory on Health Systems and Policies, 2021).
Box4.2
The Ministry of Health has announced that the draft regulation on dual practice has been submitted for public consultation. The regulation addresses the conditions under which doctors employed in the public sector may engage in additional work in the private sector.
According to the Ministry of Health, the proposed regulation introduces clearer and more transparent criteria for approving dual practice. The Minister of Health emphasized that the aim is to eliminate arbitrariness in decision-making by equipping hospital directors and heads of department with a standardized tool that can be applied consistently to all physicians, while also taking into account the specific organizational and healthcare needs of individual institutions.
The regulation sets out a structured, point-based evaluation system and introduces clear eligibility criteria. Physicians will be eligible to apply for a dual practice license only if they have at least five years of professional experience in the medical specialty for which they are seeking the license. Additionally, in the three months prior to the application, they must have met or exceeded the average performance benchmarks within their department both in terms of clinical consultations and diagnostic services.
The new framework is expected to improve the balance between the public and private healthcare sectors, and to ensure that dual practice does not negatively impact the accessibility or quality of care in public facilities.
The Ministry of Health has announced the development of a new regulation on dual practice. According to the proposal, doctors employed in the public sector will be allowed additional work in the private sector only if patients do not have to wait longer than 60 days for their first consultation in the public system.
This measure comes in response to growing issues with healthcare accessibility, considering that the current average waiting time for diagnostic tests is 126 days. The main goal of the regulation is to limit the ability of doctors employed in the public sector to also work in the private sector, while also defining clear criteria for which medical procedures these restrictions will apply.
While some hospital doctors warn that the limitation could lead to an increase in doctors moving entirely to the private sector, the Minister of Health believes this not to be the case. She emphasized that the regulation will be aligned with all stakeholders and that, in case of high risks of doctors leaving the public sector, the criteria for additional work will be adjusted.
The Croatian Association of Hospital Doctors states that dual practice of doctors is not the main cause of long waiting lists, but that the key issue lies in the poor management of the health system at all levels.
The Ministry of Health announced that the regulation should soon be sent for public consultation.
For more information (in Croatian) see:
- https://zdravlje.gov.hr/vijesti/ministrica-zdravstva-u-rtl-u-danas-o-dopunskom-radu-lijecnika/6763
- https://zdravlje.gov.hr/vijesti/hrstic-vazno-je-ograniciti-mogucnost-rada-lijecnika-u-privatnom-sustavu/6759
- https://www.index.hr/vijesti/clanak/hubol-dvojni-rad-lijecnika-nije-primarni-problem-zdravstva/2620947.aspx
The strike involved radiology and pharmacy technicians, laboratory staff, medical transport workers, and some nurses and resulted from demands for increased salaries, adjustments to pay coefficients, and higher meal allowances. Approximately 4,000 union members from 58 healthcare facilities participated, resulting in the suspension of non-urgent diagnostic procedures.
After four days of negotiations, an agreement was reached with the Ministry of Health and the strike was discontinued. The Ministry committed to addressing salary discrepancies and resolving systemic issues within four months.
References
In response to current challenges and staffing issues in the Croatian health system, as part of the human resources reform measures, specialized training for emergency medicine nurses and technicians has been introduced.
The government has allocated €13.2 million from the National Recovery and Resilience Plan to fund specialized training for 375 nurses and technicians. These professionals will be trained to provide a broader range of services for patients in life-threatening conditions. Plans also include specialized training in other areas such as oncology, haematology, and cardiology.
The first 100 nurses and technicians have already completed their emergency medicine specialization. This training is supported by legislative changes. Amendments to the Nursing Act will allow nurses and technicians with bachelor’s degrees to administer therapy or medication without a doctor’s presence. These changes apply to those who have completed the emergency medicine specialization, granting them greater competencies and responsibilities. Specialized nurses and technicians will be able to work independently in emergency medicine according to their competencies, taking over some procedures from doctors. This will help reduce the workload on doctors in emergency medical teams.
Changes have been made to the Health Care Act, abolishing the so-called “slave contracts” for medical residents. These contracts previously required doctors to repay their earned gross salaries to their employer if they left their position early. With the abolition of these contracts, residents who leave their hospital before the end of the agreed period will only need to repay education costs, up to a maximum of €7,000.
Professional associations, including the Croatian Medical Chamber, the Croatian Association of Hospital Doctors (HUBOM), and the Croatian Young Doctors’ Initiative, have welcomed this change.
However, the Croatian Association of Healthcare Employers, representing the majority of healthcare institutions, warns of serious financial damage to healthcare facilities. They also caution that parts of the country, especially rural and remote areas, could face shortages of available health workers, in view of difficulties to retain qualified staff.
References
For more information (in Croatian) see:
The government of Croatia has reached an agreement with representatives of medical associations on improving the status of Croatian doctors.
A new regulation on payment coefficients entered into force at the end of April 2023. The regulation equalizes some coefficients of narrow specializations and specializations in the hospital system, equalizes the coefficients of specialists in the hospital and outpatient system, and increases the coefficient by 10% for specialists, doctors of dental medicine, and masters of pharmacy and biochemistry who do not have a specialization.
With regard to working times and staffing norms, it was agreed that the plan and programme of health care measures will be revised by 1 October 2023. In addition, it was agreed that a law on the employment status of doctors will be drawn up in parallel with a new law on salaries in public and state services, and that it will address specific challenges faced by the medical profession, such as a large number of on-calls, standbys, and overtime hours.
On 13 February 2023, the Ministry of Health opened a public e-Consultation on the Draft Decision on the Adoption of the Supplement to the National Plan for Specialist Training of Health Workers for the five-year period 2020–2024.
For more information (in Croatian) see:
4.2.1. Planning and registration of human resources
All medical professionals in Croatia have to be registered, licensed and relicensed by their respective professional chamber. Eight categories of professionals are regulated by medical chambers in Croatia: medical doctors; dentists; pharmacists; nurses; midwives; medical biochemists; physical therapists; and other health care professionals (sanitary monitoring staff, radiology technicians, occupational therapists and medical laboratory workers). The chambers regulate registration, licensing and continuous medical education (CME), controlling whether CME requirements are being met and imposing sanctions, including conducting disciplinary proceedings, if not. They also promote professional ethics.
All health workers and associates are also registered in the Croatian Health Workforce Registry, established in 1991 at the CIPH. Every health care provider (including those in the private sector) is obliged to submit information on all the health workers it employs, including their name, age, profession, entry or departure from service, and any change of position or professional level.
4.2.2. Trends in the health workforce
By the end of 2017 there were a total of 69 841 health workers, with either permanent or temporary contracts, in both the public and private sector. In addition, there were 5269 administrative and 11 125 technical staff. Most (48.1%) employed health workers had high school education, 33.9% had a postgraduate university degree, 17.4% had an undergraduate university degree (undergraduate studies), and 0.6% had a lower level of education (below high school).
Physicians
In 2018 Croatia had 344 practising physicians per 100 000 inhabitants. This number was below the EU average (382), but had increased steadily from 237 in 2000 and exceeded the ratios in comparator countries (Fig4.2, Fig4.3). The number of GPs per 100 000 inhabitants (57 in 2019) was below the EU average (78 in 2013) and physicians are lacking especially in primary care. Shortages are also observed in rural areas and on the country’s islands.
| Fig4.2 | Fig4.3 |
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Nurses and midwives
In 2018 there were fewer practising nurses (excluding midwives) in Croatia per 100 000 population (667) than in two of the comparator countries (Slovenia and Romania), but the number of nurses per population has increased in recent years (Fig4.4). Nurses are the largest professional group in Croatia, accounting for 44.1% of all employees in the health sector, with 11.9% of them being male. Most nurses (23 872) had secondary education, 6656 had a Bachelor’s degree and 245 had a postgraduate degree. In addition, there were 1766 midwives in 2017.
Fig4.4
Dentists
There were 3714 doctors of dental medicine in 2017, with 66.1% of them being women and 12.7% specialists. The number of practising dentists in Croatia has risen in recent years, from 68 per 100 000 population in 2000 to 85 in 2018 (Eurostat, 2021).
Pharmacists
By the end of 2017 there were 2874 pharmacists and 474 medical biochemists. The number of practising pharmacists in Croatia was 76 per 100 000 population in 2018, which was roughly in line with its comparator countries (80 in Hungary, 71 in Slovenia and 90 in Romania).
4.2.3. Professional mobility of health workers
There is no systematic surveillance or reporting of migration trends in the health sector. Although Croatian policies on professional mobility have been harmonized since entering the EU, there is no national strategy to deal with the migration of health workers. There are also no systematic measures for retaining the health workforce in the country or particular regions. Some of the regions have started addressing this problem themselves, offering mostly financial benefits, such as student scholarships or subsidized mortgages.
In 2015 the key destination countries of Croatian migrants were Germany, Austria, Italy and Slovenia, but there are no specific data for health workers. The number of requests to the Croatian Medical Chamber for a certificate that allows a person to work abroad increased notably in the first year after Croatia’s accession to the EU (from 271 in 2013 to 601 in 2014), but declined afterwards (to 387 in 2015) (Župarić-Iljić, 2016). According to a survey conducted by the Croatian Medical Chamber in 2016, covering 1531 physicians aged 29–35, 58% of respondents indicated that they would leave Croatia if offered an employment opportunity abroad. The main reasons for their willingness to leave the country included better working conditions (74%), well regulated health systems (64%) and higher wages (64%) (Babacanli et al., 2016).
4.2.4. Training of health personnel
Five types of medical professionals (medical doctors, nurses, dentists, pharmacists and midwives) fall within the system of coordination of minimum training conditions according to Directive 2005/36/EC on the recognition of professional qualifications. Croatia meets these minimum training conditions for all five categories of medical professionals.
Medical doctors
Four universities (in Zagreb, Osijek, Rijeka and Split) offer medical education in Croatia. It takes six years to complete the medical degree for doctors. After joining the EU, the Ministry of Health adopted the EU directive according to which medical students enrolled after 1 July 2013 will not have to take an internship and state exam after completing their studies. Instead, graduated medical doctors will receive a work licence immediately upon graduation and move on to specialization or work as a substitute for a GP or in an outpatient emergency medical service. The licence will be granted by the Croatian Medical Chamber upon application. In the transitional period between graduation and specialization the Government introduced an optional form of internship called “work of medical doctors under supervision”, which should last between six months and up to two years.
Specialization programmes are offered in 46 medical areas. The National Commission for the Specialist Training of Physicians is responsible for defining the generic and specific competences, and for evaluating, assessing and improving the quality of specialist training. The Ministry of Health grants accreditations and supervises specialization programmes. The duration and content of each specialization programme must meet the minimum requirements set out by EU Directive 2005/36/EC.
Mandatory relicensing of all medical doctors was introduced in 1996. In order to be relicensed, a medical doctor must collect 120 credit points (through CME, publications, etc.) over a period of six years and apply for a renewal of their licence to the Chamber.
Nurses
Nurses complete either a course at a vocational high school for nurses (five years), a Bachelor’s degree in nursing at a university (three years) or an additional Master’s degree (two years). After graduation, they are eligible to apply for a licence with the Croatian Chamber of Nurses and are subsequently entered into the professional register.
Nurses can attend postgraduate specialist programmes in either public health or management. Specializations are also available in psychiatry, paediatrics, internal medicine, haematological and oncological care, intensive care, anaesthesia and resuscitation, dialysis, surgery and emergency medicine.
Nurses are required to participate in continuing education and to collect 90 points during a six-year period (with a minimum of 15 points per year). If they do not meet this requirement, they must take a reassessment examination at the Croatian Nursing Council.
Dentists
Dentists complete a six-year university programme in dental medicine, after which they may apply for a licence with the Croatian Dental Chamber and can be subsequently entered into the register of doctors of dental medicine. Dentists may then choose out of eight specializations. Dentists are required to participate in continuing education (a minimum of 10 points per year, 60 points in total) in order to have their licence renewed. The licence is issued for a period of six years.
In 2009 the Croatian Dental Chamber recognized two categories of auxiliary dental staff: dental technicians (working independently) and dental assistants (working under the direction and supervision of a doctor of dental medicine). Dental technicians and dental assistants complete a degree in vocational schools (four years) followed by a mandatory internship and state examination. After that they are registered by the Chamber (registration gives them the right to practise).
Pharmacists
Pharmacists complete a university degree in pharmacy (five years), after which they are eligible to apply for a licence with the Croatian Chamber of Pharmacists and will subsequently be entered into the register of pharmacists. The licence has to be renewed every six years and to achieve this pharmacists need to collect a minimum of five continuous professional education points per year.
Midwives
Midwives complete a Bachelor’s degree (three years) or Master’s degree (additional two years). They register with the Croatian Chamber of Midwives for the purpose of performing health care activities.
4.2.5. Physicians’ career paths
According to the 2018 Health Care Act, after graduation doctors can choose to pursue a career in three different directions: academic, scientific or clinical. A doctor choosing an academic career will begin as a teaching assistant. After completing a PhD and fulfilling all the conditions required by academic institutions, they acquire the title of assistant professor. Afterwards, it is possible to advance to associate professor and eventually to full professor. A doctor choosing a scientific career may work as a research associate or scientific adviser. A doctor choosing a clinical career first undergoes specialist training. After completing the training, they can be promoted to the position of chief of department or chief of staff and ultimately to that of hospital director. These decisions are taken internally at the institutional level. It is not unusual for doctors to pursue different career paths in parallel.
4.2.6. Other health workers’ career paths
Nurses can advance professionally in hospitals to become head of department nurses and, eventually, head of hospital nurses. According to the 2018 Health Care Act, nurses are members of the governing bodies in hospitals and participate in decision-making. They can also opt for an academic career, starting with doctoral studies.