4.2. Human resources

4.2.1. Planning and registration of human resources

There are strategic plans for planning human resources in Czechia established by MZČR, such as Health 2030, which includes 11 strategies to support staffing in the health system (for example, building a national system to monitor and plan personnel needs, and strengthening the competences of non-physician health workers) (MZČR, 2020a). Due to increasing numbers of physicians reaching retirement age, these strategies emphasize preventing future shortages. In 2019, around 14% of physicians were aged 65 and above, with another 19% aged between 55 and 64 years (Eurostat, 2022).

The number of students studying medicine has grown in the past 10 years (see Table4.2). With financial support from the state budget (CZK 6.8 billion through MŠMT for 2019–2029), medical faculties saw a 20% rise in first-year students for winter semester 2019/2020 than in previous years (MŠMT, 2018; Medical journal, 2019). MZČR also supplies accredited providers with financial support for postgraduate training (rezidenční místa), covering costs for training and part of trainees’ salaries. This allows MZČR to set priorities, define the number of subsidized positions within each specialty and set rules for how many senior physicians gain licences to train new graduates. For example, in 2018, 415 young physicians were supported through the programme rezidenční místa; and 310 in 2019 (MZČR, 2020a). Subsidy programmes, such as the one in 2018–2022, are also used to tackle uneven distributions of dental resources throughout Czechia (see Box4.2) (MZČR, 2018a).

Table4.2	Box4.2

Regional authorities try to attract workers through various subsidy schemes (recruitment bonuses, equipment for outpatient offices, etc.), while some authorities provide scholarships to medical students who commit to practising for a certain number of years in the region. Some facilities ask their physicians in postgraduate training to sign contracts committing to practise there for up to five years after passing the state licensing examination (kvalifikační dohoda). In 2019, 20.1% of physicians and 25.0% of paramedics worked in facilities owned by MZČR or other state authorities, while 23.4% of physicians and 34.6% of paramedics worked in establishments owned by local or regional authorities. The remaining 56.5% of physicians and 40.3% of paramedics were at private establishments (ÚZIS, 2020a).

The registration of providers depends on the founder and the type of facility and follows the Health Service Act (2011) (see section 2.7.2) The Ministries of Justice, Interior and Defence are responsible for authorizing care provision in their own facilities, while authorizations for setting up and running pharmacies are granted with SÚKL’s consent. Each practising physician, dentist and pharmacist has to register with their respective chamber, which, among others, supervises lifelong education for its members (see section 4.2.4).

4.2.2. Trends in the health workforce

In 2019, the numbers of physicians and nurses per 100 000 inhabitants were slightly above the EU averages: Czechia had 407 physicians per 100 000 inhabitants compared with the EU average of 389 and 856 nurses compared with the EU average of 838 (see Fig4.3). Czechia’s physician-to-population ratio has gradually increased over the past 20 years, remaining above the EU average, while ratios in neighbouring countries have either moderately increased or stagnated (see Fig4.4).

Fig4.3	Fig4.4

As shown in Fig4.5, the nurse-to-population ratio is higher in Czechia than Poland or Slovakia, but lower than in Germany and Austria (after including non-hospital nurses). Although Germany has managed to steadily increase this over the past 20 years, other countries, including Czechia, have stagnated, and roughly mirror the EU average. In Slovakia, the nurse-to-population ratio has been declining.

Fig4.5

In 2020, there were 221 567 full-time equivalents (FTEs) of workers in the Czech health sector, 43 475 of whom were physicians and 7585 were dentists. There were a further 6728 pharmacists and 114 007 paramedics. Of these, 75 011 worked as general nurses, 3787 as paediatric nurses and 3778 as midwives (ÚZIS, 2022b). Although men have historically dominated the profession, the long-running trend of female medical graduates resulted in them constituting 54% of Czech physicians in 2020 (according to headcounts; see Table4.3). In 2019, the majority of nurses (general nurses, paediatric nurses and midwives) worked in hospitals (58%, including outpatient care), roughly 33% worked in independent outpatient care establishments and 3% worked in psychiatric institutes (ÚZIS, 2020a).

Table4.3

4.2.3. Professional mobility of health workers

There are over 1300 graduates from Czech medical faculties annually. Some leave for better working conditions or salaries abroad (mainly to Germany); however, verified numbers of professional migration from the health sector are not available. The only possible source of data – the issuance of certificates allowing physicians to work abroad according to European Directive 36/2005/EC – is unreliable, as not all applicants leave the country. However, the Czech Medical Chamber estimates that approximately 200 graduates go abroad annually, which is around 15% (E15.cz, 2021). Emigration flows for nurses are not concretely known. MZČR is trying to minimize the number of departing workers by increasing wages (through reimbursement). Between 2015 and 2020, nominal wages in health and social care together increased by 52% (reaching the gross monthly salary of CZK 41 076 per FTE), in comparison with average wage growth of 34% in Czechia (see section 3.7.2) (ČSÚ, 2021b). Additionally, in 2017, legislation was passed to simplify postgraduate training, shorten its length, limit required time in specialized centres and ease potential retraining of physicians in case of specialty shortages (Act no. 67/2017 Coll.). Stabilizing and developing human resources are also the goals stipulated in Health 2030 (MZČR, 2020a). According to a survey conducted in 2020, the most frequent reasons for students to consider completing their postgraduate training abroad are expected higher quality of training, higher salaries and negative experiences with the Czech health system (Šlegerová, Michenka & Kočí, 2020).

Even though a not insignificant share of medical school graduates leaves annually, there is an inflow of health workers (mainly from Slovakia and Ukraine, among other mostly eastern European countries). Between 2013 and 2018, the annual inflow of physicians ranged between 210 and 311, though it dropped to 105 in 2019 and 148 in 2020 (Eurostat, 2022). Nevertheless, there is no state-operated programme focused on recruiting health workers from abroad.

Recognition of professional qualifications for health professionals attained in other EU countries is in line with Directive 36/2005/EC. The qualifications of physicians, dentists and pharmacists are recognized by MZČR, according to Act no. 95/2004 Coll. Applicants seeking recognition in Czechia must produce a certificate of formal qualification and proof of Czech language knowledge to the extent necessary to perform the corresponding job. To obtain recognition for foreign qualifications, a non-EU candidate (physician, dentist or pharmacist) has to go through a two-stage process: first, the diploma must be recognized by a Czech university as valid and equivalent to a Czech diploma; and second, the candidate has to pass a professional examination in Czech (aprobační zkouška). Recognizing the professional qualifications of non-physician health workers is similar (Act no. 96/2004 Coll.)

4.2.4. Training of health personnel

Training of physicians

MŠMT is responsible for setting standards in educating and training aspiring physicians. University medical studies comprise six years of instruction; dentistry and pharmacy studies comprise five years. There are eight medical faculties where general medicine can be studied, as well as the Faculty of Military Health Sciences at the University of Defence. Dentistry can be studied at six of these faculties (including military dentistry). Additionally, there are two faculties fully devoted to pharmacy and a department focusing on pharmacy at the Faculty of Military Health Sciences.

To comply with European Directive 36/2005/EC, two Czech laws established conditions for obtaining and recognizing medical degrees and specialized postgraduate training for physicians and non-physician health workers alike. Medical graduates must complete a training programme in a medical specialty and pass the state licensing examination to be allowed to work independently (that is, without supervision) as a physician. The programmes are offered by a wide range of providers throughout the country, each of which must be accredited by MZČR.

Act no. 95/2004 Coll., as amended, defines 43 basic postgraduate medical specialties (specializační obory) in 19 fields (základní kmeny). Additionally, there are three basic postgraduate specialties for dentists and five for pharmacists. These specializations take three to five years to complete, depending on the specialty, and six years for cardiac surgery and neurosurgery.

All physicians, dentists and pharmacists are obliged by Act no. 95/2004 Coll. to participate in continuous, lifelong education. Planning and oversight of this lies primarily with employers (the self-employed must plan it themselves) – this also holds for all health professionals. Employers plan and can implement lifelong learning according to their real needs and practical requirements in order to improve the quality of care they provide. Most physicians participate in opportunities organized by the Czech Medical Chamber. As such, each physician must accumulate a certain number of points every five years through publishing activities or further education (such as seminars, workshops, symposia and congresses). The Czech Dental Chamber and the Czech Chamber of Pharmacists have similar requirements. No forms of formal relicensing are otherwise required.

Training of nurses and other non-physician health workers

MŠMT is also responsible for setting graduate education standards for non-physician health workers. MŠMT is responsible for creating content and approving and publishing framework educational programmes for secondary vocational education. MŠMT also accredits educational programmes of higher vocational education or higher education. MZČR, in agreement with MŠMT, sets the minimum requirements for educational or study programmes granting professional qualifications to non-physician health workers.

Act no. 96/2004 Coll., as amended, defines the conditions for acquiring and recognizing the competences of non-physician health workers. Based on the acquired training level, nurses can work as general or practical nurses. In short, to become a general nurse, one must attain a university degree or graduate from a higher vocational school in an appropriate field. This requires at least three years of study, or, alternatively, one year for those already practical nurses, midwives, paediatric nurses or paramedics (though this depends on the compatibility of previous education with general nursing programmes and can also take longer than a year). A practical nurse needs to graduate from a specialized high school. In the long run, this is expected to result in more nurses for inpatient care. Nurses may also pursue a further specialization by taking courses accredited by MZČR and passing the state licensing examination.

In reaction to the COVID-19 pandemic, Act no. 96/2004 Coll. was amended by Act no. 585/2020 Coll. to allow students of general medical to work as practical nurses after passing eight semesters of the study with the appropriate examinations.

4.2.5. Physicians’ career paths

Upon graduation, physicians in Czechia begin training for their chosen specialization in hospitals. Certain requirements exist for each specialization (length of training, rotations, number of procedures performed). Part of the training can (or in certain fields must) be done in outpatient settings. After passing the state licensing examination, physicians can pursue hospital or outpatient work. In outpatient care, physicians can either have an independent private practice or choose to be employed in a group practice. Independent private practice is by far the most common form of work for physicians in outpatient care in Czechia.

In hospitals, physicians can rise to senior physicians, assistant medical directors and medical directors. Larger health care facilities usually have some hierarchical structure and wards are directed by senior physicians (primář). In state-run facilities, there is a link between the years served and salary, as part of the salary is determined in a way similar to that for civil servants. Generally, there is no rule stating that those with more years of service should attain senior positions or earn more. In teaching hospitals, physicians may combine clinical duties with research activities. Apart from personal merit and ambition, promotions and career progressions are dependent either on superiors or institutional boards. For details on remuneration, see section 3.7.2.

4.2.6. Other health workers’ career paths