| Abstrakt: |
Introduction: The global change in our national health system affects the foundations of its regulatory base (a series of new health laws), the priorities of the health system, the principles of governance, the relationship between the different sectors of health. Placing the general practitioner (GP) at the base of the pyramid of the healthcare system defines him as the leading figure in healthcare as a whole. Aim: To analyze the activities and staffing of the medical personnel in primary outpatient care with the leading figure being the general practitioner (GP) in Bulgaria. Material and Methods: The object of observation is the Republic of Bulgaria and the statistically differentiated regions. The logical unit is the general practitioner (GP). The technical units are PОMC units. The study is retrospective over an 11-year period from 2011 to 2021 inclusive. Quantitative and qualitative indicators were used for the analysis. Variance, alternative and non-parametric analyses were used in the statistical treatment of the primary data collected. The statistical package SPSS version 19 and Microsoft Excel were used in the computer processing of the collected data. Results: Human resources in the health sector and in particular in primary outpatient medical care in Bulgaria are facing the following challenges - an aging population with negative natural growth, with a deepening imbalance in the territorial distribution and an aging workforce in the health sector, insufficient attractiveness for younger generations to certain medical specialties, uneven territorial distribution as a result of internal migration of the medical staff from smaller to larger settlements, migration to EU member states and other countries. Discussion: The decrease in the number of GPs and their uneven distribution over the years has its objective and subjective sides. Placing the GP at the base of the pyramid of the healthcare system defines him as a leading figure in healthcare as a whole. The success of the healthcare system depends to a large extent on his motivation for work, on his educational background and qualifications. The lack of financial incentives, including additional payment for a recognized specialty, an additional financial „bonus" when signing a contract with the National Health Insurance Fund, a higher price for an examination, etc., also determine the low motivation of some family physicians to complete their postgraduate training in general medicine and obtain the necessary specialty. The processes of internal migration of medical professionals, including doctors, from small to larger settlements follow the general trend in the country. Conclusion: Human resources are not subject to mechanical or mandatory territorial redistribution. A favorable environment, providing opportunities and incentives, activates in the medical professionals themselves (doctors and nurses) a desire to change the workplace and locality. [ABSTRACT FROM AUTHOR] |
