Reorganisation, migration overseas and qualification gaps: What is causing the shortage of medical personnel?

In early 2020, the World Health Organisation (WHO) stated that there is a shortage of healthcare workers worldwide due to low salaries and underinvestment in education and recruitment. This shortage negatively affects the sustainability of health systems and threatens the existence of health facilities.

Covid-19 and Russia's full-scale invasion of Ukraine have added to the ongoing problem of healthcare workforce shortages. As a result, the Ministry of Health of Ukraine predicts a global staff shortage by 2030.

Read more about the causes and consequences of the shortage of medical staff in Ukrainian hospitals in the article by Svidomi.

Currently, there is a shortage of medical staff across Ukraine. In the medical facilities of the Kharkiv region alone, 3220 vacancies remain unfilled. The greatest demand in the region is for anesthesiologists, orthopedists, and laboratory diagnostics specialists.

At the same time, there is a shortage of junior staff in hospitals, according to Serhii Kish, a representative of the press service of the regional military administration. 

"The shortage of doctors and junior medical staff is observed mainly in the de-occupied areas and regions near the borders and combat zones," Serhii Kish said.

Additionally, there is a shortage of doctors specialising in rehabilitation in the Kharkiv region. 

Viktor Liashko, Ukraine's Minister of Healthcare, said that the need for medical specialists varies from region to region, depending on the speciality. However, he noted a nationwide shortage of psychiatrists, clinical psychologists, physiotherapists, occupational therapists and speech therapists.

In response to a request from Svidomi, the Sumy regional military administration's health department reported that the region needs 238 doctors. The greatest shortage is in the following specialities: general practitioners of family medicine (21), surgeons (19), anesthesiologists (14), and neurologists (12).

The Mykolaiv Regional Health Department informed Svidomi about a shortage of doctors in the following specialities: therapists, family medicine doctors, surgeons, anesthesiologists, obstetricians-gynaecologists, paediatricians, and doctors specializing in physical and rehabilitation medicine.

The chief physician of Mykolaiv City Hospital No. 5, Olena Terentieva, told Svidomi that the staffing situation remains difficult but stable. The medical facility is staffed with nurses, junior medical, and technical personnel but lacks therapists for the emergency department, neurologists and radiologists.

Terentieva noted that the positions of specialists who were forced to leave the country due to the invasion or who joined the military are not being filled by new hires.

She also said that the hospital continued to operate even after Russian shelling on April 3. The medical facility was damaged, with the blast blowing out all the windows, but the doctors continued to treat the wounded.

"Our specialists are covering the workload, but there are still not enough of them. This increases the burden on the doctors who continue to work," Terentieva emphasised.

However, the chief physician added that the medical facility employs two psychologists to help staff cope with emotional exhaustion and burnout.

Meanwhile, in the Zaporizhzhia region, medical facilities have undergone optimisation. On May 6, 2024, the head of the Zaporizhzhia regional military administration, Ivan Fedorov, signed Order No. 262, "On the Termination of the Zaporizhzhia Regional Anti-Tumor Center as a Communal Non-Commercial Enterprise of the Zaporizhzhia Regional Council by Merging it with the Zaporizhzhia Regional Clinical Hospital of the Zaporizhzhia Regional Council."

On May 16, 2024, a petition was registered on the website of the President of Ukraine requesting the cancellation of the regional head's order, citing concerns about:

Over a two-month period, around 50 staff were dismissed or voluntarily resigned from the medical facility.

Mykhailo Yesaiants, director of the Zaporizhzhia Regional Anti-Tumour Centre, feared more resignations. He noted that in July, the dismissal commission issued another 14 dismissals to medical staff, including senior nurses from the surgical and chemotherapy departments, several surgical oncologists specialising in urology and dermatology, and anaesthetists who work in the operating theatres every day.

"People get a reprimand dated today and are dismissed on the same day. And the person had operations scheduled for tomorrow... We don't even know what to say to the patients who came specifically to see this doctor," said Yesaiants.

Despite the 25,000 signatures on the petition, on August 7, the head of the health department of the Zaporizhzhia regional military administration, Viktoriia Klymenko, announced that the regional oncology centre would be reorganised. She explained that this was necessary because of the low workload of doctors at the centre despite their high salaries.

In addition, the director of the Zaporizhzhia Regional Clinical Hospital, Ihor Shyshka, commented on the layoffs at the regional anti-tumour centre: 

"From May 8 to August 1, 49 or 51 people voluntarily resigned, and seven were dismissed for violating work discipline. On August 1, almost 370 workers were transferred to the Zaporizhzhia Regional Clinical Hospital. And there's no need to distort the facts — just because someone was dismissed doesn't mean that anyone was harmed. The dismissals were carried out in accordance with the law"

In an interview with the BBC, Viktor Liashko, Ukraine's Minister of Healthcare, said that during martial law, medical personnel would be subject to conscription. The exemption from mobilisation for medical personnel is conditional, meaning that it can be lifted for a particular doctor at the request of the Ukrainian Armed Forces.

However, Liashko noted that the Ministry of Health monitors the distribution of medical personnel between the army and the rear to ensure that medical facilities can continue to operate.

If so many specialists are withdrawn from a facility that it disrupts the treatment process, hospital directors can contact the Ministry of Health to oversee the redistribution of medical personnel.

Liashko mentioned that Ministry of Health staff are contacting recruitment centres, examining specific situations and proposing solutions that will allow medical units of the Ukrainian Armed Forces to remain combat-ready while providing quality care in civilian medical facilities.

"If our military sector suffers today, there won't be a civilian sector tomorrow. The country is at war," Liashko said.

To obtain an exemption for specialists, the heads of regional medical institutions submit lists to the military administration and, after approval, to the Ministry of Defence.

The global trend of declining numbers of nurses and health workers began during the coronavirus pandemic. The World Health Organisation (WHO) has designated 2020 as the Year of Nursing, highlighting the need to invest in the support, training and development of nurses.

Ukraine is also facing this problem. According to the Ministry of Health's Centre for Medical Statistics, in 201, there were 262,000 nurses and medical technicians in Ukraine, but by 2020 their number had fallen to 213,400.

With the onset of the full-scale invasion, many medical professionals went to the front, exacerbating the shortage of staff in Ukrainian hospitals. However, the Health Ministry's Centre for Nursing Development reports that 188,000 nurses and medical technicians remained at their posts across the country.

Lovitskyi noted that the outdated education system for mid-level medical personnel exacerbates the staffing problem. He pointed out the shortage of operating room nurses in surgery as an example. In colleges, nurses mainly receive basic knowledge and acquire specialisation through on-the-job training. There is no separate profession of operating room nurse in Ukraine, so the medical facility itself must invest time in training for this position.

"Introducing the speciality of 'operating room assistant' in medical schools and developing the profession of operating room nurse into a more specialised field would help solve the problem of shortage of qualified personnel," Lovitskyi emphasised.

In 2021, Vox Ukraine and the Nursing Development Centre of the Ministry of Health conducted a survey among nurses. Respondents noted that the content of their education does not meet the demands of the workplace and that the system of professional development is outdated and largely serves a formal function.

Lovitskyi noted that the shortage of qualified mid-level staff is most acute in surgery. Ongoing hostilities are increasing the number of complex surgeries with which Ukrainian doctors and medical staff have had little or no experience. All of these require well-trained operating room nurses.