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Southern Europe rues exodus of doctors, nurses as coronavirus surges

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BARCELONA/ROME (Reuters) – Thirty-year-old Pep Iglesies emigrated to Canada from Spain in August for a new job that is much like his old one – taking care of coronavirus patients and working as a cardiologist.

“I am a big defender of Spain’s health system, but workers there are not treated well enough,” he said, explaining that he had felt professionally thwarted back at home.

Like Iglesies, thousands of doctors and nurses have left Spain in the past decade, exasperated by austerity cuts in the health system and seeking better pay and prospects abroad.

It is a similar story in Italy and Portugal, two other southern European nations that slashed budgets in response to the financial crisis and are paying the price as a second wave of coronavirus hits the continent and puts hospitals under enormous strain.

The pandemic hit Italy and Spain especially hard, with the two countries registering 47,217 and 42,039 deaths respectively. Portugal was largely spared in the spring, but now has record numbers of COVID patients filling intensive care units.

“Coronavirus has made the situation worse because the workload has increased significantly,” said Carlo Palermo, head of Italy’s ANAAO-ASSOMED doctors’ union.

In 2019, Spain had a shortage of more than 4,000 public doctors, according to a study by Las Palmas University requested by the Health Ministry.

It was expected to rise to around 7,000 in 2020 but the figure could be higher still due to the pandemic, said co-author Patricia Barber.

The CGIL union in Rome estimates that Italy needs an extra 15,000 specialist doctors.

Governments are hurriedly trying to fill the gaps, but it is proving difficult.


Italy is pushing medical students onto the frontline and trying to entice retired doctors back to the wards. The southern region of Campania advertised this month for 450 doctors and used state television to broadcast nationwide appeals for help.

It only received 165 applicants.

In Spain, the government has allowed regions – which manage healthcare – to temporarily hire some 10,000 additional health workers, mainly graduates and professionals from outside the European Union.

But while Barcelona’s Sant Pau Hospital has the budget to open new intensive care wards, it cannot find highly qualified people to staff them all.

“There’s not enough trained people and the existing ones are very tired,” said its medical director Xavier Borras.

Borras’ lament carries little weight with Lluis Enseñat, 35, who moved to France in 2017, where he works in the intensive care unit of a hospital in a Paris suburb. His 5,500-euro net monthly salary more than doubles what he earned in Barcelona.

“(The authorities) should not be moaning because these people left after they were offered crappy contracts,” he said.

Money is a major factor in many moves abroad.

Anna Dalmau, a 29-year-old family doctor in Barcelona, thinks she will leave next year, doubtful that conditions will improve despite a string of recent strikes aimed at putting pressure on the government.

“For me, it’s like a moral obligation to leave,” she said, adding that she had seen job offers in southern France that would more than double her 2,000-euro gross monthly wage.

Francesco Staltari, 29, from Calabria in southern Italy, emigrated to Germany in 2014 and works as a nurse in Hamburg.

The basic salary is at least 2,000 euros a month, before overtime and night bonuses, he said. At home, the average salary for a nurse is 1,400 euros, Italy’s Nursing Up union says.

“I would never go back to Italy,” said Staltari. “Here they offer you free training courses and in Germany we are generally very respected both socially and in the hospital.”


Even before the virus struck, Europe’s southern nations were short of nurses.

In a 2019 report, the Organisation for Economic Co-operation and Development said Italy and Spain had just 5.8 nurses per 1,000 inhabitants and Portugal 6.7 compared with 12.9 in Germany and an average of 8.8 amongst major industrialised nations.

The Nurses General Council in Madrid estimates that Spain needs as many as 150,000 nurses to come into line with the European Union average.

Between 2010 and 2019, close to 75,000 Spanish nurses were registered working in nine foreign countries, it said.

Antonio De Palma, the head of Nursing Up, said Italy needed about 60,000-65,000 nurses.

“The optimal ratio between nurses and beds should be 1-to-6. In Italy it has reached peaks of 1-to-17,” he said, denouncing some local health authorities for relying heavily on part-time workers who had no job security and were paid as little as 16 euros an hour.

Portugal’s Order of Nurses says some 18,000 Portuguese nurses work abroad, mostly in Britain.

Their importance to the British National Health Service was highlighted in April when Prime Minister Boris Johnson publicly thanked a Portuguese nurse for his care after he was hospitalized for COVID.

The Portuguese Order says 30,000 nurses are needed at home to help deal with the coronavirus crisis, but has warned about a spike in requests from other EU nations looking to attract their members, including from the Netherlands, which was offering bigger salaries, accommodation, transport and language courses.

“We cannot continue to buy ventilators and export nurses,” said Ana Cavaco, head of the order.

Additional reporting by Catarina Demony in Lisbon; Editing by Ingrid Melander, Crispian Balmer and Mike Collett-White

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