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‘Patients here are much more assertive. That took some getting used to’: foreign doctor about working in Belgium

In the past decade, the number of foreign doctors practicing in Belgium has doubled, raising concerns among experts. nonetheless, the perspective of the doctors themselves provides valuable insight into this trend. Olena Zemtsova, a Ukrainian gynecologist who moved to Belgium twenty years ago, highlights the challenges she faced in adapting to the Belgian healthcare system, including language differences and patient interaction. Zemtsova, along with over 10,000 other doctors with foreign diplomas, now plays an integral role in Belgian healthcare. The reasons for their migration to Belgium vary, including employment opportunities and a shortage of healthcare professionals in the country. Romania has become a major source of doctors for Belgium, and other countries like Poland, Portugal, Italy, and Congo also contribute to the foreign medical workforce. nonetheless, concerns exist regarding the quality of the medical education and language proficiency of these foreign doctors. Language barriers, in particular, are problematic, with patients sometimes unable to communicate with their doctors in their preferred language. Efforts are being made to address these issues, such as language requirements for doctors’ visas and increased quotas for medical training. Balancing the need for foreign doctors with ensuring the quality of healthcare remains a complex challenge for Belgium.

In ten years time the number of foreign doctors in our country doubled. A worrying trend according to experts, but how do the doctors themselves view it? “Whoever speaks Russian comes to visit me. From Bruges to Durbuy.’

Jorn Auction

Long before the war, about twenty years ago, the Ukrainian gynecologist Olena Zemtsova (45) moved to Belgium. As a doctor, she not only had to learn the language and the health system, but especially the other ways of interacting with Belgian patients. “In Ukraine, the doctor determines the policy. Here there is more interaction, and the patients are much more vocal. That took some getting used to.”

As a Ukrainian, who now also has Belgian nationality, she sees many Ukrainian, Russian and other Russian-speaking patients in addition to Belgian patients. “They come to visit me from Bruges to Durbuy and even the Netherlands. They really enjoy being helped in their own language.”

Zemtsova is one of the 10,071 doctors who are active in our country with a foreign diploma, figures from the Organization for European Economic Cooperation (OECD) learn. That is twice as many as ten years ago. Foreign doctors therefore occupy an increasingly large part of our medical corps. In 2000, 4 percent of doctors were foreign, today that is already 14 percent.

The reasons for moving to Belgium can be very diverse. There are hospitals that hire their own doctors because of their specific expertise. There are doctors who leave their home country for love, because the situation in their country is unfavorable, or simply because they see better career opportunities in Belgium. “It is of course also known abroad that we have a shortage of healthcare personnel in Belgium,” says professor of general practice Dirk Devroey (UZ Brussel). “For example, foreign nurses have been transferred to Belgium for years, for example to residential care centers. Now you also see that more and more doctors are coming to Belgium.”

Romania is one of the main suppliers. Partly because there is no entrance exam for medical training in Romania, year after year too many doctors graduate for the number of places available. Our country now has 1,558 Romanian doctors – only the French (1,620) and Dutch doctors (1,590) in our country are even more numerous. More and more doctors are also coming from other Eastern European countries such as Poland, Southern European countries such as Portugal or Italy, and African countries such as Congo.

Language problems

Anyone from outside the EU who wants to work as a doctor in Belgium must apply for recognition of the foreign diploma. Those who come from another European country can immediately start working here as a doctor. “nonetheless, we unfortunately have to conclude that the quality of those doctors depends very much on the university where they attended,” says Devroey. “Before Romania joined the European Union (in 2007, JL) a Romanian diploma in medicine gave access to the third bachelor with us. Now, like other Europeans, they can immediately start as doctors. And because there is such a shortage at some practices, they are immediately called in. That is a worrying trend.”

According to Devroey, not only the medical training of the students sometimes leaves much to be desired. He mainly sees that many foreign doctors do not know the health system sufficiently and do not speak the language. “Especially in the Brussels periphery, we see more and more doctors who do not speak Dutch or French. It cannot be the intention that as a patient you can no longer go to the doctor in your own national language.”

Olena Zemtsova knows only too well how much it takes to work as a healthcare provider in another country. Although she had already graduated in Ukraine, she had to join medicine in Belgium in her penultimate year. She also took a crash course in Dutch for a year to pass the compulsory language tests that apply to entrants from countries outside the EU. With the specialization years added, she would still be at school in our country for another ten years. “I would have felt very uncomfortable as a doctor if I could get started right away,” she says. “Not only learning the language requires a lot of effort. You also have to learn how to request examinations, how to arrange all administration with the health insurance companies and the RIZIV. You need some time to master all those things.”

Minister of Health Frank Vandenbroucke (Vooruit) is preparing a ‘conclusive’ bill that stipulates that doctors must demonstrate their knowledge of Dutch, French or German in order to obtain a doctor’s visa. Healthcare providers who do not meet the requirements would lose their accreditation.

Increase quota

Yet the discussion is about more than language knowledge. Under Vandenbroucke, the quotas for starting medical training were increased for the second year in a row. Nevertheless, the situation remains that every year Belgian students cannot start their training, while no quotas apply to foreign doctors. “Very sour for students who pass the entrance exam, but are not among the first 1,600,” says Devroey. “I think it is important to increase the quotas more quickly.”

The question is whether that is also feasible. Piet Hoebeke, dean of the Faculty of Medicine and Health Sciences at Ghent University, points out that the quota increase is already causing headaches. “We now have 500 students from the first bachelor’s degree, while we were always organized at 350. If those quotas go up further, more government support will also have to be provided. Because we have to guarantee that we can provide quality training.”

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