In Šibenik-Knin County, no one has applied for a pediatrician position in a year and a half. The system is kept afloat by retirees, with consequences visible in vaccination rates and the burden on existing doctors.
Croatia is facing a serious shortage of pediatricians in primary health care, a problem particularly acute in Šibenik-Knin County. The county's Health Center currently has three pediatric practices without a lead doctor, and not a single application has been received for the advertised positions in over a year and a half.
Operations are only possible through the engagement of substitute staff and external collaborators, while permanent pediatricians are unavailable. According to data from the Croatian Health Insurance Fund (HZZO), one in seven pediatric teams nationwide lacks a lead doctor.
Petar Čagalj, director of the Šibenik-Knin County Health Center, told 24sata how the system is being kept on the brink of sustainability. "We keep the system going thanks to substitutes and retired doctors, but that's not a long-term solution," Čagalj emphasizes. In all three practices without a lead doctor, retired pediatricians are working, including one female doctor working part-time and one retired male pediatrician.
When retired pediatricians are not on shift and sick children come in, a large portion of the work falls on doctors who are not primarily pediatricians. "They do their best, but it's not the same as when a child is examined by a pediatric specialist," warns Čagalj. The consequences are already visible-in some communities, children are falling behind on vaccinations, which has prevented some from enrolling in kindergarten.
Čagalj believes the problem has been building for decades. "It's as if primary health care is slowly being extinguished. Both family medicine and pediatrics have been degraded in status and financially over the past 15 years. It's become a job few want to do. It's literally like mining," the director says.
Despite increases in pay, it still does not match the actual workload and level of responsibility. A pediatrician's monthly earnings are approximately 3,000 euros, and the Šibenik-Knin County and the City of Knin provide an additional net amount of about 1,000 euros. Despite this, staff cannot be found. "We haven't had a single application for a pediatrician in a year and a half. You can't hire a doctor who doesn't exist. You can only 'steal' one from another institution, but that doesn't solve the problem-it just deepens the shortage elsewhere," explains Čagalj.
According to the Atlas of Croatian Medicine, 240 pediatric specialists currently work in primary health care. Their average age is 53, and as many as 74 pediatricians-31 percent-are over 60. The system is short 108 pediatricians, also 31 percent of the total shortage. Currently, 66 doctors are in pediatric specialization.
The situation is worst in Sisak-Moslavina and Šibenik-Knin counties, with Međimurje County and the City of Zagreb also in poor shape. Pediatrician Dr. Ilonka Artuković, a member of the Croatian Medical Chamber's (HLK) Primary Health Care Committee responsible for pediatrics, points out that the system is largely kept running by doctors who have already retired.
"Many colleagues from retirement are still working. That's actually the best option when a doctor stays in the practice where they worked because patients maintain continuity of care," Dr. Artuković told 24sata.
The biggest problem is practices with no permanent lead doctor at all. "That's by far the worst form of health care. Children are then seen by different doctors who rotate, and in pediatrics, continuity is extremely important. You need to know the child, track their development, know the parents, and build a relationship of trust," emphasizes Dr. Artuković.
She adds that pediatrics is not just about treating illness. "Parents need advice on nutrition, rational antibiotic use, monitoring a child's growth and development, and guidance through different stages of growing up. All of that is missing when a practice has no doctor. I know what it's like when I cover for colleagues," she says. As a result, parents often bypass such practices and seek help elsewhere, further increasing the burden on pediatricians who already have too many patients. Dr. Artuković has 1,250 patients in her practice, although the official standard is 950 children per team.
She views positively the fact that the Ministry of Health has started announcing specializations again. "For four to five years, specializations in primary health care were hardly announced at all, but now things have started moving. The minister has established a working group for improving primary health care, with representatives from all professional societies. We meet regularly and propose solutions, and pediatric specializations have been re-announced," says Dr. Artuković.
However, she warns that it will be years before new specialists start working. "Specialization takes several years, and in the meantime, our new doctors are retiring. That's why we need careful planning and continuous announcements of a sufficient number of specializations," she adds.
She cites the City of Velika Gorica as a good example, offering a monthly support of 1,200 euros this year to every pediatrician working full-time at the Health Center. "Such practice has proven effective and should be expanded," concludes Dr. Artuković.
