Medical university leaderships generally support the idea put forward by Prime Minister Ilie Bolojan regarding the obligation for graduates trained on state funds and doctors who have completed state-funded residency programs to work for a period in Romania. However, rectors warn that such a measure must be built on solid legal grounds, with flexible mechanisms and respect for fundamental rights.
The topic was revisited by the Prime Minister in the context of discussions about the personnel crisis in the healthcare system and public investment in medical training.
"A mechanism of reciprocity," not a restriction of rights
The Rector of the University of Medicine, Pharmacy, Sciences, and Technology "George Emil Palade" in Târgu Mureș, Leonard Azamfirei, stated to Edupedu.ro that the discussion should be held in the logic of reciprocity between the state and graduates, given that medical education is funded by public money.
"We need to talk about a mechanism of reciprocity when medical education is funded by public money," he said. In his opinion, the issue is not just about the number of graduates, but especially about their distribution across the country and the attractiveness of the system for young doctors.
Major imbalances in the system: urban vs. rural
Romania annually produces a large number of medical graduates, but a significant portion are international students who do not stay in the country. At the same time, there are major imbalances: family medicine represents about one-fifth of all doctors, and over 90% of them practice in urban areas.
"We have a major discrepancy that requires a long-term solution, which is primarily political and only then administrative," explained the rector from Târgu Mureș, emphasizing that the real issue is the unequal distribution of human resources.
Contract upon entering residency and buyback option
Azamfirei believes that Ilie Bolojan's proposal could be seen as a way to recover the state's investment and as a solution to cover deficits in certain areas or specialties. However, the measure should be configured as a service commitment, not as a restriction on professional mobility.
"The proposal can be discussed as a form of recovering public investment and correcting a territorial deficit if we can design it as a service commitment rather than an arbitrary restriction on mobility," the rector specified.
In his view, a more realistic approach would be a contract signed upon entering residency, "legally robust," which should prioritize allocation to deficient areas and specialties and include a proportional buyback option.
Constitutional risks
The rector warns that a strict obligation without real alternatives could raise constitutional issues.
"An imperative obligation to work in the country without a real alternative is vulnerable because it touches upon the freedom to choose a workplace and the right to free movement. It should be very clearly analyzed in terms of necessity and proportionality," he emphasized.
In his view, the model should be contractual, applied without discrimination, possibly accompanied by incentives and clearly defined exceptions.
The obligation must be accompanied by concrete support
For such a policy to work, a real support package for young doctors is essential: actual positions, adequate infrastructure, housing, transportation, mentoring, and a clear career path.
"There must be a mandatory support package with real positions, reasonable infrastructure, housing, transportation, mentoring, and career path, so that this obligation does not become counterproductive," the rector cautioned.
Support for the idea also from Cluj
A similar position was expressed by the Rector of the University of Medicine and Pharmacy in Cluj-Napoca, Anca Buzoianu, who stated that the Prime Minister's idea is legitimate and deserves serious discussion, with clear and applicable rules.
"We are not just talking about budgets, but also about real patient access to medical services, especially in areas where the deficit is already critical. Therefore, a minimum period of practice in Romania after a state-funded educational path can be a fair solution, provided it is accompanied by measures that make this obligation realistic and equitable," she said.
College of Physicians: obligation can only exist where there is a position
The President of the College of Physicians in Romania, Prof. Dr. Cătălina Poiană, explained to News.ro that situations need to be nuanced and that there are already cases where a doctor could have a moral and professional obligation to remain in the system.
She refers to residents who have obtained a position in a hospital through a competition, a position that is blocked for the duration of their five-year residency.
After completing the training, "perhaps that doctor should work for a while in that hospital that held the position for him during that time," believes the CMR president.
Regarding the distribution of doctors in rural areas or small towns, Cătălina Poiană emphasizes that the issue cannot be solved through obligation but through real working conditions: adequate infrastructure, multidisciplinary teams, and proper payment for on-call duties.
Response from the diaspora: "Why only doctors?"
Prime Minister Ilie Bolojan recently reiterated the idea that doctors trained on public funds should work "at least a few years" in Romania, arguing that the state needs to recover its investment and that there is a need for personnel in the country's hospitals.
However, the proposal was criticized by doctors in the diaspora. "If state-funded medical graduates who become specialists should be 'obliged' to work for the state, then the state should also compel other professions whose studies are funded by the state to do the same," said Dr. Alma Stancu, a medical oncologist at the Institut du Cancer Sainte-Catherine Avignon, Provence.
Her argument shifts the discussion to a principle: if public investment justifies a professional obligation, then the rule should be uniformly applied to all fields funded by public money.
Anesthesiologist Dr. Iuliu Torje, practicing in Germany, stated that the idea of obligation is "a symptom of a state that no longer knows how to convince and tries to constrain". He summarized his position as follows: "The state offers → the professional stays. The state fails → the professional leaves."