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There are no clearly defined salaries and good working conditions for medical professionals. This opinion was expressed by the medical assistant and secretary general of the Bulgarian Union of Medical Assistants and paramedics Hristo Ivanov and the paramedic and deputy chairman of the Union Galina Zaharieva.

“From 8,500 paramedics, we have melted down to 2,000. Two thirds work in the Emergency Medical Centers," Zaharieva said. She explained that the production of such cadres was stopped in 1999, and then the training of paramedics was restored in 2014. However, Zaharieva believes that it would be very difficult to quickly recover the lost cadres, because their education takes four years, and those who want it are not many due to the lack of realization in the future.

Ivanov discovered the problem of pay. "We don't get enough pay for the work we do," he said. The expert said that he had to work in several places because of the shortage of staff.

There is no single strategy for health care. No one knows exactly how it will be realized after finishing and what forms of professional growth there will be. That is why colleagues are fleeing outside," says Galina Zaharieva. According to her, the shortage of medical personnel is global and about two million medical specialists are in demand in Europe alone.

You can watch the full participation of the Vice-President and the Secretary-General of UCLAF via the button below.

Nova News

The Rector of MU-Pleven Prof. Dr. Dobromir Dimitrov, in his capacity as Chairman of the Association of Medical Universities in Bulgaria, initiated on March 10 the first meeting-discussion to discuss the problems in the admission and education of students in the specialties in the field of Health Care. Emphasis was placed on the need to increase the prestige and attractiveness of the professions "Nurse", "Midwife", "Assistant Pharmacist", "Medical Assistant".

Alexander Alexandrov, Chairman of the Bulgarian Union of Medical Assistants and Paramedics (BULAF) and Galina Zaharieva, Deputy Chairman of BULAF, spoke about the problems and professional challenges in the field in Our Day.

Zaharieva states: "The shortage of staff is a global problem – it is not only in Bulgaria. In 2021, there was a deficit of about 2 million medical professionals in European health care. The lack of medical professionals outside the country is the reason many of ours leave and go there, as there are better working conditions.

According to the Deputy Chairman of BULAF, there are many problems in Bulgaria, some of which are related to education – insufficient investment in the training of specialists, constant change in curricula and educational programmes, the professional status of trainees, changes in the time for obtaining a degree.

Alexandrov points out that before the reforms, paramedics covered small settlements and remote areas well. The healthcare system was saturated with quality, qualified healthcare personnel in the face of paramedics. After 2000, when the new system came into operation, the offices of general practitioners were established to replace paramedics. According to the Bulgarian legislation, healthcare should be equal and on one level everywhere, so the rule has been introduced that people must be examined by doctors instead of paramedics (medical assistants). According to Alexandrov, the problem is that doctors prefer to stay in the city and so a large number of people do not receive medical care – a serious gap in healthcare.

Six universities currently train medical assistants. Unfortunately, there are few, but there is an interest in the profession. We already have talks with the Association of Rectors to increase the number and number of universities, because it turned out that in the central part of Northern Bulgaria there is no university to train such staff and their deficit in the medical institutions in this region is tangible. There remains the problem of the attractiveness of the profession in terms of subsequent realization", says Zaharieva.

Today, the paramedic is equated to a doctor's assistant. Legally, the paramedic enjoys the rights of a doctor's assistant, but the doctor's assistant does not have the rights yet. The paradox is due to regulatory turmoil, in Zaharieva’s words, which gives the example of the Ordinance on the establishment of death, according to which paramedics have the right to issue a report of death, but medical assistants do not, as they do not appear there.

European society is ageing, which leads to the need for long-term treatment of a number of patients, Zaharieva emphasizes. However, for doctors, this type of activity is not attractive – they are interested in the active phase of treatment. That is why in almost all areas of healthcare, medical assistants can be introduced to engage in routine medical practices and facilitate the work of doctors in hospitals.

Alexandrov adds that the lost connection between the general practitioner and the hospital can be made precisely by the medical assistants.

Currently, medical assistants are the main unit in the emergency medical centers and cannot be replaced by paramedics due to the specifics of the Bulgarian emergency system, Alexandrov believes.

"The medical assistant, going to one address in a sick person, performs a wide volume of medical activities that replace to some extent the activity of the general practitioner. This assistant can take the patient with an ambulance for treatment in a hospital, but can provide appropriate medical care on the spot, give medicine at home. In the West, the paramedic takes the patient to the ambulance and transports him to the hospital in any case," Aleksandrov said.

The full participation of Alexander Alexandrov and Galina Zaharieva can be heard on the sound file via the button below:

BNR

You can read the whole post in Clinic.bg via the button below.

Clinica.bg

A working group will propose changes in their training and work

At this stage, the duration of the training of nurses and midwives will not be reduced, an idea against which all interested professional organisations have expressed their opposition. The reason is that the line ministers did not support the proposal for 3+2 years of undergraduate training of nurses.

This became clear from the words of the President of the Association of Medical Universities in Bulgaria, Prof. Dobromir Dimitrov, Rector of the Medical University of Pleven, during a meeting he organised on the problems of health care professionals.

Prof. Dimitrov proposed to work towards updating the Unified State Requirements and updating the curricula of the health care specialties. In addition, Prof. Dobromir Dimitrov stressed that not enough is being done to introduce high technologies in the training of health professionals, as is the case for doctors - there is no training through virtual and augmented reality, as well as sufficient simulation training before entering clinical practice.

There are two major groups of problems related to health care professionals in Bulgaria. The first unites the problems in their training and the second - the problems related to their detention in Bulgaria. The participants in the meeting united around this conclusion.

It was attended by representatives of all interested professional organizations: The Bulgarian Association of Health Care Professionals (BAHCP), the Bulgarian Association of Assistant Pharmacists (BAPF), the Bulgarian Union of Medical Assistants and Paramedics (BSLAF). On the part of the medical universities, members of the management and faculties of public health participated in the meeting, as well as members of the academic staff of the departments that train students in the field of health care, the Medical University of Pleven informed.

The participants decided to set up a working group within one month, including representatives from each of the professional organisations present, as well as from the Bulgarian Medical Association, one representative from each specialty in the field of health care of higher education institutions, as well as from university and municipal hospitals as employers. Within two months, the working group will make proposals to the line ministries for changes in terms of both university training of health professionals and employers in the healthcare system.

At the meeting, it was also decided to develop a unified strategy for the development of the Health Care strand and, in terms of communication, to join efforts in a nationwide information campaign that would increase the interest of young people in the professions of health care professionals.

Respect on the part of society and colleagues, opportunities for professional and academic growth, defining a clear program for forming a starting salary and gradually increasing wages, maintaining a high quality of education, unifying the criteria for admission of students in the specialties of the Health Care Department in the higher education institutions that offer them. These are the key factors for the satisfaction of health care professionals, summarized during the meeting the Chairwoman of BAPZG Milka Vasileva.

The Chairwoman of BAPF, Lilyana Petrova, presented several problems related to the motivation and realization of the assistant pharmacists in Bulgaria, as well as the need for synchronization of the Bulgarian legislation with the European practices and international standards.

Alexander Alexandrov, Chairman of the Bulgarian Medical Association, presented the opportunities offered by the profession of medical assistant. These medical professionals diagnose, treat common diseases and can prescribe medications. It was recalled that even now a large part of the emergency workers are medical assistants and paramedics. According to BSLAF, with the more active integration of medical assistants in the healthcare system, many of the problems with the personnel crisis in outpatient care can be solved in the short term within a few years. In this regard, attention was drawn to the urgent need to increase the number of students in this specialty, especially in Northern Bulgaria. The representatives of BSLAF suggested that the profession of medical assistant should also be protected.

You can read the post on Zdrave.net via the button below.

Zdrave.net

The Rector of MU-Pleven, Prof. Dr. Dobromir Dimitrov, in his capacity as President of the Association of Medical Universities in Bulgaria, initiated the first discussion meeting on 10 March 2025 to discuss the problems in the admission and training of students in the field of health care. Emphasis was also placed on the need to increase the prestige and attractiveness of the professions of nurse, midwife, assistant pharmacist, medical assistant, etc. The meeting was attended by members of the management boards of the Bulgarian Association of Health Care Professionals, the Bulgarian Association of Assistant Pharmacists and the Bulgarian Union of Medical Assistants and Doctors - Milka Vasileva, Chairperson of BAPZG, Lilyana Petrova, Chairperson of BAPF, Alexander Alexandrov, Chairperson of BASLAF, as well as the Chairperson of the Regional Board of BAPZG Nadia Dimitrova and others. On the part of the medical universities, online members of the management and faculties of public health attended or participated in the meeting, as well as members of the academic staff of the departments that train students in the field of health care - Prof. Todorka Kostadinova, Director of the Accreditation, Quality and Project Activity Directorate, Prof. Teodora Dimitrova and Prof. Silvia Borisova, Dean and Deputy Dean of the Faculty of Public Health at MU-Varna, Prof. Sonia Toncheva, Deputy Director of the Branch of Shumen at MU-Varna, Prof. Mariela Kamburova and Prof. Makreta Draganova, Deputy Deans of the Faculty of Public Health at MU-Pleven, Prof. Alexandrina Vodenicharova, Dean of the Faculty of Public Health at MU-Sofia, Assoc. Dr. Stanislavaza Harinova, Deputy Dean of the Faculty of Public Health and Public Health at MU-Sofia. Maria Bozhkova, Director of Medical College at MU-Plovdiv.

The aim of the meeting was to discuss all problems related to the training, academic development and professional realization of health care professionals in order to unite the efforts of stakeholders to find workable solutions and increase the interest of young people in these specialties.

The Rector of MU-Pleven Prof. Dobromir Dimitrov presented to the participants in the meeting the chronology of the events that led to the escalation of tensions in the professional guild of health professionals. He assured them that the duration of the training would not be reduced at this stage, as the line ministers did not support the proposal for 3+2 years of undergraduate training for nurses. He proposed to work in the direction of updating the Unified State Requirements and updating the curricula of the specialties of the Health Care Department. In addition, Prof. Dobromir Dimitrov stressed that not enough is being done to introduce high technologies in the training of health professionals, as is the case for doctors - there is no training through virtual and augmented reality, as well as sufficient simulation training before entering clinical practice.

Milka Vassileva, Chairman of BFPA, summarized the key factors for satisfaction of health care professionals: respect on the part of society and colleagues, opportunities for professional and academic growth, the definition of a clear program for the formation of a starting salary and a step-by-step increase in wages, the maintenance of a high quality of training, the unification of the criteria for admission of students to the specialties of the Health Care Department in the higher education institutions offering them.

Lilyana Petrova, Chairman of BAPF, presented several problems related to the motivation and realization of assistant pharmacists in Bulgaria, as well as the need for synchronization of Bulgarian legislation with European practices and international standards.

Alexander Alexandrov, Chairman of the Bulgarian Medical Association, presented the opportunities offered by the profession of medical assistant. These medical professionals diagnose, treat common diseases and can prescribe medications. It was recalled that even now a large part of the emergency workers are medical assistants and paramedics. According to BSLAF, with the more active integration of medical assistants in the healthcare system, many of the problems with the personnel crisis in outpatient care can be solved in the short term within a few years. In this regard, attention was drawn to the urgent need to increase the number of students in this specialty, especially in Northern Bulgaria. The representatives of BSLAF suggested that the profession of medical assistant should also be protected.

The participants in the meeting agreed on the conclusion that there are two large groups of problems - the first group unites the problems in training and the second - the problems related to the retention of health professionals by employers in Bulgaria. They decided to set up a working group within one month, including representatives from each of the professional organisations present, as well as from the Bulgarian Medical Association, one representative from each specialty in the field of health care of higher education institutions, as well as from university and municipal hospitals as employers. Within two months the working group to come forward with proposals to the line ministries for changes in terms of both university training of health professionals and employers in the healthcare system. Develop a unified strategy for the development of the Health Care strand. In terms of communication, join efforts in a nationwide information campaign that will increase the interest of young people in the professions of health care professionals.

You can read the press release of MU-Pleven on the website of BTA (Official Acts and Communications) via the button below.

BTA

Alexander Alexandrov, Chairman of the Board of Directors of BULFA, in front of Stoycho Stoychev, in a Saturday edition of ‘For Health’:

My colleagues and members of our professional organization can successfully perform basic medical activities and work in practices unattractive to doctors - in urgency, in remote and hard-to-reach areas.

This would solve the big problem of access to health care and the existing imbalances.

Alexandrov presented the organization and outlined the most important tasks ahead of it.  Feldshers, who already have the status of medical assistants, are trained to work both on emergencies and to perform the functions of diagnosis, treatment and prevention.

All participation can be listened to via the button below.

BNR

Paramedics ready to get involved as medical professionals in schools

The proposal is based on information about the previous two school years

Against the backdrop of the flu wave and forced holidays, paramedics are ready to help the education system and get involved as medical professionals in the offices in schools. The problem in the system goes back a long time. On the one hand, there is a shortage of nurses to examine children at school, and on the other hand, the current Ordinance 3 limits their opportunities in emergency situations.

The proposal of the paramedics is based on information about the previous two school years, covering the whole country. On an annual basis, about 300 visits are registered in a school with about 1000 students in the health office.

In 1 in 10 cases, the student seeks help because of a wound. Eight times more visits to the office with complaints such as headaches, fever, abdominal pain, rash or insect bites.

The medical specialist does not have the power to act, accordingly, he must call emergency care and parents - in only 1% of all incidents at school.

Just till 3:00 p.m. through the medical office at 107. The Khan Krum Primary School in Sofia has more than 20 pupils. In case of such complaints, Desislava Tsenova calls a parent and a GP and sends the child home. But there is no shortage of more serious situations in which he turns to 112.

“Last week there was a case of a child with a nut allergy. She had eaten a chocolate candy, in which she had, respectively, an allergic reaction. I really have my hands tied and I can't give him medicine because I don't have the right by law, even though I've been trained. I had to call the mother and 112 to do what I could do in three minutes," the doctor said.

The reason – although he is a medical assistant and can work alongside doctors in a hospital, in school he can only be a medical professional, without the right to apply his skills in an emergency situation. Before she was recruited, 107th School was looking for a man for the position for eight months. “We had an associate military doctor re-appointed as a medical specialist. The man was 81 years old. There are no such specialists willing, extremely low pay, humiliating, I would say," said Director Danko Calapis.

The City Council, however, countered. “There is no shortage. The increased salaries start at BGN 1 890 for medical professionals,” said Ivan Vassilev, Deputy Mayor of Sofia responsible for Finance and Health.

But schools with fewer than 800 students, such as the threshold for hiring a full-time health professional, are in a stalemate. There is someone to examine students with complaints only four hours a day or every other day.

The Union of Paramedics offered help. “We already have over 3000 graduates of paramedics in Bulgaria, many of them would be happy to help. They provide sports events in which children participate, provide mass concerts and other cultural events. I do not know that in Bulgaria anyone is better prepared than paramedic for first aid", said the President of the Union of Paramedics in Bulgaria Iva Pehlivanska.

The response in schools: ‘Paramedics in Bulgaria are trained in a course of 900 hours

They can, in case he has a broken leg, immobilize it and transport it to the nearest medical institution. But I do not agree that medical care can be carried out by them,” said Calapis.

"They could replace a completely missing medical person in the school", added the medical assistant by profession Desislava Tsenova.

The position of the Ministry of Health: ‘In order to extend the scope of medical professionals who can examine children at school or to extend their rights to react in an emergency situation, the current Ordinance 3 needs to be revised.’

In a position to NOVA, the ministry said that such changes are already on the agenda, but are being agreed between the institutions and will still be subject to public discussion.

You can watch the NOVA TV report via the button below.

NOVA

Lack of staff and aging staff reported by the Emergency Services Centers

Lack of staff and aging staff are reported by the emergency centers in the country. The vacancies in the emergency centers in all 27 districts are nearly 750, with the most vacancies in emergency services in Sofia, Plovdiv, Pleven and Burgas. A crisis with the cadres is also reported in the Center for Emergency Care in Blagoevgrad.

How do they deal with the available footage there?

About 30% are the vacancies in the Center for Emergency Medical Care in Blagoevgrad. Eleven medics are in demand in the whole region, with the largest shortage in the branches in Sandanski, Razlog and the regional center.

Dr Hristo Atanasov – Head of Emergency Branch – Blagoevgrad: Advertisements are constantly given in the relevant places, they are searched for as in the past in our branch in Blagoevgrad, but this shortage of medics is observed, despite the fact that the conditions offered by the emergency centers are quite good.

Dr. Svetlana Kitanova - Medic inCSMP – Blagoevgrad: Everywhere there is a shortage of doctors, nurses, everything. I explain this to myself by the fact that young people are not sufficiently motivated, financially motivated.

51 years is the average age of the personnel in the emergency centers in the region. Most disturbing is the picture of paramedics, where the average age is currently about 60 years old.

Dr Krasimir Mihaylov, Director of the Blagoevgrad Center for the Study of Democracy: "The problem with the cadres is very serious in the CSMP - Blagoevgrad. The problem is the ageing of the staff, especially in the case of paramedics, who have been in the emergency care system for many years. Currently, most of them are in retirement age, and at the moment those who replace them are medical assistants.

A long-term solution to the problem of emergency personnel is not visible at least for the time being.

Dr. Krasimir Mihaylov - Director ofCSMP – Blagoevgrad: Paramedics cannot solve the problem with regard to the personnel in the CSMP system. They can be assistants and help in the work of the teams, but they can not replace either doctors or paramedics.

Another big problem that the medics in Blagoevgrad report are the frequent signals that are not urgently needed. However, the teams are also obliged to provide assistance, as they are sent on alert.

Dr. Svetlana Kitanova - Medic inCSMP – Blagoevgrad: "I give this really as an example, because it is the freshest, for a woman who is presented on the phone as having a heart attack with many diseases and is currently suffering from very severe pain and shortness of breath, and the moment we go. The RE-team goes and the woman with her luggage is waiting for us in front of her home with her son and she just wanted us to take her to the emergency room.

Wage increases and other types of material stimulation. These are the main things that would attract young medics to smaller cities in the country, the medics add.

You can watch the BNT report via the button below.

BNT

Neglected health professions push for new standards

The problems were raised in the years many times, noted Alexander Alexandrov

Representatives of several health professions, including nurses, midwives, rehabilitators, laboratory technicians, medical assistants and assistant pharmacists, advocated clear rules and standards to work on.

These problems have been raised many times over the years. The problems have long been unresolved and now it is high time to pay attention because we are really in a difficult situation in healthcare, in crisis", said the Chairman of the Union of Medical Assistants and Paramedics in Bulgaria Alexander Alexandrov in the studio of "Bulgaria in the Morning".

The main problem is the lack of appropriate rules and standards for nurses, medical assistants and other health professionals to be recognised and regulated. These professionals play a key role in healthcare and are often at the forefront of helping patients.

Aleksandrov pointed out on the air of Bulgaria ON AIR that at the moment a large part of the medical staff does not stay in Bulgaria, and the reasons are not only financial, but also related to the working conditions and the lack of opportunities for professional development.

He stressed that legislation and regulations need to be changed, taking into account the views of these professionals already when creating new rules.

You can watch the video of the whole interview of the Chairman of BULAF via the button below.

Bulgaria On Air

You can read the full interview of the Chairman of BSLAF on the website of Clinica.bg via the button below.

Clinica.bg