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NOVA NEWS, ‘Social network’: Crisis with medical staff – medical assistants and paramedics can ‘cover’ small settlements

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.

The Media About Us BUPAF

BNR, Hristo Botev Programme: Medical assistants: paradoxes, deficits, potential

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:

Message BUPAF

Letter of thanks

The Management Board of the Bulgarian Union of Medical Assistants and Paramedics (BSLAF) expresses its gratitude and sincere gratitude to the owners, management and team of Glavbolgarstroy Holding AD.

At an important moment for BSLAF, they supported us and provided grants to the organization. This gave us the opportunity to use representative office premises, which use not only the Union, but also two regional colleges.

We thank them for being real and dignified people, whom we can call our friends and supporters of our cause for a prosperous profession of ‘Medical Assistant’ and a prosperous Bulgarian Union of Medical Assistants and Paramedics.

We wish them to be healthy and still human!

 

 

Publications BUPAF

DISCERTATION for the award of an educational and scientific degree ‘Doctor’ to Assoc. Penka Vracheva

The professions of ‘medical paramedic’ and ‘medical assistant’ in Bulgaria – historical development, up-to-date training and realisation

 

The main goal of the higher medical schools in Bulgaria today is the training of highly qualified, motivated and competitive specialists with competence suggesting successful realization in the health system.
Ensuring quality human resources in the field of healthcare is a complex and responsible challenge. It is addressed by factors such as training and specialization in accordance with new standards and technologies, advances in medical science and innovation, long-term planning tailored to the needs of society and the labour market.
The World Health Organization (WHO) defines health workforce shortages and uneven distribution. It forecasts a deepening of the problem in response to migration and demographic processes.
"The most critical problem facing health systems in the world is the shortage of people working in these systems" WHO.
Bulgaria is no exception to the global trend. Democracy, the country's membership in the European Union, the opening of borders for the transfer of professionals have opened new horizons for the professional realization of health professionals. At the same time, unresolved problems over the years such as:
Insufficient investment in education;
Difficulties in the opportunities for specialization of staff;
➢inadequate responsibilities and disincentives professionals to work remuneration;
insufficient financing of healthcare facilities with consequent difficulties and problems of the working environment;
➢ Absence of targeted state policy in the field of human resource management in healthcare
have become a reason for Bulgarian medical specialists to migrate and look for other opportunities for realization and career development.

Publications BUPAF

International experience in the development of the profession of Medical Assistant

The World Health Organization (WHO) defines health workforce shortages and uneven distribution as a global phenomenon. Addressing these shortages requires a multilateral strategy. Part of it is the introduction of a new type of health profession, the ‘Medical Assistant’.
The review follows the emergence and development of the profession of Medical Assistant in some European countries, the United States and Canada. Presents the successful realization of the staff as a professional and economically profitable model of medical staff.
In recent years, many European countries – the Netherlands, Germany, the UK, including Bulgaria – have been training medical assistants. The profession has been practiced in India since 2009, in Australia - 2010, South Africa, Afghanistan, Saudi Arabia, New Zealand. Countries such as Belgium, Switzerland, France, Spain, Japan, Singapore, Ukraine, Moldova, Romania, Latvia, Estonia are also interested to varying degrees.
It can reasonably be argued that ‘Medical Assistant’ is a profession in the process of globalisation, with good prospects for staff development and realisation.

Publications BUPAF

Attitudes of medical assistant students for future careers

This study, as part of an empirical sociological study, aims to establish the attitude of medical assistant students at the Faculty of Medicine in Stara Zagora towards future professional realization. Methods: In the period November-December 2016 a semi-standardized face-to-face interview was conducted with all 42 students studying in the specialty. Results: Attitude for professional activity in the health system of the country is stated by 2/3 of the respondents, 17 of them with an attitude for work in Emergency Medical Care (EMS) and 12 - in Primary Outpatient Medical Care (PNMH). Readiness to work in a village in a team with a general practitioner (GP) is stated by 30 students, discussing certain conditions for this activity. Those inclined to work in a hospital (34) state an expectation of practising the position of ‘medical assistant’ and a job description tailored to the specific qualifications.

Publications BUPAF

Students – Medical Assistants for Continuing Education and Specialisation

The present study, as part of an empirical sociological study, aims to establish the attitudes and preferences of medical assistant students at the Faculty of Medicine in Stara Zagora for continuing education and specialisation, as a means of increasing professional qualifications, with the subsequent possibility of providing quality medical care, in accordance with the current legal framework and international trends in Bulgaria.

News BUPAF

The National Assembly of BSLAF was held

From 14 to 16 March 2025, the National Council of BLAF was held in Stara Zagora. The meeting was attended by 24 Chairpersons of the Board of Regional Colleges in the country.

After a majority vote, the Council passed on the previously announced agenda. The first day the Board of BULAF presented in detail to all attending chairpersons of the RoC information about the work done so far, the collection of the membership fee and the deductions under the rules for collection and spending of funds. The chairmen of the Control Committee, the Professional Ethics Committee and the National Quality Council also informed about their activities. The format for the upcoming reports of the RoC presidents was discussed.  Participants also commented on other issues related to the operational work of the Union, including institutions and individuals outside the organization. The opportunities for providing RC offices in the country, problems with notification letters to and from employers about the need to issue a certificate of membership in BULAF, etc. were also commented. It was decided that the next regular SC would take place on 14 March 2026 in Gabrovo. After passing on all the items on the agenda, the meeting of the National Assembly was closed.

On the next day, a training of the Chairpersons of the Board of Directors of the RoC was held to work with the Register of UASFF and the requirements for the document flow of the Union. The Board of BULAF discussed with the Chairpersons of the Professional Ethics Committees of the Regional Colleges the rules for the organization of their activities in the performance of the functions for monitoring the observance of the professional-medical, moral-ethical and deontological issues and rules related to the exercise of the profession. The examination of complaints and the issuance of infringement notices under Article 40 of the ZSOMSAAMSLAZF and other operational issues were also presented and discussed.

During the meeting, all 27 registered participants had the opportunity to receive business computers and printers to use for the needs of the RoC.

The presentations of the training together with the annexes thereto will be sent by email to the Chairpersons of the Managing Board of the RoC and the Chairpersons of the REK in the country, as well as published on the official website of BULAF.

The report of the Chairman of the Board of BULAF on the activities of the management body of the organization can be found through the button below.

News BUPAF

Report of the Chairman of the Board of BULAF on the activities of the management body of the organization

 

Dear Members of the National Council of BULAF,

We left behind an exciting and turning point - the establishment of our professional organization, defined by law. In 2024, Decree No 132 of the President of the Republic of Bulgaria promulgated in the State Gazette the Act amending the Act on professional organisations of nurses, midwives and associated medical specialists, dental technicians and assistant pharmacists, adopted by the National Assembly on 24 April 2024.

According to these amendments, BLAF is defined as a professional organisation as of 1 May 2024. Medical assistants/feldchers are now free professionals with a separate and independent professional organisation.

A fundamental objective of the Union is to protect and represent the rights and interests of medical assistants and paramedics.

It was the beginning of a new age, an age of ascension for our class. This will remain in the history of our profession, because we are moral people responsible for our own destiny, because we have made this history, and we have not been bystanders.

We have revived our profession from the ashes and this fills me with pride. Immediately after the establishment of our union began consolidation of the profession and construction of regional structures. The process was difficult - given the new factual situation, in many regions colleagues needed clarification and help in the creation of local structures. With a lot of effort and will, we managed to build a working structure of the organization on a national level and to set the beginning of BSLAF as a monolithic organization that enjoys respect and respect in the medical community. Preparatory activities for organizing and building the activities of the organization began immediately after the publication of the Law. Since 1 November 2024, the registration of the regional colleges in each district city has also started and the active activity of BULAF has started. To this end, we undertook a series of difficult, even sometimes impossible negotiations and dialogues with, on the one hand, the Ministry of Health and, on the other hand, the Regional Health Inspectorates. Unfortunately, in Bulgaria, things are set in such a way that in order to fulfill their duties, civil servants must be asked, pressured, persuaded. We've done it.

Dozens of consultations and talks were held with lawyers, experts and financiers to prepare and submit the necessary documents for the legal accreditation of the professional organization, including BULSTAT registration. After consultations and relevant researches, a bank was selected in which BSLAF opened its bank accounts. With persistence, perseverance and dedication, despite the difficulties and obstacles, we began to build our verbal project in order to equalize and stand with dignity and equal to all other medical professions, for years having their own professional organizations. This was done by the people around me: the management of the then active non-governmental organisation - BULAF until the date of our recognition as an official and legal professional association. These people worked tirelessly, devotedly and gratuitously for the cause. We worked with the possibility of a rematch, hand in hand, motivated by the realization of a dream. We have worked with our personal contacts and resources and with a lot of effort we have achieved incredible success to provide you with what is BLAF now - a serious and respectful professional organization with solid capabilities, performing its functions perfectly.

We have created stability for our profession and our professional community, but this should not reassure us, because there is still a lot of serious work to come to the big results and big victories.

 

Dear colleagues,

Our statement is of exceptional historical importance for the Bulgarian society, with a clear identity and authority.

Further, I would like to briefly inform you about the organizational activities carried out by the Management Board and the management of BSLAF. Thanks to the dedicated work of colleagues and the administrative staff of the Union, three official administrative registers have been created, with my express order, and have been approved, which are kept in the BULAF – a register book of incoming mail, a register book of outgoing mail and a register of orders issued by the Chairman of the Board of BULAF. In connection with the requirement of Art. 7 of the BULSTAT Register Act for mandatory indication of the seat and address of management of the Union, reflecting the actual settlement of BULSTAT, the following actions were taken: Thanks to the stubborn negotiations conducted by Ms G. Zaharieva, Deputy Chairperson of BULAF, on 31 January 2025 a lease agreement was concluded with Glavbolgarstroy International AD for two office premises located on the ground floor at: Sofia, 136-A Tsar Boris III Blvd. Parking spaces for the needs of BLAF are also provided to the lease agreement. Utility costs are borne by the landlord as BULAF does not owe any additional payment. The total monthly rental price was BGN 719.87, including the price of parking spaces and maintenance of rented premises. The cost of both rooms includes the use of a conference room upon prior request, a reception room, security, cleaning and the free use of the bathrooms on the floor. The two premises are provided for the needs of BSLAF and one of the premises BSLAF has provided for the use of RC Sofia-city and RC Sofia-district. In the period between the date of conclusion of the lease contract and 17 February 2025, Ms G. Zaharieva started new negotiations with Glavbolgarstroy International AD, taking into account that BULAF was a newly formed professional organisation and the cost of renting the premises would strain the budget of the organisation. After successful negotiations, Glavbolgarstroy International AD provided BLAF with a targeted donation of BGN 10 000 excluding VAT to be used to pay the monthly rent from BLAF, for which a donation contract was signed on 25 February 2025.

At the time when we officially established the representation of the Union and in compliance with the requirement of Art. 7 of the BULSTAT Register Act on 06.03.2025, the accounting officer of BULSAT has entered in the BULSTAT Register for an official address of the Union and for the seat and address of management of BULSAT: Sofia, Post code 1618, 136A Tsar Boris III Blvd.

 

Dear colleagues,

I use the moment to give you guidance on the organization of renting offices on the RoC. All professional organizations should have offices at regional level. I recommend to the Presidents of the RoC who have not taken action to provide offices to start meetings with the local authorities and local businesses to provide premises in which to carry out their activities. After the organisation of the offices, the chairs of the RoC issue an order for the organisation of the working time of the respective RoC, so that members can address you on the spot, as well as make contacts there with representatives of employers or, if necessary, with the local authorities. It is necessary to organise the proper keeping and on-the-spot storage of CFW documentation. Create with an order the keeping of the registry of RC - outgoing and incoming mail, order books, protocol books for the decisions of the Management Board.

I remind you that we work with personal data and it is necessary to organize its proper storage on a regional level - limited access and security.

The management of BSLAF expresses its readiness to assist you in your contacts with the local authorities if necessary. These contacts at local level are of utmost importance to the Union as a whole and will bear fruit in the future with the support you need.

Dear colleagues,

The Professional Organizations Act and the Statutes of the Bulgarian Association of Professional Organizations put you in a very special place and in a high management position. Use the powers given to you at local level to create contacts and work to raise and differentiate the salaries of your members, and if necessary, I assure you again that the management of BULAF will assist in the contacts with the local authorities.

The above issue was discussed at the meeting with the NAMRB, at which we were confident that they would assist us with contacts in order to hold further talks with the mayors on the ground.

The elaboration of the official website of BULSAT was assigned to a company that provided us with the lowest offer, as well as it was the only one that undertook to start work on creating the site before BULSAT was entered in the BULSTAT register, respectively, before we had operational means with which to pay for the service. The expenditure was approved by the Board of BSLAF.

Currently, the site works and is at a very high technological level, its development continues. A special subpage is to be created on the site, on which to keep a register of donations to BULAF, as well as to the Regional Colleges. Thank you letters for our support will also be published on this page. CVs of all members of the management of BULAF are to be published. Consistent with the need for legal support to the RC, uniform forms will be published in stages, to be used by all RCs of BULAF.

With regard to the technical security of the operation of UASF and RC and realizing that this is a significant cost, the management of UASF collected offers for the supply of computer equipment. The decision to choose a supplier was taken by the Management Board of BULAF on the basis of the offers provided. A company was selected as the supplier of the computer equipment, which gave not only the lowest offer price, but also an additional discount for 6 monitors in the amount of BGN 720. The price of the offer also included a service for installation and configuration of the software of the equipment, the offer had the longest validity period, online support in case of problems and last but not least the longest warranty period.

BSLAF has signed a contract for full accounting and tax services with an accounting company. Most of you are aware that the accountant of BSLAF currently provides full support to RC. You are aware that BSLAF uses the services of a PR expert with over 25 years of experience in the field of public relations. His work is of the utmost importance for the Union. Since 01.03.25 we have also concluded a contract for complex legal services with a lawyer with over 25 years of legal experience, a large part of it also in support of the work of the employees' representatives and participation in the development and public discussion of numerous bills.

Next, I should point out that the construction of its own network of modern and reliable business emails was also carried out.

In parallel with the construction of the structure of the organization and its technical support, the management of UASF began work on:

  1. Participation in working groups set up by the Ministry of Health and the Minister of Health on the development of an EU-funded programme for the ‘Development of outpatient health care outpatient care facilities’ providing medical care in small towns and remote areas. There was a meeting.
  2. Partnership relations and a negotiated strategic agreement have been established between BULAF, BAPZG and BAPF for cooperation in the protection of common interests before state institutions, employers, educational institutions or other structures.
  3. We participated in meetings with the Minister of Health at which we raised the issue of the UIN problem and our requests for changes in compliance with the norm of §22 of the Professional Organizations Act, namely: ‘regulatory acts implementing this Act shall be brought into conformity with its requirements within six months of the entry into force of this Act.’ At the meeting, once again, we insisted on the issue of the necessary integration of our register into the NZIS and the activation of the WIN through the Information Services system. On their part, we received assurance that work on integration is underway and in the shortest possible time it will be a fact, with which our WINs will be active and visible in the electronic information system. Thanks to this meeting, the necessary assistance was provided as a matter of urgency and as a result we already have active WINs.
  4. Our proposed comprehensive and essential changes to all of us are in a number of laws and regulations: the Health Insurance Act, Ordinance No 1 of 8 February 2011 on the professional activities that nurses, midwives, associated medical assistants, dental technicians and health assistants may carry out by appointment or independently, Ordinance No 3 of 27 April 2000 on health offices in children’s facilities and schools, Ordinance No 2 of 21 April 2011 on health requirements for cemeteries and the burial and transfer of the deceased, Ordinance No 4 of 4 March 2009 on the conditions and procedure for prescribing and dispensing medicinal products, Ordinance No 14 of 15 April 2004 on medical criteria and the procedure for establishing death. As well as changes in the National Classification of Occupations and Positions. Immediately after the meeting, the proposals were submitted for consideration by an official letter to the Ministry of Health, from which we expect the commitments made by them to be fulfilled.
  5. At the second meeting with the Minister of Health, together with our partners - BAPZG and the Bulgarian Association of Assistant Pharmacists, we raised and discussed the issues related to improving the communication of the Ministry of Health with professional organizations. At the last meeting, the Minister of Health expressed his strong support for our common demands.
  6. We held a meeting with the National Association of Municipalities in the Republic of Bulgaria (NAMRB). The meeting discussed concrete opportunities for interaction between the NAMRB, the local authorities and the Bulgarian Union of Medical Assistants and paramedics in order to improve health and medical services and strengthen the health system at local level. A serious focus of the meeting was the discussion on the issue of improving the working conditions for LA/F and improving their pay in the field of SWD (child and school health care). There was an understanding and a desire for dialogue and joint problem-solving.
  7. We had a fruitful meeting with the management of the Bulgarian Medical Association, at which they expressed goodwill for cooperation with BSLAF;
  8. The management of BSLAF is present as an equal partner at each meeting of the Health Committee of the National Assembly.
  9. The management of BSLAF participated in numerous working groups of the Health Committee of the National Assembly, including at the invitation of the Chairperson of the Committee and on the examination of a draft budget for the NHIF 2025. At the meeting, the Secretary General of BSLAF expressed the opinion of BSLAF regarding the general differentiation of the salaries of LA/F and the development of new job descriptions, not by professional field, but by professional qualification.
  10. The management of BSLAF held numerous meetings with representatives of various political parties and associations who expressed their support for us and showed understanding of the pressing issues raised by BSLAF.
  11. At the initiative of the Rector of MU-Pleven, Prof. Dr. Dobromir Dimitrov, in his capacity as President of the Association of Medical Universities in Bulgaria, on 10 March 2025, the first meeting was held at MU-Pleven between representatives of BAPZG, BAPF, BLAF and the management and faculties of public health in higher education institutions in the country, as well as the academic staff of the departments that train students in the field of health care. As a result of the meeting, it was decided to develop a unified Strategy for the Development of Occupational Health Care. Another commitment of the working group is to unite the efforts of stakeholders in the implementation of a nationwide information campaign, supported by the Ministry of Health and the Ministry of Education and Science, to promote the meaning, importance and authority of the professions of the Health Care strand, so as to increase the interest of young people in training in these professions.

We have shown the medical community and the general public that our community consists of valuable people and worthy people, and that is you, the leaders of our community by region. I am convinced that our already functioning professional organization will increase the motivation and quality of the medical care and health service we offer, as well as ensure the necessary representation in defense of our legitimate rights and interests, and this is actually beneficial for the whole society.

 

Dear colleagues,

I take this opportunity to thank all of you who have given us and continue to provide support for the cause: Prosperous profession of medical assistant and prosperous Bulgarian Union of Medical Assistants and paramedics.

 

Dear colleagues,

Recognizing the fact that it is not within the competence of the SC to examine or make financial statements of the organisation, however, in order to ensure publicity and transparency, we will do so by giving the floor to the accounting officer of BULAF, who will report the financial statements of the Union. The report will be uploaded to the website of BASF by the end of March and will be available to everyone.

 

            With respect,

            Alexander Alexandrov,

           The President

           the Board of BSLAF