Dr. Nikolay Branzalov: "Patient care and respect for colleagues have always been at the core."

Dr. Nikolay Branzalov is a graduate of the Medical University of Plovdiv. He holds specialties in Internal Medicine and General Medicine, as well as a Master’s degree in Health Management. For over two decades, he has practiced as a general practitioner, focusing on outpatient care and long-term patient management. His professional career includes clinical work, administrative activities, and participation in professional organizations. Between June 2018 and September 2024, Dr. Branzalov served two consecutive terms as Vice President of the Board of the Bulgarian Medical Association. On September 28, 2024, during the 77th regular reporting and election assembly, he was elected President of the BMA.

1. Dr. Branzalov, from personal medical practice to the leadership of the Bulgarian Medical Association – what motivated you on this path and how have your priorities changed over the years?

Dr. Branzalov: Patient care and respect for colleagues have always been at the core. Over time, however, one realizes that to change something significant in healthcare, work must be done not only at the individual level but also at the systemic level. I accepted this responsibility – to be the voice of the profession and to work for a more effective, fair, and sustainable healthcare system.

2. What does the experience in real medical practice give you that you can bring to the leadership of a professional structure like the BMA?

Dr. Branzalov: When you are still an active general practitioner, you have no illusions – you know the problems firsthand. This helps in making decisions that meet the needs of doctors, rather than being abstract or purely administrative. Practice has taught me to seek the balance between ideals and reality.

3. What does a sustainable healthcare system mean in the Bulgarian context and what are its main weaknesses today?

Dr. Branzalov: A sustainable system provides a continuous, accessible, and high-quality health process – with guaranteed funding, motivated staff, and a clear regulatory mechanism. Currently, in our country, it suffers from chronic underfunding, uneven distribution of resources, and demotivation of medical specialists, especially in the periphery. The lack of predictability related to frequent changes of ministers, working under caretaker governments, as well as the inability of the NHIF to have a governor for a full term, undoubtedly affects the entire system, its goals, policies, and vision.

4. What specific changes in the financing of the system do you believe are urgent?

Dr. Branzalov: Firstly, Bulgaria must increase the share of public funds for healthcare as a percentage of GDP. Currently, our country is among the last in the EU by this indicator, which directly affects the access, quality, and sustainability of healthcare. We believe that the health of the nation cannot be a compromise – it must be a strategic priority, and this should be clearly reflected in the budget. Also, for years we have been insisting on increasing the health insurance contribution – an unpopular but fully justified measure. The current 8% does not meet the real needs of the system, especially in conditions of inflation and rising prices for medications, equipment, and services. In most of the EU, the contribution is significantly higher, and the results are visible.

Without this, we cannot guarantee either predictability or fairness in the distribution of funds. Real reform of clinical pathways is also imperative. They should reflect medical logic and real costs, rather than being a tool for budget constraints.

5. How should the role of the Bulgarian Medical Association change in the management of the system?

Dr. Branzalov: In recent years, the Bulgarian Medical Association has decisively managed to take its place as a defender of the interests of the profession and an active participant in the public debate on healthcare. Nevertheless, we are still witnessing a series of changes in regulations, laws, and normative acts that are adopted without prior consultation with the Association. This is not only an undervaluation of expertise in the system but also undermines trust between institutions. We are ready and insist on participating not only at the negotiation stage of the National Framework Agreement but also in the process of developing long-term strategies, health policies, staffing programs, and mechanisms for evaluating results. The professional organization must have institutionalized participation in the strategic management of the sector. For this to happen, a change in the Law on Professional Organizations is necessary to strengthen the powers of the BMA – especially regarding professional ethics, quality standards, control over continuing education, and the protection of medical dignity. Our role is not only to protect colleagues – we also bear responsibility to society. And this responsibility must be supported by legal instruments so that the medical association can effectively perform regulatory and control functions, as it does in many other European countries.

6. What should be the function of the Commission on Professional Ethics and what are your plans for it?

Dr. Branzalov: The Commission on Professional Ethics must have real powers, including the ability to impose sanctions – as is the case in other European countries, such as Greece. Currently, its capabilities are limited to moral assessments. We want real self-regulation within the profession – with clear rules, protection of patients, and protection of the profession’s reputation.

7. What is the BMA’s position regarding continuing medical education and why do you think it should be mandatory?

Dr. Branzalov: Continuing education is the foundation of quality medicine. Different countries apply mandatory, voluntary, or hybrid models of continuing education. In 13 European Union countries, continuing medical education is mandatory. In many European countries – such as Germany, France, and the Netherlands – maintaining qualifications is linked to the very right to practice the profession. We insist that CME becomes mandatory in Bulgaria as well – with a clear system for evaluation and certification under the control of the BMA.

8. What specific steps is the professional organization taking in this direction?

Dr. Branzalov: There are several initiatives that the Bulgarian Medical Association has initiated on this topic in recent years. At forums organized by the BMA, we sought the opinion of the guild, which clearly stated that continuing education, in addition to maintaining knowledge and qualifications, will be in the interest of patients and society because it will guarantee them qualified healthcare. We also studied international experience in this regard and it turned out that we are among the few who have left it to the self-initiative of doctors whether to continue qualifying or to remain throughout their professional life with the knowledge from their student days. We have repeatedly raised the issue with the politicians on whom this depends; we were assured that the topic is important and work would be done to make CME mandatory, but at the moment this is still not a reality.

9. What is the international role of the Bulgarian Medical Association at the moment and what would you like it to be?

Dr. Branzalov: The BMA actively participates in the work of European and international structures – such as the CPME and the World Medical Association. Our goal is to put Bulgaria on the map of health diplomacy – both in terms of policies and in sharing best practices. I believe that the voice of Eastern European countries should be heard more loudly in common European decisions.

10. Which international healthcare models impress you and would you like to see adapted here?

Dr. Branzalov: Germany is a good example of a balanced system with public-private partnership. Scandinavian countries, on the other hand, show how investments in prevention and primary care can relieve the hospital sector. From these models, we can learn how the system works not only during crises but in the long term.

11. How do you see the healthcare system in Bulgaria in 10 years? What needs to change to get there?

Dr. Branzalov: I see a system where doctors are motivated, patients are at ease, and politicians are responsible. To get there, we need vision, continuity between governments, and a real role for professional organizations in management. Most importantly – to restore trust between the three parties: patients, doctors, and the state.

12. 12. What would you say to young doctors who are considering emigration?

Dr. Branzalov: I can understand them. But I want to tell them that change comes when you stay and fight for it. I would like to share that, fortunately, in recent years young colleagues have been actively involved in professional activities in the regional structures of the BMA across the country, and several youth organizations have been opened. I mention this to point out that this process of change and the desire of young people to be active and carriers of change is also observed here. Otherwise, to those considering emigration, I would say that the Bulgarian Medical Association is by their side – with a cause, with protection, and with the clear ambition to make the environment here more worthy of their profession.

13. Your message to the readers of Healthcare Magazine – health managers, institutions, and politicians? Dr. Branzalov: Today more than ever we need a union between experts, doctors, and visionaries. Let us stop managing piecemeal and start building a system. Not only for our generation but for those to come.