Medical Professionals and Ministry of Health Discuss Increasing Remuneration for Residents

“We will work together on changes to the regulation on specializations,” stated the Minister of Health, Assoc. Prof. Dr. Silvi Kirilov, MD. During the first meeting of the working group formed to draft proposals for amendments to Ordinance No. 1 on the acquisition of specialties in the healthcare system, he added that the presence of all professional organizations and representatives from the “Future in Bulgaria” Initiative Committee would guarantee transparency in the work process.

Conducting a Centralized Examination for Medical Residents

Specific steps were outlined during the meeting. The first is related to conducting a centralized examination for medical residents. Minister Kirilov pointed out that such a change had already been discussed by the Ministry’s team. “There are various options, but together we will seek the best solution, taking into account all the pros and cons,” Assoc. Prof. Kirilov noted. He reminded that the centralized exam was abolished years ago at the initiative of resident organizations. The Initiative Committee committed to submitting their written position on a centralized competition shortly. All parties in the working group agreed on the importance of ensuring transparency in the conduct of residency competitions.

Remuneration for Medical Residents May Be Included in Ordinance 1

Another change discussed during the meeting concerns Art. 15, para. 3 of the Ordinance. It states that the remuneration received by a resident for their activities cannot be less than the minimum monthly social security income for the respective economic activity. The Minister of Health committed to having the working group examine all possibilities for correcting this text and discussing the proposals with employers.

The next step identified was the creation of a digital platform for reporting irregularities during residency training. Their representatives pointed out that currently, such reports are not submitted due to concerns about job security. For his part, Deputy Health Minister Dr. Boyko Penkov noted that it is within the Minister of Health’s powers to carry out inspections. He added that it is important to guarantee the rights of residents and to implement systematic control.

BMA: We Stand 100% Behind the Demands of Our Young Colleagues

The Vice President of the BMA, Dr. Madzharov, stated after the meeting that the Medical Association stands 100% behind the demands of their young colleagues. “We must be careful in the implementation. Where they have no complaints regarding the Ordinance, they have complaints regarding its application. We must consider an option for objective control that does not jeopardize the resident. Young doctors are concerned that if they file a report, something might happen to them, and they are completely right,” he said.

“For me, it is no less important to focus on the fact that in Ordinance 1 on specializations, the amount mentioned for state-funded positions is no less than 2.5 minimum wages, and it must be increased. The other problem is that for residents who are not state-funded, the remuneration must be no less than the minimum social security income for a doctor, which is BGN 1,077. This must categorically be removed, and the two forms of specialization must be equalized. Every healthcare facility should know that if it wants to hire a young doctor, especially if they are a resident, it cannot do so for less than 150% of the average national wage,” Dr. Madzharov added.

The BMA believes that the remuneration levels should be recorded in Ordinance 1. According to them, this will guarantee their payment. The BMA committed to requesting negotiations for new texts in the National Framework Agreement (NFA). These will grant residents the right to be included as providers of medical activities under contracts with the National Health Insurance Fund (NHIF). This activity will be carried out under the supervision of a doctor with the relevant specialty.

Graduated Doctors and Residents to Have Full Rights as Providers under Clinical Pathways

“We will insist, as we have for years, that the new NFA states that graduated doctors and residents have full rights as providers under clinical pathways,” Dr. Madzharov added. “This will give meaning to both their appointment and the remuneration they receive, because none of them want to receive unearned pay,” he concluded.

Specialization Competitions Must Be Transparent

The most fundamental problems that need to be addressed in the Ordinance on Specialization are the specialization competitions, which are currently not transparent and do not give the best candidates a chance to be ranked and secure their positions, said Kalina Bozhilova from the “Future in Bulgaria” Initiative Committee. She specified that currently, medical professionals often start specializations through family connections or because they have worked in a particular hospital department for a long time, which is not a sufficient criterion for the positions that should be filled by residents.

Bozhilova added that Minister Kirilov has made a specific commitment to regulate the basic minimum remuneration of residents, as the ordinance currently states that residents cannot receive less than the minimum social security income for the country, which is BGN 1,077. “In 2025, this remuneration is shameful,” she added.

The first meeting of the working group was also attended by representatives of the Ministry of Health, the Bulgarian Medical Association, the Bulgarian Dental Association, the Bulgarian Pharmaceutical Union, the Bulgarian Association of Healthcare Professionals, the Bulgarian Union of Physician Assistants and Feldshers, the Bulgarian Association of Assistant Pharmacists, and the Bulgarian Association of Dental Technicians.

Discussions in the working group will continue at upcoming meetings until the end of the month. Meanwhile, working meetings will also be held with the rectors of Medical Universities and the deans of Faculties, as well as with employer organizations in the sector.