THESSALONIKI, GREECE -- Ioanna Prassopoulou is 18-years-old and very confused. At least that’s how she explains it to me from her home in Alexandroupoli, in the northeast corner of Greece, as she waits for the letter that will determine her career.
Ioanna doesn’t know where she’ll be in two months, but she has her fingers crossed for medical school, which bestows upon young Greeks the same prestige as attending an Ivy League school.
She’s not a shoo-in. No one really is.
Admission to one of Greece’s seven medical schools is based entirely on a student’s performance on the two-week, six-subject-long Panhellenic Examinations. Ioanna’s scores will determine which science-based discipline she’ll be allowed to study. Her’s are a bit low, she thinks, for medical school. Now she, along with more than 100,000 other 18-year-olds across Greece, waits anxiously for her next move.
“Here you’re 18, you don’t know anything about the world around you, you don’t know what you want, and you don’t have that many responsibilities -- and then suddenly you have to study all the time for this one test and put a list of universities in order that will determine your future,” she said. “It’s a little bit awkward.”
But what Ioanna also knows, what sits persistently in the back of her mind, is that if she does get into medical school, it may mean she will eventually have to leave her home country.
Greece has far more doctors per capita than any other country in Europe -- one for every 158 people. And being a country of just 11 million people (that’s seven million fewer than the Greater Los Angeles area), there aren’t nearly enough jobs available to keep them. (According to the latest available data, one in 7,000 Greeks was a medical school graduate in 2007, making it the OECD nation with the fourth-largest graduating class of doctors that year.)
In turn, thousands of Greece’s best doctors find work abroad. As of August 2014, more than 7,500 doctors have left Greece.
Dr. Alexandros Garyfallos, a rheumatologist and head of Thessaloniki’s medical school, Aristotelion University, has seen droves of his students leave after graduating -- especially for Germany, a country known for its hard stance on Greece’s crippling debt and which now has 3,500 Greek doctors and counting.
“Over the crisis period, Germany has been asking for more and more doctors,” Garyfallos told me. “They don’t need to produce them, because they can get them from us ready-made and cheap.”
He laughed. “Soon there will be more doctors in Germany than in all of northern Greece.”
This problem was further exacerbated by the 2010 austerity package that hit Greece after its initial economic crisis, which mandated a horizontal hiring freeze across government jobs. In short, this meant that across all sectors, from ministry offices known for gratuitous hiring to schools and hospitals known for their lack of resources, only one hire was allowed for every 10 retirements.
This measure was meant to wrangle in the bloated number of employees working for the state, but actually weakened hospitals significantly: The Federation of Greek Hospital Doctors estimates that public hospitals are short about 6,000 doctors. The new austerity package of 2015 will stabilize this number (hospitals are now allowed to replace retirees), but it won’t help with already debilitating shortages.
Ioanna’s father, Panos Prassopoulos, leads the radiology department at the University Hospital of Evros in Alexandroupoli. He lost his two best residents to hospitals in Switzerland and Sweden because he was unable to hire them.
“Young doctors can’t see any future for themselves here,” he told me. “These guys are already trained. The government has spent a lot of money on their training. They are the best brains in the country. And now, as fully formed doctors, they leave. This is very sad for me, and a disaster for the country. Keeping this brainpower is so much more important than saving the money.”
Ioanna and many of her classmates have come to terms with the fact that they may not be able to settle in Greece. “I see the problems my father has in his hospital,” she said. “So yes, I think a lot about going abroad after medical school. My family and I were looking at specializations in medicine that may give me more opportunities to stay, and we realized there aren’t many things that could keep me here. There are not many chances here.”
I asked Ioanna how that makes her feel.
“Disappointed,” she said, pausing. “And very disabled. I can’t do what I want in my own country, where I’m close with my parents and where I’ve learned to live for 18 years.”
Over the past six decades, Greece’s medical community has repeatedly suggested an obvious fix: tighten medical school admission rates. But politicians, worried about threatening their public support and feeling no real pressure to change, have instead loosened the rate over time. “Public support” includes local and small business owners, who rely on the swath of medical students as an essential layer of their bottom line -- they don’t want to see fewer young Greeks in their stores and restaurants.
But perhaps even more importantly, “public support” includes parents. Being a doctor comes with prestige in Greece.
“Greece is a country where social status plays a very important role,” Ioanna explained. “Even if a student doesn’t want to go to medical school but gets good enough grades to get in, his parents push him to go. That happens a lot. Many of my friends have this pressure from their parents.”
This setup ultimately forces students into a difficult situation come graduation time, when they have to decide whether to stay or leave. Twenty-four-year-old Eleni Erkotidou was just beginning medical school when the financial crisis hit Greece in 2009. This July, she graduated from Democritus University of Thrace, and is currently deciding where she’ll do her five year residency in pediatrics.
It’s not a painless decision for Eleni. She knows that another country will likely offer more opportunities and a better education. But going abroad isn’t easy. She’d have to leave her family and her country, and learn to practice medicine in another language.
“I don’t want to say that going abroad is the best solution, and that Greece is hell,” she said.
Eleni is also proud, that, despite the difficulties facing Greek hospitals and students, Greek medical schools still work. They prepare students well for successful careers in countries around the world.
“Some people think we Greeks are only bad and lazy, that we don’t study, but that’s not true,” she said. “We have very good professors. We have a reputation for being good doctors. We easily manage to find work abroad.”
Deep down, however, Eleni really wants to stay. Leaving her country in a time of need, whether there is space here for her or not, feels like abandonment. “I want to be helpful in these difficult times by providing the services I can for my own country. If I feel that Greece is pushing me to go, I’ll go. But if there wasn’t the financial crisis, I would stay.”
The first chance she got, 35 year-old Alexandra Panteleon left. In 2004, she moved from Athens to Munich, Germany, to do her radiology residency at a shiny university hospital. When her mother got sick a few years in, she moved back to Greece to finish up at a public hospital in Athens. Although it’s hard to compare them (university hospitals are known for having better facilities in every country), the difference between the two still highlighted the unquestionable dearth of resources in Greece.
“In Germany, we had CT scans with 64 slices, and in Greece, our CT scans had four slices -- that was decade old technology,” she said. “The MRI was not working properly in Greece, so we could only do two or three exams per day. In Germany we produced more than 50 exams per day.”
So in 2011, after receiving her title, Alexandra immediately moved back to Munich. She is now a radiologist at a public hospital there.
“Every year I meet more Greek doctors in Germany,” she told me. “Last year I had two friends stay in my apartment for six months to find a job in medicine. They both did and are very happy. But it’s not always easy for Greeks to adjust to the language and the German mindset. I went thinking, I might be Greek but I should not think like a Greek, I should think like a German. Many Greeks have trouble with this.”
I asked her how often she sees people return to Greece because they’d prefer to be back home.
“One,” she said. She didn’t even need a second to think. “It is harder for some people to adapt than it was for me, but of all the years I’ve worked in Germany, I’ve only seen one person choose to go back to Greece.”
These students are comparatively more free than the doctors who have built careers here in Greece and now face instability. My cousin, Amalia Raptopoulou, grew up in Thessaloniki; she graduated from Aristotelion University. She’s now a rheumatologist with a private practice in the small neighboring city of Veria. We sat in her empty office -- business for her is down 80 percent -- as she openly questioned her choices.
“I became a doctor because I was a good student, and because my teachers and parents wanted me to,” she said. “But I didn’t know exactly what I was getting into. I don’t think I would choose medicine if I had to do it again. I would choose something lighter, that took fewer years of training and work. Now, I wonder why I put myself through that ordeal for all those years, to be 43 and still struggling, still worrying if tomorrow disaster will knock at my door.”
Amalia now faces a problem many of her generation, with developed careers and young children, face. “When you hear about people going abroad, you have a dilemma. Am I going to sit here and risk everything, or do I pack my bags and my family and go?”
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