The importance of the medical profession of doctor is unquestionable. A doctor has a huge influence on individuals, but also on society as a whole. It helps people, relieves their pain and many times saves life. A lot has changed over the past few years through scientific and technological advancements. Progress has brought new knowledge and information that the doctor is no longer able to absorb. Therefore, they are no longer universal doctors as in the past, but specialization is required to maintain the expertise of a doctor.

Medical profession doctor in Slovakia

In 2022, according to data from the National Center for Health Information (2023), 20,234 doctors worked in Slovakia. In terms of age structure, in 2022 we will record the most doctors aged 60 and over (25.1%) and 30-39 (23.1%). In the period of the last ten years (2013-2022), there was a slight increase in the proportion of doctors under the age of 40 (30.8% in 2013; 34.9% in 2022).

Table no. 1: Age structure of doctors for the period 2009-2022

The situation in our healthcare is serious. According to the Health Journal (2024), Slovakia lacked a total of 713 general practitioners at the beginning of 2023, of which 484 were doctors for adults and 229 were doctors for children and adolescents. Of course, it is not only a lack of these doctors, but also of other specialists. The Žilina self-governing region published a press release on April 17, 2024, where it stated the current status and age range of doctors in the Žilina region as follows:

  • doctors - specialists in the field of Neurology - of the total number of 36 contracted doctors, 34% are over 60 years old,
  • doctors - specialists in the field of Pneumology and Physiology - 25% of the total number of 8 contracted doctors are over 60 years old,
  • doctors - specialists in the field of psychiatry - of the total number of 29 contracted doctors, 38% are over 60 years old,
  • doctors - specialists in the field of Urology - of the total number of contracted doctors 15, 47% are over 60 years old,
  • doctors - specialists in the field of Cardiology - 41% of the total number of 17 contracted doctors are over 60 years old,
  • doctors - specialists in the field of Ophthalmology - 34% of the total number of 41 contracted doctors are over 60 years old,
  • doctors - specialists in the field of Clinical Immunology and Allergology - 23% of the total number of 22 contracted doctors are over 60 years old.

The shortage of medical specialists begins already during education and the acquisition of expertise. The education of one specialist doctor who can run a clinic takes at least 10-12 years, even more in the case of more demanding fields. Graduates of medical studies specialize in financially more attractive fields (e.g. plastic surgery, ophthalmology, etc.), specializations with less attractive performance evaluations suffer from a lack of applicants (neurology, pneumology and phthisiology). The number of doctors also decreases when they go abroad. (Press release, 2024)

Conditions for practicing the medical profession of doctor in Slovakia

The condition for exercising the medical profession of a doctor is the acquisition of professional competence, according to Government Regulation no. 296/2010 Coll. on the professional qualification for the performance of the health profession, the method of further education of health workers, the system of specialist fields and the system of certified work activities, as amended (hereinafter referred to as the "Government Regulation"), which stipulates that the professional qualification for the performance of professional work activities is obtained by acquiring a second-level university education in the doctoral study program in general medicine in the field of general medicine. In Slovakia, we can complete this education at four medical schools faculties, namely:

  • Faculty of Medicine of the Comenius University in Bratislava,
  • Jessenius Faculty of Medicine of the Comenius University in Martin,
  • Faculty of Medicine of the University of Pavel Jozef Šafárik in Košice,
  • Faculty of Medicine of the Slovak Medical University.

After acquiring professional competence, the doctor is entitled to perform professional work activities of preventive and curative care, which correspond to the scope and content of the acquired education.

Medical education is essential throughout life, not just during college. Through the second-level university education in the doctoral study program of general medicine in the study field of general medicine, the doctor acquires professional competence to perform professional work activities. The study of this field lasts six years in the full-time form of study, and its successful completion leads to the acquisition of the title "MUDr." – doctor of general medicine.

It is also important to mention the conditions for the performance of the medical profession, which are in accordance with Act no. 578/2004 Coll. on health care providers, health workers, state organizations in the health sector and on the amendment of certain laws as amended (hereinafter referred to as the "Law on Providers"): a) capacity for legal acts in their entirety, b) medical fitness, c) professional competence, d) integrity, e) registration.

After acquiring the professional competence to perform professional work activities, the doctor is obliged to continue his education. Following the acquired professional competence for the performance of the medical profession, the doctor provides further education through:

  • specialization study,
  • certified work activities, - continuous education.

Specialization studies

The list of all specializations in the medical profession is given in Annex no. 3 and Annex no. 4 of the government regulation, which we also list in the table below:

Table no. 2 List of specialized departments for the medical profession of doctor

By continuing education of health workers, we mean increasing or deepening professional competence. Professional competence is increased by obtaining a specialization diploma and obtaining a certificate and is deepened by continuous education.

If a doctor wants to perform specialized work activities, he must obtain a specialization diploma in the specialized fields listed in Annex no. 3 or Annex no. 4 of the government regulation (list shown in table no. 2). By completing a specialization study, a doctor has the right to use the professional designation "specialist doctor" associated with the name of the relevant specialization field.

There are currently 96 specialized study programs and 30 certified work activities in Slovakia that doctors can enroll in.

The minimum length of the specialized study is specified in the government regulation and is regulated in more detail by the individual minimum standards that are published on the website of the Ministry of Health of the Slovak Republic (hereinafter referred to as "the Ministry of Health of the Slovak Republic") and are binding for all educational institutions. Proposals to change the length of study, the name, content and scope of the minimum standard are proposed by the Accreditation Commission of the Ministry of Health of the Slovak Republic for further education of health workers.

Course of specialization study

A healthcare worker, i.e. also a doctor, is enrolled in a specialized study by an educational institution that has received an accreditation certificate.

Specialized education takes place with the help of accredited study programs. According to § 69 of the government regulation, the specialization study consists of a practical part and a theoretical part, while the majority of the specialization study consists of the practical part. The practical part is completed by a medical worker under the guidance of a senior worker of the relevant workplace of a medical facility or under the guidance of a medical worker with the relevant professional qualifications for the performance of specialized work activities (hereinafter referred to as the "trainer"). This means that during the specialization study, the doctor can perform specialized work activities only under the professional guidance of the trainer.

According to decree no. 74/2019 Coll. on the criteria and method of evaluation of continuous education of health workers, doctors are allocated credits for specialized studies, certification preparation and completion of an accredited study program of continuous education.

Completion of specialized education is carried out according to § 41a of the Act on Providers with a final exam, the so-called specialization exam. The educational institution establishes an examination committee to conduct the specialization examination. The examination board is mainly composed of specialists in the relevant field of specialization, in which specialists from all educational institutions implementing an accredited specialization study program in the relevant field of specialization are represented.

After successful completion of the specialization study, the educational institution will issue the doctor with a specialization diploma in accordance with the Decree of the Ministry of Health of the Slovak Republic no. 133/2022 Coll. which establishes models of specialization diplomas and certificates.

Specialization studies are currently provided by several educational institutions in Slovakia. In the table below, we present a list of these educational institutions with individual faculties.

Table no. 3 List of educational institutions teaching medical specialties

Recognition of undergraduate education of a Ukrainian doctor

Pursuant to § 7 of Act no. 422/2015 Coll. on the recognition of educational documents and on the recognition of professional qualifications and on the amendment and supplementing of certain laws as amended (hereinafter referred to as Act No. 422/2015 Coll. z.), a second-level university education is required to exercise the medical profession of a doctor. The applicant meets the established qualification requirements if he holds a university diploma according to § 4 paragraph 2 letter b) or letter c), which confirms that the doctor from of Ukraine (hereinafter referred to as the "applicant") completed the education required for the performance of the medical profession as a doctor, and after comparing the content and scope of the applicant's completed education, it is equivalent to the content and scope of education required in the Slovak Republic.

Every doctor from Ukraine or another third country must apply for recognition of education. Without recognition of a professional qualification, a doctor with a qualification obtained in Ukraine does not have professional competence and cannot work as a doctor in accordance with the legislation of the Slovak Republic.

The recognition of medical basic professional (undergraduate) qualifications takes place in a two-stage process:

1st degree

The applicant will apply to the Ministry of Education, Research, Development and Youth of the Slovak Republic (hereinafter referred to as the Ministry of Education, Research, Development and Youth of the Slovak Republic) for the recognition of a document of education. When recognizing documents of education, it will be assessed whether the document of education was acquired at a state-recognized school and whether the education meets the formal requirements of comparability according to the requirements required in the Slovak Republic. If so, the Ministry of Education and Culture of the Slovak Republic will issue a decision on the recognition of the document of educated.

2nd degree

After the recognition of the educational document (the 1st level of recognition has been completed), the applicant is obliged to take a supplementary exam at a university that provides the same study program in which the applicant is applying for recognition of the professional qualification.

The supplementary exam for doctors is conducted at a recognized educational institution (university or secondary school in the Slovak Republic). The supplementary exam for the medical profession of doctor is a verification of the knowledge and skills of applicants who apply for recognition of professional qualifications for the practice of the medical profession of doctor in the Slovak Republic. The exam is conducted in the state language (Slovak language). The requirements and procedure for the supplementary examination are governed by § 18a of Act no. 422/2015 Coll. and Decree of the Ministry of Education, Research, Development and Youth of the Slovak Republic No. 30/2018 Coll. about the supplementary exam.

After successful completion of the supplementary exam, the Ministry of Education, Culture and Sports of the SR will issue a decision on the recognition of the professional qualification. The decision of the Ministry of Education and Culture of the Slovak Republic on the recognition of professional qualifications is proof of professional competence for the independent performance of professional work activities in the medical profession of doctor. Pursuant to the government regulation, a doctor who has obtained professional competence for the performance of professional work activities independently performs professional work activities of preventive and curative care, which correspond to the scope and content of the acquired education. This education is equivalent to the Slovak one, i.e. when a person completes a second-level university education in Slovakia in a doctoral study program in general medicine in the study field of general medicine, which lasts six years in full-time study and includes at least 5,500 hours of theoretical teaching and practical teaching. Adequate knowledge and skills are acquired through this study:

  1. in the sciences, in the scientific fields on which medicine is based and a good command of scientific methods, including the principles of measuring biological functions, evaluation of scientifically established facts and data analysis,
  2. about the structure, functions and behavior of healthy people and sick people, about the relationship between health and the living and working environment, the psychosocial environment and the way of life of a person,
  3. from clinical disciplines and practices that provide a comprehensive understanding of mental illnesses and physical illnesses and of medicine in terms of prevention, diagnosis, treatment and human reproduction,
  4. in radiation protection focused on the origin, interactions and basics of detection of ionizing radiation, physical characteristics of radiological devices used for diagnosis and treatment, basic principles of radiation protection of health workers when working with radiation sources, ensuring radiation protection of patients, justification, optimization and diagnostic reference levels of medical radiation, special requirements for ensuring radiation protection of children and pregnant women and aimed at emergency situations and accidents and clinical practice in a hospital under expert guidance. (government regulation)

Additional recognition physician education

After the recognition of professional - undergraduate qualifications, the Ministry of Health of the Slovak Republic recognizes medical specialized professional qualifications in a one-step process. According to Act no. 576/2004 Coll. on health care, services related to the provision of health care and on the amendment of certain laws as amended by the competent authority for recognition:

  • documents on specialization issued by educational institutions or other authorized bodies according to the legislation of member states or third countries, which correspond to the professional competence for the performance of specialized work activities (specialization fields listed in table no. 2 in accordance with the government regulation)
  • certificates issued by educational institutions or other authorized bodies according to the legislation of member states or third countries, which do not have the character of a document on specialization and which correspond to professional competence for the performance of certified work activities (certified work activities listed in Annex No. 3 of the Government Regulation).

If the applicant meets all the necessary requirements, the Ministry of Health of the SR will issue a decision on the recognition of the specialization document (or certificate).

A doctor who has obtained professional competence for the performance of specialized work activities independently performs specialized work activities of preventive and curative care, review activities and assessment activities according to the accredited specialization study program of the relevant specialization field and independently also performs consulting activities, directs care in the creation and protection of healthy living and working conditions, and carries out research, educational and educational activities connected with the provision of health care. A doctor who has obtained professional competence for the performance of certified work activities independently performs certified work activities of preventive and curative care according to the accredited certification study program of the relevant certified work activity.

In Slovakia, after completing undergraduate education, i.e. after completing a doctoral study program in general medicine in the field of general medicine, a doctor is employed by a health care provider, and the doctor is enrolled in a specialized study in a specialized field according to the agreement with the employer.

Conclusion

Despite the lack of doctors and other health workers, the system of recognition of education in Slovakia is quite complicated. Not every doctor from abroad can immediately work in Slovakia. Foreigners - persons who received medical education in non-member states of the European Union - are primarily interested in practicing the medical profession in the Slovak Republic. The Slovak Republic has implemented several measures to simplify the integration of health workers from non-member states of the European Union (hereinafter referred to as the "EU") into the system of providing health care in the Slovak Republic. For persons who have received a medical education in the medical profession of doctor in the territory of Ukraine, the Institute of Medical Terminology and Foreign Languages of the Faculty of Medicine of the Comenius University in Bratislava has provided Slovak language teaching with a professional focus for the study of medicine and practice in the field prior to the recognition of professional qualifications, persons who obtained medical education in the territory of non-EU countries were allowed to perform a temporary professional internship with health care providers, with the aim of enabling them to familiarize themselves with the working conditions and material and technical equipment of medical facilities, as well as with the entire system of providing health care. EU states.

Author: Marianna, Kapustová, PhDr. VŠZaSP St. Elizabeth

List of bibliographic references

MINISTRY OF HEALTH OF THE SLOVAK REPUBLIC. 2006. Education of health workers in the Slovak Republic. ISBN 978-80-968133-3-9.

Government Regulation no. 296/2010 Coll. on the professional competence for the performance of the health profession, the method of further education of health workers, the system of specialized fields and the system of certified work activities, as amended

Decree of the Ministry of Education, Science, Research and Sports of the Slovak Republic no. 30/2018 Coll. about the supplementary exam.

Law no. 422/2015 Coll. on the recognition of educational documents and on the recognition of professional qualifications and on the amendment of certain laws as amended.

Law no. 576/2004 Coll. on health care, services related to the provision of health care and on the amendment of certain laws as amended.

Law no. 578/2004 Coll. on health care providers, health workers, professional organizations in the health sector and on the amendment of certain laws as amended.

Decree no. 74/2019 Coll. on the criteria and method of evaluation of continuous education of health workers.

Decree of the Ministry of Health of the Slovak Republic no. 133/2022 Coll. which establishes models of specialization diplomas and certificates.

NATIONAL CENTER FOR HEALTH INFORMATION. 2022. Annual reports for 2022. [online]. NCZI [cit. 2024. 08. 20]. Available online: https://www.nczisk.sk/Pages/default.aspx

Medical journal. 713 general practitioners were missing in Slovakia last year, according to the ÚDZS, the situation is alarming. [online]. ÚDZS [cit. 2024. 07. 10]. Available online: https://zdravotnickydennik.sk/2024/07/na-slovensku-vlani-chybalo-713-vseobecnych-lekarov-podla-udzs-je-situacia-alarmujuca/

Žilina self-governing region: Press release. Without a systemic solution from the state, there is a risk of deterioration of patients' access to health care [online]. Žilina: ŽSK [cit. 2024-04-17]. Available online: https://www.zilinskazupa.sk/sk/aktuality/aktuality/bez-systemoveho-riesenia-zo-strany-statu-hrozi-zhorsovanie-pristupu-pacientov-k-zdravotnej-starostlivosti.html