|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 3 | Page : 192-193
Ophthalmology training in Greece during its financial crisis: A need for change
Konstantinos T Tsaousis
Department of Ophthalmology, Friedrich Alexander University, Erlangen Nuremberg, Erlangen, Germany
|Date of Web Publication||28-Jan-2014|
Konstantinos T Tsaousis
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tsaousis KT. Ophthalmology training in Greece during its financial crisis: A need for change. Educ Health 2013;26:192-3
Greece has seen major problems in the quality of its medical training in the past  but the situation has been aggravated in the recent years. This decline is mainly due to two factors. The first is the remarkable increase in the number of Greek junior medical doctors that seek specialty training. According to the Organization for Economic Co-operation and Development (OECD), Greece has the highest doctor per capita ratio (6.1 practicing physicians per 1000 population) in 2010, almost twice the OECD average of 3.1.  The economic prosperity of previous decades combined with established stereotypes within vocational guidance given young Greeks led many to study medicine in either domestic or foreign universities. Admission into medical specialty training programs (internships) in Greece uses an out-of-date model with waiting lists based on the order that applications are submitted. Consequently, the wait for admission into internships has lengthened, up to as much as 10 years for specialties like ophthalmology.
A second cause for poor quality in Greek medical training has been the country's current financial crisis that has led to shrinking financial resources with a lack of equipment and consumables necessary for medical education, worsening training standards. , Most Greek ophthalmology departments lack sophisticated and modern equipment leading to deficient clinical practise and problems in training. Surgical training has been nearly impossible at some training centers. In addition, restricted funds prevent Greek residents from attending major international congresses, wet laboratories and courses.
All these have created a dysfunctional environment and affected the quality of training. This has led many Greek doctors to look for training opportunities abroad. As is the case for many sectors, the current financial crisis demands that new standards for medical training be created. The principal need is to preserve a good standard of medical care for the general population and simultaneously secure a strong quality of training for young medical trainees.
For the specialty of ophthalmology, one suggestion is to create an additional 2-year advanced training cycle focused on the surgical aspects of the discipline. After completion of the current first 4 years of training, graduates would be able to practice ophthalmology apart from performing intraocular surgeries, perhaps referred to as "conservative ophthalmology." The additional 2-year phase of training would take place in selected centers, and admission would be through Pan-Hellenic examinations that could be organized centrally every 1 or 2 years. Interested candidates would be eligible for this examination after successfully passing a demanding international assessment of their ophthalmology knowledge, such as through the European Board of Ophthalmology Diploma Examination. Given the country's current fiscal situation and Greek Parliament's commitment to austerity measures, a realistic approach would be to convert internship posts to "fellowships".
The advantages of creating a 2-year surgical ophthalmology fellowship are:
- Junior residents will focus on obtaining nonsurgical clinical skills without being distracted in the initial stages of their training by current nonstandard and sometimes poor quality surgical training approaches.
- Fellows will enhance surgical procedures within ophthalmology departments where there is currently a lack of specialists. Assisting in the teaching of residents in their first 4 years of training could a complementary assignment for them.
- A significant number of adequately trained ophthalmological surgeons will be created and available to staff Greek hospitals as consultants in the near future.
- Ophthalmology residents would gain no surgical experience in the first 4 years of training. The counter here is that presently trainees are sometimes not satisfied with their surgical training. Many ophthalmologists will not proceed to the surgical part of training and will practice conservative ophthalmology. This term is not official but does reflect current reality since few Greek ophthalmologists are active surgeons. 
- The 2-year training posts will not be well remunerated. The response here is that Greek ophthalmologists in the current fiscal crisis have two alternatives: Immigration or unemployment. Subsequently, an even not-so-well salaried additional training period would be financially more favorable.
In conclusion, there is a great need to improve the ability of the Greek healthcare system to meet its human resource needs. In ophthalmology, the creation of a new type of post for advanced training could improve current deficiencies in the surgical preparations of ophthalmologists. A dialog should take place with all interested parties but the call for direct action is fundamental.
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