ICU Management & Practice, ICU Volume 11 - Issue 4 - Winter 2011/2012

Anaesthesiology and Intensive Care in Bulgaria

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Zlatina Alexieva, MD
Department of
Anaesthesiology and
Intensive Care Medicine
Military Medical Academy
Sofia, Bulgaria

Nikolay Petrov, MD
Department of
Anaesthesiology and
Intensive Care Medicine
Military Medical Academy
Sofia, Bulgaria

The accession of Bulgaria as a member of the European Union in 2007, has meant that in recent years, there is an increasing drive to reset Bulgaria’s healthcare system along the lines of the other EU member states. However, such modernisation is not easily arrived at. The recent and ongoing instability in the political environment engendered by the severe economic crisis and frequent changes in the political climate present healthcare centres in Bulgaria with the challenge of providing their patients European quality healthcare services with limited and often insufficient resources. This challenge applies particularly to hospital departments that provide high-cost medical services such as the departments of intensive care and anaesthesiology, and which we focus on in this article.


Organisation of Anaesthesiology and Intensive Care

The Bulgarian Ministry of Health defines how the clinics of anaesthesiology and intensive care are organised. Departments of anaesthesiology exist either as independent clinics within general hospitals for active treatment, located in every major city in the country, or as separate units appended to other clinics such as neurology and cardiology depending on the needs of intensive care in each particular hospital. There are currently five medical universities in Bulgaria with academic departments in anaesthesiology and intensive care in Sofia, Plovdiv, Varna, Pleven and Stara Zagora.

Statistics from recent years show that the average annual number of incoming patients in intensive treatment in Bulgaria is around 77,000. Of those 46,000 will be discharged, 9,000 pass away, and the remaining transferred for further treatment to other departments. Specialists in anaesthesiology and intensive care are responsible also for the transport of critically ill patients in and outside Bulgaria. Specialised anaesthesiology and resuscitation teams participate in peacekeeping missions in Iraq and Afghanistan.


Staff Shortages & Economic Migration

Currently, the number of anaesthesiologists/ intensivists in Bulgaria is around 700, which amounts to roughly two percent of the total number of doctors in the country. There is one anaesthesiologist per 10,000 patients, which is highly insufficient for the needs of the territory. Understaffing is one of the most serious issues anaesthesiology and intensive care in Bulgaria faces. The primary reasons noted for the deficit in staff are low pay and heavy workloads on medical staff in these units. Understandably, a significant percentage of trained anaesthesiology professionals choose to continue their careers abroad.

Another problem stems from the inadequate funding of the anaesthesiology and intensive care units by the State. As there is a lack of follow-up centres (i.e. rehabilitation centres, homecare, etc.) for further treatment following patient discharge, patients’ length of stay in ICU is prolonged, despite the fact that their condition is no longer life-threatening. Thus an additional burden is being placed on ICUs’ already inadequate budgets.


Goals and Future Challenges

There are several goals that the Society of Anaesthesiolgists in Bulgaria have set out to deal with existing and anticipated challenges in the field in the years to follow, that fall into three categories.

1. Scientific and Human Resource Development

• Enhance and develop qualifications and continuous training of existing staff;

• Retain current medical professionals and encourage addition of new specialists.

2. Optimisation of Funding

• Improve existing facilities and purchase modern equipment;

• Attract funding on project basis under EU programmes, and

• Ensure adequate valuation of medical services performed by anaesthesiology and intensive care units.

3. Reorganisation

• Redirect personnel to regional medical facilities depending on the demographic profile of the particular region.



Anaesthesiology and intensive care have a long tradition in Bulgaria and it is a highly respected profession. In their practice, Bulgarian anaesthesiologists and intensivists are confronted with many problems. Nevertheless, our specialists manage to develop and drive growth in accordance with the leading trends in Europe and worldwide.

Evidence of the enthusiasm with which Bulgarian anaesthesiologists and intensivists work and develop, are the regular congresses which enjoy international participation, organised by the Society of Anaesthesiologists in Bulgaria. The 17th edition of this congress took place in late October 2011 in Plovdiv. More than 600 doctors from Bulgaria and around the world participated.

Zlatina Alexieva, MD Department of Anaesthesiology and Intensive Care Medicine Military Medical Academy Sofia, Bulgaria <br> Nikolay Petrov, MD Departmen

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