Shortage of Pediatricians: Severe Deficit in Sofia and Across the Country

A challenge that nearly every parent in Bulgaria—especially in Sofia—faces is finding a general practitioner for their newborn child, as pediatricians are critically scarce. Currently, there are only 1,445 pediatricians in the country, with just 276 practicing in Sofia. However, the issue is not limited to numbers alone; the working conditions for pediatric professionals are also deteriorating.

On April 14, doctors from the pediatric department of the Fifth City Hospital in Sofia resigned due to low pay. Several pediatric units across the country were closed last year for similar reasons.

Maya Petkova began her search for a general practitioner for her unborn son as early as the fifth month of pregnancy, based on her difficult experience with her first child.

"I probably contacted six or seven pediatricians, and all of them declined. Eventually, I found one, but she was overwhelmed—we had to wait for hours, so I voluntarily left. This time, we were very lucky; we found someone before the baby was born," Petkova shared.

The number of general practitioners willing to care for children is steadily declining, while the overall number of GPs is already insufficient.

"For many years, there were no training slots for general practitioners. Legal and administrative hurdles prevented young doctors from entering the field, and over time, this led to a severe gap in the profession," explained pediatrician Dr. Alexander Atanasov.

"Many GPs don't want to work with children, and understandably so—they aren't specially trained in pediatrics. In fact, for a ten-year-old child, only one preventive check-up per year is reimbursed by the National Health Insurance Fund (NHIF); all other visits are unpaid. So even if the child visits five times a day, the GP is paid nothing extra. In most European countries, pediatric outpatient care is handled exclusively by pediatricians," added Assoc. Prof. Dr. Yordanka Uzunova of the Bulgarian Pediatric Association.

In order to have someone to examine their children, parents often directly seek the help of paediatricians. For Sofia, in theory, they are enough. In practice, however, very few of them work with the Health Insurance Fund. So parents are forced to pay.

"A large number of colleagues don’t work with referrals at all and operate solely on a private basis, which forces parents to pay for every visit—something that’s neither ethical nor socially sustainable. Those who can afford private health insurance visit designated medical centres, pay 150–200 BGN per appointment, and then get reimbursed by their insurer. These physicians are far better compensated," said Dr. Atanasov.

This underfunding by the NHIF is turning pediatric care into a luxury for many Bulgarian families.

According to the Ministry of Health, steps are being taken to increase the number of pediatricians. However, experts agree that the lack of timely policy planning and investment in medical specializations has already created long-term issues that will take years to resolve.