In a Box

Comedians seem to be the voice of reason. Maybe because they actually philosophize about life and are able to mock the wrong in people in a way to make people laugh. George Carlin was one of the masters of modern philosophy.

Most everyone in Croatia, who I have met, says the problem is me and not them; the culture, the society.

Instead of practicing tolerance and letting me be me, and nurturing my skills, these people making up that society impose their language, food and culture upon my established personality. People are afraid of what I can do when I am let loose. Only in the USA did they let me loose, and at the age of 21, I made my pharma clinic almost 4x more profit; from 1.2 million dollars to 4-5 million dollars per month. That was after one month in the company. Just imagine how much further I could have gone if the economy didn’t go to $h!t, due to the attack on Wall Street.

Croatia held me back.

Everything I did to make every clinic at which I worked more ergonomic was met with criticism (even though they use it that way now, and even take credit for it). The concept of ergonomics is lost in Croatia, but it was a psychology course at NC State University. I didn’t grow into this naturally; I was taught how to think and to create an environment with the most efficacy.

Like most US universities, I went for one major and was allowed to (and encouraged to) explore outside my major. I took electives from psychology to cinematography to choir to orchestra. Even physical activity is encouraged in all majors, in which I did triathlon class and club, and outdoor survival training.

I could advance in classes, and followed my pace instead of being held back like in the Medical College at the University of Zagreb. Since the pace was slow, I could come in drunk, sleep through class, and still maintain a B average.

At NC State, I finished my biochemistry course load by end of 19-years-old (I entered university at 17) and was able to teach biochemistry to my peers as an undergrad! I was one of two undergrads advanced enough to be able to teach the course. The other was Bryan.

The sky was the limit! Until I encountered the Croatian culture, and was mentally bashed into subservience.

Malaysia, I’m disappointed to say, doesn’t work on innovation either. They earn money by selling raw resources, but not manipulating them. People are so comfortable here that they can concentrate on hedonism, and leave the responsibilities of the world to others.

Those others happen to be people like me.

A Fight for Equality!

Important Legislation

From The Constitution of the Republic of Croatia:

Protection of Human Rights and Fundamental Freedoms
1. Common Provisions

Article 14
All persons in the Republic of Croatia shall enjoy rights and freedoms, regardless of race, colour, gender, language, religion, political or other conviction, national or social origin, property, birth, education, social status or other characteristics.
All persons shall be equal before the law. (1)

Introduction

Being a third national doctor in Croatia, an EU country, it is nearly impossible to be accepted for any position. Since Croatia’s accession in to the EU, there have been amendments to the ordinances governing third nationals in the country. I attended the full program at the University of Zagreb, Faculty of Medicine, did the one year internship, the state licensing exam in Croatian, and am now having difficulty obtaining a permanent license, as I do not have the same rights as Croatian or EU nationals despite my commitment to Croatia.

Background

In 2003, I moved to Croatia to attend the University of Zagreb, Faculty of Medicine. It was in English and originally a Harvard Medical International program that had the promise of being, “USMLE Included”. This is a very important fact that attracted a lot of students, because most medical graduates will have to spend around USD 10,000 to complete all three steps of the USMLE. Within the third year, the school dropped the program and adjusted to become compliant with the Bologna system.

I graduated on time in 2009 and decided to go back home to Malaysia only to find that the degree is not recognized. (2) After four months of being unemployed, I moved back to Croatia and applied for the internship, only to find out that I needed a Croatian Citizenship to:
1. Attend the internship,
2. Do the state licensing examination,
3. To be regularly licensed, and
4. To be able to specialize.

Dr. Jean Loup Gassend and I managed to amend the first in 2011 and the second in 2013, allowing the foreign graduates of the University of Zagreb to attend the internship and to do the state licensing examination. Dr. Gassend is a French national, which is a point that I will bring up later in this paper. Before Croatia joined the EU and all EU amendments to the laws took hold, I was allowed a license and easily obtained a job during the summer when doctors were lacking during peak tourist season. (3)

However after July 2013 when Croatia joined the EU, the laws changed and since I am a third national and would like to stay and work in a country missing 4500 doctors (4) and Croatian doctors are leaving for better opportunities (5,6) and, the only thing hindering me now are only the ordinances from the Ministry of Interior (7), which states that I need to have an minimal one year employment contract! Most employers, even within the Ministry of Health, will not give a contract longer than 6 months unless you are in a specialization. According to the Croatian Chamber of Medicine (HLK), a person from a third nation has no right to specialize in Croatia, (8) thus limiting the possibilities of advancing my career.

In the newly published proclamation from the HLK, in the “Pravilnik o izdavanju, obnavljanju i oduzimanju odobrenja za samostalan rad (licence)” (članak/article 21-29) (9), a person like me has no right to a full license due to my nationality despite:
1. Attending the University of Zagreb, Faculty of Medicine. (10)
2. Completing my internship at KBC “Sestre Milosrdnice” (11) in Zagreb, and
3. Passing the Croatian State Licensing Examination in on April 24, 2013.

This would not be a problem, but the health institutions have not caught up to European Union standards and still require many documents that a Croatian-graduated, third-national like me cannot obtain. The usual requirements to obtain a position:

“Uz pisanu zamolbu priložiti: životopis i presliku: diplome, licence, osobne iskaznice, potvrde o poznavanju stranog jezika i elektronski zapis ili potvrdu Hrvatskog zavoda za mirovinsko osiguranje o radnom stažu.”

“In addition to a written request, submit: resume and a copy of: diplomas, license, identity cards, certificates of proficiency in a foreign language and an electronic record or certificate from the Croatian Pension Insurance Institute of proof of employment.”
– Zavod za hitnu medicinu Grada Zagreba.

Another aspect to consider is the lack of the ability to specialize in Croatia for third nationals. According to the EU Directive 2013/25/EC (12), the equivalent to a General Practitioner in the EU is to have a specialty in Obiteljska Medicina or Family Medicine. Since I cannot specialize in Croatia due to my nationality, my career is blocked only by administration. I understand the need of compliance of qualifications between nations and schools before a specialization is given. However, my qualifications and license were obtained in Croatia, and in most EU countries, there would be no hindrance in obtaining further training only based on nationality if this was the case.

Looking after my future third national colleagues graduating from the University of Zagreb, Faculty of Medicine, I am also worried that since Croatia is lowering the length of internship to five months (13), this will not comply with the time of training needed for compliance with the EU Directive 2005/36/EC (14). Therefore, for third nationals, they are not qualified to practice after attending and completing their medical education in Croatia. In comparison, EU citizens have the right to a regular license once they finish their five month internship and will be compliant in the EU.

Conclusion

With the restrictions from the government and the global shortage of doctors, I cannot help but wonder why there are bureaucratic roadblocks in this profession. When I attended medical school, my thirst for knowledge and need to be a person who can eventually contribute to society peaked. However after graduation, with the lack of guidance, I was lost as a medical doctor and have been fighting the system to let me work with patients. I have the motivation to extend my knowledge and train in Internal Medicine, allowing me to work with a wide range of patients, diseases and make my impact on society.

Simply because of my nationality, I and many others in my position cannot formally apply for any position or find our direction in medicine. From all the articles and regulations, the future of medical care in the EU can be easily fixed by alleviating the differentiation between nations and its borders.

What Can You Do to Help?

Help me by emailing or sending a letter of concern, and by signing and sharing this petition.  I would appreciate any help in changing the policies that discriminate people from third nations who studied, interned and passed Croatia’s state licensing examination.  Read below at the responses from other Medical Chambers and if you want to help, I have put up the email list so that you can cut and paste.

Hopefully they will listen!

hlk@hlk.hr, hrvoje.minigo@hlk.hr, vjekoslav.mahovlic@hlk.hr, info@baek.de, registration@mcirl.ie, gmc@gmc-uk.org, conseil-national@cn.medecin.fr, info@bag.admin.ch, post@aerztekammer.at, info@collegemedical.lu, dadl@dadl.dk, yl@dadl.dk, fas@dadl.dk, plo@dadl.dk, ufl@dadl.dk, info@slf.se, medlem@slf.se, legeforeningen@legeforeningen.no, hege.gjessing@legeforeningen.no, marijan.cesarik@miz.hr, info@ombudsman.hr, malzgreb@kln.gov.my, info@indianembassy.hr, zagrb@international.gc.ca, gassend@gmail.com, mahsihye@gmail.com, aiffel.azman@gmail.com, smeetz@gmail.com, davorjezek@yahoo.com, pitajtenas@miz.hr