Prof. Krzysztof J. Filipiak from CMKP: "I would not generalize the opinion about the reluctance of older specialists to educate younger ones"

Prof. Krzysztof J. Filipiak: There are currently too few doctors in Poland, even though we have reached a record number of medical students, seen through the lens of recent decades. In just a few years, 10,000 graduates will enter the system each year – that's a significant number. Some even voices, including those from professional self-government, claim that there are already too many students and this will result in an "overproduction of doctors" around 2034. However, this is only one opinion; the problem lies more in the efficiency of the healthcare system and the management of these doctors' time, their specialization in scarce areas, as well as the uneven distribution of medical personnel in Poland. I agree that we must focus on the quality of specialization training, and CMKP will also be moving in this direction. However, I wouldn't generalize the opinion about "older specialists' reluctance to train younger ones." If such signals appear regarding centers accredited for specialization, we will verify them.

KF: Mentoring culture is a separate issue, and the challenges it poses are a concern for many professions of public trust, not just physicians. I have very positive experiences of my own, both as a trainee and as a supervisor of many specialties in mentor-specialist relationships. These issues are also addressed by the ethical principles of professional associations, and I don't believe this is the most important issue in training. However, I share the view that it's necessary to motivate specialists – specialty heads. We've been talking about this for years, and for years we've been advocating for a larger financial pool for specialty heads.

KF: Again, I'd avoid generalizations. Hospitals vary, with different management and varying financial and staffing situations. It also varies significantly depending on the specialty. I agree that we're seeing extremes of the phenomena described: there are places where residents overstay their welcome, filling vacancies, even if not necessarily in places directly relevant to the specialization program, which can compromise the quality of training.

On the other hand, we hear from many disgruntled hospital directors who see residents avoiding additional medical duties as much as possible, instead pursuing them "across the street," in another facility, in another place that offers more attractive additional compensation. Does being on call non-stop at another facility for financial reasons impact the quality of their residency training? As usual, the truth lies somewhere in the middle. I'm not discrediting the opinions of my colleagues from the Residents' Agreement, but I'd prefer to discuss specific situations and resolve issues. We will evolve the system; many tasks lie ahead, and I promise to listen carefully to the voices coming directly from those conducting specialization training.

KF: Again, I wouldn't generalize, as the matter is a bit more complicated. This includes, among other things, the issue of requirements for the so-called European and Polish specializations, and the possibility of taking one or the other exam. Also important is the percentage of people retaking the same exam, having repeated problems with passing, which suddenly "increases" the percentage of those failing the exam in the overall pool of candidates. It's a bit more complicated in fields such as anesthesiology, urology, thoracic surgery, radiology, or ophthalmology. The PES issue is handled by a different institution than the CMKP, but of course, wherever controversies and suggestions arise, such as those in the question ("the system is actually failing"), we will examine the specialization programs and seek clarification from the national consultant and the CEM – Medical Examination Center.

If you ask me about my personal feelings about whether "the current exam model truly verifies knowledge and competence, or creates an additional barrier to entry into the profession," I'll answer this: when I was pursuing my cardiology specialization, I had to pass: a written exam, an oral exam, and a practical exam in ECG, coronary angiography, and echocardiography, which was part of the oral exam. Today, cardiology specialists, if they pass the test very well, no longer have to pass the subsequent stages. Is this really, in your opinion, a "barrier to becoming a cardiologist"? Also, adopting solutions unfamiliar to my generation of doctors—the ability to take the specialization exam before completing training and internships—facilitates, rather than hinders, entry into the ranks of specialists.

KF: This is a slightly more complicated issue. All analyses indicate that the greatest specialist shortages are in internal medicine, general surgery, medical rehabilitation, pulmonary diseases, pediatric surgery, infectious diseases, occupational medicine, and otorhinolaryngology, among others. The availability of pediatricians and family medicine physicians is increasing. Many people are specializing, and will soon join the ranks of specialists, in radiology, psychiatry, cardiology, and orthopedics. The demographic situation is changing – more and more people in an aging society will require oncological, geriatric, and neurological care. There will be less demand in obstetrics. Therefore, access to doctors in the system will vary depending on specialization and will change dynamically in the future. These data cannot be generalized to all of Poland. The largest number of doctors and specialists are in the Mazovia and Łódź regions. However, availability is much lower in voivodeships such as the Lubusz, Warmian-Masurian, and Opole regions. Interestingly, these three voivodeships typically have one medical school, and it's well known that graduates often pursue training and remain in the region where they graduated. In contrast, Masovia, which has the largest number of physicians, has five universities in Warsaw and three outside Warsaw. At least three more universities plan to open medical programs in the capital. This would bring the total number of universities educating physicians in Masovia alone to 11. Without delving further into these considerations, many different mechanisms need to be implemented to promote postgraduate education and specialization in underserved specialties, especially in areas where physicians are scarce.

KF: I'll mention four. First, the continuous improvement of the residency placement system, taking into account the projected specialist needs in a given region. Second, monitoring the quality of education at accredited institutions and responding to the monitoring results. Third, opening accreditation placements in regions with a lower physician density, while maintaining the quality of education. Fourth, increasing the pool of residency places in the coming years and enabling the selection of a second residency after completing the first, short-staffed residency: internal medicine and general surgery. These are just the most important planned changes. Many modifications are necessary in postgraduate education, and we will gradually implement them in consultation with all stakeholders.