Ana (real name known to the editorial staff), a second-year student at the Faculty of Economics in Podgorica, received, when she began her studies, from her chosen pediatrician at the Pljevlja Health Center (DZ) all the necessary documents for accommodation in the student dormitory. After the pediatrician retired, this girl and three of her friends were left without a chosen doctor, because the Pljevlja Health Center simply does not have enough staff. Ana, who usually suffers from chronic sore throats, often has to be examined and receive therapy.
"When I first went to the DZ, after my doctor retired, I was barely admitted to the doctor on duty at the insistence of the nurse who assessed that the examination was necessary," Ana tells Center for Investigative Journalism of Montenegro (CIN-CG).
"The doctor was angry with the nurse for taking my health card. In the end, I felt it was my fault for being sick, even though the problem was in the system that left me without a doctor of my choice...", says Ana.
Currently, 28 doctors work at the Pljevlja Health Center, although the systematization provides for 40. The shortage is evident in almost all specialties: three selected doctors for adults, three pediatricians, two gynecologists, two psychiatrists, one internist and one pulmonologist.
"Demographic projections warn that, due to negative natural growth and migration trends, the north of Montenegro will be particularly affected by a shortage of personnel, while the central and coastal regions are recording population growth," the Ministry of Health (MoH) told CIN-CG.
Health centers face shortage of medical staff
CIN-CG, through the Law on Free Access to Information (FOI), collected data from all health centers in Montenegro on the lack of specialized medical staff in these primary health care institutions.
According to an analysis by CIN-CG, Montenegrin health centers are missing an average of about 20 percent of the medical staff required by the systematization.
The most critical situation is in the Mojkovac Health Center, where 50 percent of the planned number of doctors is missing. In Pljevlja and Bijelo Polje, the shortage is about 30 percent, while in Bar, Kolašin, Nikšić, Rožaje and Ulcinj, an average shortage of about 26 percent of doctors is missing. Budva and Herceg Novi also record above-average shortages.
CIN-CG's analysis shows that the biggest shortage is of adult doctors (34 in total, 10 of which are in Nikšić), followed by pediatricians (29) - only one of the three planned pediatricians is working in Ulcinj, and Nikšić and Bar each lack four pediatricians.
The Capital City Hospital is missing four pediatric specialists from the service selected for children, as well as one pediatric specialist in the Center for Children with Special Needs.
Gynecology and obstetrics, as well as occupational medicine, also record a significant shortage, with 11 doctors missing in each of these fields.
Number of family medicine doctors below European average
From the department Vojislav Šimun They told CIN-CG that in 2024, a total of 393 elected doctors worked in Montenegro (273 for adults, 83 for children, and 37 for women).
"This means that there are approximately 63 elected primary care physicians per 100.000 inhabitants," the Ministry of Health said. The number of elected primary care physicians is among the lowest in Europe.
The latest available data for comparing the number of doctors by country are Eurostat statistics from 2022. According to Eurostat data from 2022, Montenegro has 51,8 general practitioners per 100.000 inhabitants and is at the bottom of the list, right after Greece.
"The Netherlands was at the top when it came to the ratio of general practitioners, 183,4 per 100 thousand inhabitants, followed by Ireland (174,1), Austria (146,1) and Cyprus (137,7). In contrast, the lowest ratio was recorded in Greece (licensed doctors) with 45,8 per 100 thousand inhabitants, followed by Bulgaria (59,8), Sweden (62,2, data from 2021) and Slovenia (68,8), while Hungary was very close with 68,9," Eurostat data from 2022 show.
According to data provided to CIN-CG by the Ministry of Health, the shortage of family medicine doctors in Montenegro is particularly pronounced in larger urban centers, where the ratio of the number of doctors to the population is significantly below the national average (-41 percent in Podgorica, -38 percent in Nikšić), while in some smaller municipalities, such as Plav or Mojkovac, the situation is better than average.
"This clearly shows that the biggest challenge is posed by larger centers, where the need for doctors is greatest," the Ministry of Health told CIN-CG.
The Ministry stated that it is trying to solve this problem through a more even distribution of residents and the planned hiring of new staff.
The functioning of health centers is threatened by a lack of doctors
Health centers often lack doctors of various specializations.
Mental Health Centers currently lack nine psychiatrists, while internal medicine clinics at health centers lack nine internal medicine specialists. In the centers for pulmonary diseases at health centers, a total of seven positions for specialists, pulmonologists and pneumophthisiologists are vacant.
Some organizational units of health centers cannot operate because there are no specialist doctors to cover the only systematized position.
"One epidemiologist has been systematized in the Hygiene and Epidemiology Service, and that position is vacant," the Kotor Public Health Service told CIN-CG.
"The regulations stipulate: one pneumophthisiology specialist - not filled; one hygiene specialist - not filled; one sports medicine specialist - not filled; one occupational medicine specialist - not filled...", they told CIN-CG from the Ulcinj Public Health Center.
Occupational medicine services cannot be on duty in health centers in Bijelo Polje, Budva, Bar, Ulcinj, Kolašin and Cetinje. Sports medicine services are missing in health centers in Bijelo Polje, Berane, Nikšić, Ulcinj and Cetinje.
Montenegro among countries with the lowest number of doctors in Europe
According to data from the Institute of Public Health of Montenegro, in 2024 there were 285 doctors per 100 thousand inhabitants.
"This is a significant improvement compared to 2010, when the rate was 205, but it is still below the European average of around 380 doctors per 100 inhabitants," the Ministry of Health told CIN-CG.
This data is confirmed by the international report Health Systems in Action: Montenegro: 2024 edition, published in 2025 by the European Observatory for Health Systems and Policies and the Regional Office of the World Health Organization (WHO), the number of doctors and nurses in Montenegro is still significantly below the average of the European Union (EU) and the countries of the South-Eastern Europe Health Network (SEEHN: Albania, Bosnia and Herzegovina, Bulgaria, Israel, North Macedonia, the Republic of Moldova, Romania and Serbia).
"The average in the EU is 412 doctors per 100 thousand inhabitants, while in SEEHN countries the average is 312 doctors per 100 thousand inhabitants," states the report of the European Observatory at the WHO.
"In the coming period, the Ministry of Health plans to continue increasing the number of residents, strengthening the education system, employing young doctors, and improving working conditions in health institutions. At the same time, due to the pronounced process of population aging and the fact that Montenegro is entering a phase of deep demographic aging, special attention will be paid to the development of geriatric capacities, preventive programs, and specializations for chronic diseases, in order to ensure the long-term sustainability of the health system," the Ministry of Health told CIN-CG.
Factors influencing the departure of medical staff
According to the records of the Union of Medical Doctors of Montenegro (Union), from 2014 to 2018, around 100 doctors left the state healthcare system.
"Out of 100 of them, as many as 52 left Montenegro and found employment abroad, while the rest of the doctors continued their work engagement within the private sector," the union told CIN-CG.
However, according to the same sources, from 2018 to the end of 2024, 78 doctors left the country and found employment in other countries.
"This figure is partial because it does not include the youngest doctors, who left immediately after completing their studies, without first obtaining a license in Montenegro. So the number is certainly higher," the union said.
The outflow of medical staff is a problem that also affects other European countries, and improving working and living conditions is key to retaining professional staff.
The Ministry of Health claims that the data shows an increase in the total number of doctors, from 1275 doctors in 2010 to 1726 in 2022, which represents an increase of over 35 percent.
"However, the overall migration balance of Montenegro in the period 2011–2021 was negative (- 7622 persons), with the majority of migrants being young and middle-aged workers. This indirectly indicates the risk of losing part of the medical staff, as well as the uneven distribution of doctors, as internal migration additionally burdens central and coastal municipalities. The Ministry recognizes the need to establish a precise monitoring system and is working to develop such a mechanism," the Ministry of Health said.
Systemic, professional and economic factors
According to the experience of Dr. Zane Blagojevic, a radiology specialist who left Montenegro in 2017, the departure of medical staff from the country is the result of a combination of systemic, professional and economic factors. At the time of her departure, at 40 years of age and with 13 years of work experience, Dr. Blagojević was at full professional strength, eager to improve and contribute to Montenegrin healthcare.
The main reasons he points out are: nepotism and corruption, which are reflected in hiring, granting specializations and promotion, often according to the principle of "the fit and the obedient"; poor working conditions, including a lack of basic equipment, outdated infrastructure and overload with administrative and political tasks; limited opportunities for professional development, as training programs are underfunded and often based on family or friendship ties. The reason is also low salaries.
"At the time of my departure from Montenegro, my salary, including all allowances, was 600 euros net! I don't think I need to explain this further," Blagojević explains.
There is also uncertainty and instability, both economic and political, which further demotivates staff.
Additional factors include increased workload, pressure for a large number of examinations and global demand for medical workers in the EU, where better working conditions and opportunities for professional advancement are offered. Dr Blagojević points out that the differences in equipment, infrastructure, workload and work organization between Montenegro and countries like Slovenia make leaving easier and more attractive.
She emphasizes that preventing the outflow would require extensive reforms, including improving working conditions, modernizing equipment, decentralizing health centers, transparent recruitment, reducing workload, supporting young doctors, and international cooperation. In the long run, these measures would not only retain staff in the country, but also improve the quality of healthcare for all Montenegrin citizens.
The experience of a young doctor who left Montenegro
CIN-CG got in touch with Paul (real name known to the editorial staff), a young doctor, a specialist in ophthalmology, who left Montenegro immediately after completing his studies and began his professional engagement in Croatia.
When asked by CIN-CG whether he would return to Montenegro, Pavle replied that the key conditions for returning would be improved working conditions for medical staff, better equipment in hospitals, higher salaries, and the introduction of technical innovations in everyday work.
"In Western Europe, a lot is invested in ensuring that both medical staff and patients are satisfied. The working atmosphere for medical staff is very important (these are also important issues that the union, which has a strong influence, is dealing with). Medical staff must not be allowed to be overloaded, because then, of course, they will not be able to help those who need help," Pavle told CIN-CG.
The Ministry of Health told CIN-CG that analyses show an increase in the administrative burden on doctors, with the number of non-medical workers per 100 medical workers in outpatient healthcare increasing from 23,3 in 2010 to 24,3 in 2022.
"In order to relieve the burden on selected doctors and dedicate more time to patients, the Ministry plans to strengthen administrative support, better manage human resources, and further digitize processes," the government department said.
They add that, due to the aging population and the growth of chronic diseases, the administrative and medical burden will be even greater, and that they are working on introducing digitalized patient registries, better coordination between healthcare institutions, and hiring additional non-medical staff to take on administrative duties.
Unorganized organization and necessary digitalization: what we can't see, we can't control
According to the Doctors' Union, the key problem with the public healthcare system is its chaotic functioning.
The Union believes that the lack of a unified information system, as well as a quality control system, is a major shortcoming. "There is no unified information system from which we can draw data on the number and type of services provided in a precise and reliable manner. All the work of the private sector, which, according to WHO data, is not small and accounts for between 36 and 40 percent of total health spending, is completely invisible to the system."
Out-of-pocket health care costs are particularly significant. In 2021, public expenditure per capita on health in Montenegro amounted to 1.492 United States dollars (USD), adjusted for purchasing power, which is higher than the SEEHN average (1.316 USD). Private expenditure, primarily through out-of-pocket payments, amounted to 929 USD per person, which exceeds the EU average (799 USD), upper-middle-income countries (UMIC) (619 USD) and SEEHN (661 USD).
"We don't know where the number of complications during treatment has increased, in order to improve practices. We use raw data, how many services were provided, and we don't know whether eight out of 10 services were associated with a preventable complication. What we don't see and don't identify, we can't improve. The problem is the lack of a quality control system," the Union warns.
Budgetary policies in healthcare
After the introduction of the economic program "Europe Now 1" in 2022, health insurance contributions were abolished, and the Health Insurance Fund of Montenegro (the Fund) is no longer financed from these contributions. Instead, its financing is provided from the budget, which is filled through direct and indirect taxes.
However, the Fund proposed a budget of 535 million euros for 2025, but 80 million less was approved, and the rebalance has not yet been implemented.
"Given the importance of the smooth functioning of the healthcare system for the entire country, we warned in time that problems could arise due to the lack of funds," the Health Insurance Fund of Montenegro points out.
The Government and the Ministry of Finance quickly allocated an additional 18 million euros for Montefarma's needs in 2024. The Government also took on the responsibility of financing capital investments in healthcare, which the Fund planned at around 20 million euros for 2025.
"The current difference between what the Fund requested and what was approved is around 40 million euros, and we still believe that this amount will need to be provided through a rebalance in order for the Fund to meet all its obligations," the state fund said.
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