6:16pm

Mon December 23, 2013
Parallels

With Its Economy Hobbled, Greece's Well-Educated Drain Away

Originally published on Mon December 23, 2013 6:54 pm

Thanos Ntoumanis and his wife, Laura, are crashing at his parents' apartment in Greece's northern city of Thessaloniki.

The couple have packed their home and are moving to Germany. Thanos, a 38-year-old psychiatrist, is joining some 4,000 Greek doctors who have left the austerity-hit country for jobs abroad in the past three years. It's the largest brain drain in three decades.

"I won't say that I'm never coming back," he says. "I do need some distance, though. I don't want to get to that tipping point. I don't want to get to that point where I hate it here."

"You'll come back," says his mother, Pepi Mavrogianni, trying to break the gloom. She's a retired pediatrician in a "Hippocratic Oath" T-shirt. She brings out a tray of warm cheese pies.

"And we have Skype, so we can talk every day if we want," she says.

Three of her four children became doctors, like her and her husband, a cardiologist. Now, due to a confluence of austerity and an overproduction of physicians, her kids are all working abroad.

"It's good to have your child nearby, but if he's not happy, what's the point?" Mavrogianni says. "You can't block their progress because you want him to stay."

Before the debt crisis hit Greece in 2010, Ntoumanis was an army psychiatrist with a modest salary — less than $2,000 a month — and also had a private practice that brought in a bit of extra money. He and his American wife lived in a cottage nestled in the hills outside Thessaloniki.

After 2010, when Greece took multibillion-dollar bailouts from the European Union and International Monetary Fund, the government was forced to cut the wages of public servants, including those in the military.

Ntoumanis' salary was cut by $500. With more than one-quarter of the workforce unemployed, his private-practice patients had less money. He struggled to keep up with rent on his office and skyrocketing taxes on his property and income.

"It was humiliating not to be able to pay for heating oil and have to borrow money from my parents," he says. "And we really didn't have many luxuries in life."

He also despaired as Greek society fractured, corruption continued to flourish, and no one offered a clear plan out of the crisis.

"If there is someone to lead and to say, 'Look, we'll go through this kind of hell, and we'll have to do these things,' I'd stay here," he says. "But there is no one."

In Greece, A Physician Surplus

For Ntoumanis, an escape came about a year ago when a young German headhunter contacted him on the social media service LinkedIn. She told him Germany needed doctors.

"The recruiter set up appointments with five different clinics," he says. "I interviewed at all of them. I was offered all five jobs."

It helped that Ntoumanis, like many Greek doctors, already knew German. He was born in North Rhine-Westphalia while his parents were doing their residencies there 40 years ago. He moved to Thessaloniki when he was 6.

He decided on a job in the lush, steepled city of Muenster, the same region where his younger brother Vassilis, also a psychiatrist, is already working.

The new job pays far more than what he was making as an army doctor in Greece. And he needs the money — he has to pay the Greek army the equivalent of $260,000 to get out of his remaining service.

"I had to leave," he says. "I wanted to prevent waking up one day, 50 years old, and still being in the same position ... like Groundhog Day."

Greece's economic collapse and its increasingly toxic social crisis aren't the only reasons Greek doctors are leaving, says Tassos Philalithis, a professor of social medicine at the University of Crete.

After a military dictatorship fell in 1974 and Greece returned to democracy, the government tried to expand its small middle class. Many Greeks chose medicine as a job of security and prestige.

"For the last 40 years, the number of new physicians in Greece has grown annually by a net of 1,200 physicians," says Philalithis. "We have surplus of gynecologists, a surplus of neurosurgeons. Greece itself has more neurosurgeons than the whole of Germany."

Because of the status and higher pay attached to specialized medicine, fewer Greeks have gone into family medicine or fields like nursing, he says, "and this is what we really need."

Students who don't matriculate into Greek medical schools study anywhere they can get in — even Uzbekistan — and return to Greece to work. Then they wait years to get spots in hospitals for specializations. "There are not enough jobs," Philalithis says.

In Germany, Departing Doctors Leave A Vacuum

Germany, on the other hand, needs doctors. Medical schools aren't graduating enough of them, and practicing doctors are retiring at the same time the German population is aging, says Dr. Alexander Jaekel, a policy adviser at the German Medical Association in Berlin.

"This means we are facing quite a considerable lack of doctors in at least 10 to 20 years," Jaekel says. "So there are job vacancies in Germany already, and this number of vacancies [will] slightly grow in the next couple of years."

Many German doctors are heading abroad, including to Scandinavia, where the hours are not as grueling. Thanos Ntoumanis' sister Eleni left Greece in 2006 to do her pediatrics residency in Sweden, and plans to stay there.

The number of Greek doctors moving to Germany has more than doubled between 2000 and 2012 — from 1,000 to 2,500, Jaekel says.

The day before Ntoumanis leaves for Muenster, his siblings and their families fete him with a farewell dinner at his parents' apartment in Thessaloniki.

His father, Pantelis, 68, is happy they're all here. He treats many of his patients for free — "I'm not going to turn them away because they don't have insurance and can't pay," he says — but that means he can't afford to fly to Muenster and Stockholm to see his kids.

The next day, Pantelis drives his son and daughter-in-law to the airport. Everyone is quiet.

Ntoumanis looks out the window for a last glimpse of the hills and sea. Outside the terminal, father and son embrace in silence, their faces both tight with sadness.

The night before, Pantelis' wife tried to convince him that the kids would move back to Greece in 10 years.

"Ten years is nothing," she said, taking his hand in hers. "Let's just hope it's not 50."

"Well," he replied, "I think it's going to be forever."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

German companies use to do very well by exporting products to Greece. That was before the deep economic recession that hit Southern Europe and hammered Greece especially. Now it's the Greeks who are exporting, not goods but their brightest people, including thousands of highly-trained doctors. And many are recruited by German clinics short on physicians.

Reporter Joanna Kakissis met one Greek psychiatrist and learned about his painful decision to leave his homeland.

LAURA NTOUMANIS: Today was a hard day.

THANOS NTOUMANIS: Today was a hard day. We're packing and yeah, closing the house.

NTOUMANIS: Closing the house so there was a lot of welling up, I guess.

NTOUMANIS: Yeah.

NTOUMANIS: On both of our parts.

NTOUMANIS: Yes.

JOANNA KAKISSIS, BYLINE: Thanos Ntoumanis and his wife Laura are staying for a couple of days at his parents' apartment in the northern city of Thessaloniki. Soon they will leave Greece for Germany, where Thanos, a 38-year-old psychiatrist will begin a new job. He joins some 4,000 doctors who have left Greece in the last three years.

NTOUMANIS: I won't say, you know, I'm never coming back or anything like that. I do need some distance, though, I think. I don't want to get to that tipping point. I don't want to get to that point where I hate it here.

KAKISSIS: His mother, Pepi Mavrogianni, brings out a tray of warm cheese pies. She's a retired pediatrician wearing a T-shirt with the Hippocratic Oath.

PEPI MAVROGIANNI: (Foreign language spoken)

KAKISSIS: We have Skype, so we can talk every day if we want, she says. Three of her four children became doctors, like her and her husband, a cardiologist. Now, due to a confluence of austerity and an oversupply of physicians in Greece, her kids have to work abroad.

MAVROGIANNI: (Through Translator) It's good to have your child nearby. But if he's not happy, what's the point? You can't block his progress because you want him to stay.

KAKISSIS: Before the debt crisis hit in 2010, Thanos made less than $2,000 a month as a psychiatrist for the military. He also had a private practice that brought in a bit of extra cash. But after international lenders forced Greece to cut public sector wages, in exchange for billions in bailout loans, that monthly salary was cut by $500. And with more than a quarter of the work force unemployed, his private practice patients had less money.

He struggled to pay rent on his office and skyrocketing taxes on his property and income.

NTOUMANIS: It was humiliating, OK, to not to be able to pay for heating petrol - heating oil, and to have to borrow money from my parents. Not to be able to do these simple things that defines self-sufficiency, really.

KAKISSIS: He also despaired as Greek society fractured and no one offered a clear plan to get out of the crisis.

NTOUMANIS: If there came someone to lead and to say: Look, we'll go through this kind of hell and we'll have to do these things, I'd stay here. I'd go through that. But there's no one.

KAKISSIS: An opportunity to escape came about a year ago, when a young German headhunter contacted Thanos on the social media service LinkedIn. The recruiter told him Germany needed doctors.

NTOUMANIS: The recruiter set up appointments with five different clinics. I interviewed at all of them. They were all very, very good, I thought.

KAKISSIS: All five clinics offered him work. It helped that Thanos, like many Greek doctors, already knew German. He was born in Western Germany, where parents did their residencies 40 years ago. So he has chosen a job in the same area, in the lush, steepled-city of Muenster. His younger brother, also a psychiatrist, is already working there.

In Germany were you offered a lot more money? Was that one of the things that attracted you?

NTOUMANIS: Yes, it was, especially in light of the huge debt I would have to pay off.

KAKISSIS: He must pay the Greek army the equivalent of $260,000 for leaving before his military service is complete.

But it's not like Greece is short of specialized doctors, says Tassos Philalithis, a professor of social medicine at the University of Crete.

TASSOS PHILALITHIS: For the last 40 years, the number of new physicians in Greece annually increases by a net 1,200 physicians. You know, we have a surplus of gynecologists, a surplus of neurosurgeons and we don't have primary care physicians. We don't have public health specialists.

KAKISSIS: As Greece rose out of poverty and dictatorship after 1974, people chose medicine for its job security and prestige. Those who did not get into Greek universities studied anywhere they could get in - even Uzbekistan, Philalithis says. Now there are too many of them.

ALEXANDER JAKEL: My name is Alexander Jakel. I'm a policy advisor in the International Department of the German Medical Association.

KAKISSIS: Alexander Jakel says Germany, on the other hand, has not had enough physicians. Medical schools are not producing enough of them, and practicing doctors are retiring at the same time the German population is aging.

JAKEL: This means we are facing a quite considerable lack of doctors in, well, at least 10 to 20 years. So there are job vacancies in Germany already and this number of vacancies is slightly to grow in the next couple of years.

KAKISSIS: Jakel says the number of Greek doctors moving to Germany has more than doubled in the last 13 years.

(SOUNDBITE OF CRYING INFANT)

KAKISSIS: The day before Thanos leaves for Muenster, his siblings and their families gather for a farewell dinner at his parents' house in Thessaloniki.

PANTELIS NTOUMANIS: (Foreign language spoken)

KAKISSIS: His father, Pantelis, the cardiologist, says these days he treats many patients these days for free. But that means he cannot afford to fly to Muenster to see his sons or Stockholm, where his daughter works as a pediatrician.

(SOUNDBITE OF A VEHICLE)

KAKISSIS: The next morning, Pantelis drives Thanos and Laura to the airport. Everyone is quiet. Thanos looks out the window for a last glimpse of the hills and the sea.

(SOUNDBITE OF A VEHICLE DOOR)

KAKISSIS: Outside the terminal, father and son embrace in silence, their faces tight with sadness. The night before, Pantelis' wife tried to convince him that Greece will recover and their kids will move back in ten years.

MAVROGIANNI: (Foreign language spoken)

KAKISSIS: Ten years is nothing, she said, holding his hand. Well, Pantelis replied, I think it's going to be forever.

For NPR News, I'm Joanna Kakissis. Transcript provided by NPR, Copyright NPR.

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