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

by JOANNA KAKISSIS

December 23, 2013 6:17 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."

http://www.npr.org/blogs/parallels/2013/12/23/247530831/with-its-economy-hobbled-greeces-well-educated-drain-away