College of Physicians calls for government reforms: on-call duties paid at 2017 salary levels

The Romanian College of Physicians (CMR) has sent a public letter to designated Prime Minister Luca Niculescu calling for the inclusion of urgent healthcare measures in the governing programme: updating on-call pay, attracting doctors to underserved areas, and guaranteeing safe working conditions in hospitals. The document was also sent to representatives of the political class.

The CMR highlights that, despite it now being 2026, on-call shifts continue to be remunerated based on the basic salary from 2017. The organisation also presents the findings of a sociological study showing that more than two thirds of resident doctors face overwork, lack of resources, and precarious working conditions.

The letter is signed by the CMR President, Prof. Dr. Cătălina Poiană, on behalf of the Executive Bureau, and sets out seven areas of intervention for the "Healthcare" chapter of the governing programme. Alongside issues relating to medical staff, the proposals address service funding, patient care coordination, prevention of medicine shortages, and the drafting of a new Healthcare Act and a Medical Profession Act. The CMR states that these proposals are put forward in accordance with its statutory remit, as defined by Law No. 95/2006.

On-call pay stuck at 2017 rates

The CMR calls for legislative amendments to ensure that pay for on-call shifts performed beyond the statutory working hours is calculated on the basis of the current basic salary, with appropriate funding guaranteed. The letter states: "Nevertheless, applying in 2026 an hourly rate based on the 2017 basic salary does not constitute behaviour that treats doctors in Romania with respect and dignity."

The organisation points out that the current mechanism, which relies on part-time individual employment contracts for on-call duties, limits payment for hours that in practice constitute overtime. The CMR invokes European Directive 2003/88/EC on the organisation of working time, as well as Articles 120, 122, and 123 of the Labour Code, concerning overtime and its compensation through paid time off or salary supplements — rules which, the CMR argues, are not being observed in the case of doctors working in the public system.

According to the College, updating on-call pay could improve patient access to medical services without significant financial cost, but the measure must be properly budgeted for. The CMR also calls for strict compliance with statutory working hours and rest periods, including post-call rest, through scheduling arrangements that do not compromise continuity of patient care.

93.7% of resident doctors willing to work in underserved areas

The CMR considers the balanced distribution of medical staff a priority and calls for the implementation of the Multiannual Strategy for Health Human Resources Development 2022–2030 (Government Decision No. 854/2022). Post planning should take into account active staff, vacant positions, demographic trends, and the real needs of the population. The number of residency places should be aligned with specialist requirements, through collaboration between the Ministry of Health, the Ministry of Education, and medical universities.

The organisation also proposes dedicated programmes, developed in partnership with local authorities, to attract and retain doctors in communities experiencing staff shortages.

According to a sociological study conducted by the CMR in 2026 among resident doctors, 93.7% of respondents said they were open to working in less attractive or medically underserved areas, whilst 6.3% categorically refused this option. The CMR notes: "Young doctors are not asking for privileges or disproportionate advantages in exchange for making this choice — they are asking for basic guarantees that will allow them to practise their profession under conditions of clinical safety and human dignity."

Conditions required by resident doctors to accept a post in an underserved area, according to the study:

• adequate infrastructure and medical equipment — 86.7%
• well-trained teams and a positive organisational environment — 81.3%
• attractive salaries or significant allowances — 79.6%
• career development and advancement prospects — 76.9%
• funded continuing education courses — 68.9%
• contractual stability and respect for employment rights — 67.4%
• employer-provided accommodation or subsidised rent — 65.9%
• reimbursement of travel costs — 59.3%

Additionally, 33.5% of respondents prefer fixed-term contracts with the possibility of relocation thereafter. The CMR calls for these needs to be translated into a national incentive package and has offered to share data on the distribution of doctors by county and specialty.

Basic shortfalls in hospitals: computers, functioning toilets, post-call rest

According to the same study, more than two thirds of resident doctors report a working environment characterised by overwork, lack of resources, and structural deficiencies. The CMR flags the systematic failure to observe certain statutory rights, such as rest days following on-call shifts, as well as the absence of basic equipment.

The organisation calls for the regulation of workload and the appropriate sizing of teams and on-call rotas in line with each unit's profile and the complexity of cases.

The study data show:

• 96.8% of respondents need functioning computers with up-to-date software
• 96.5% need access to a desk and a computerised workstation
• 96% require functioning and properly equipped toilet facilities
• 95.1% require constant access to disinfectants and hygiene supplies
• 92.6% stress the need for guaranteed access to essential devices such as blood pressure monitors, pulse oximeters, and scales
• 92.5% require a dedicated on-call room for resident doctors
• 91.9% require an adequate space for breaks and meals
• 91% report insufficient space for professional activities
• 87.6% highlight the importance of having their statutory right to a meal break respected

Funding calculated on actual costs

The CMR calls for a transparent methodology for the periodic assessment of the actual costs of medical services, as well as a clear timetable for reviewing funding and reimbursement mechanisms. Calculations should include expenditure on staff, medicines, medical supplies, utilities, and equipment maintenance, taking into account the complexity of cases and population needs.

The organisation demands that any additional service or responsibility imposed on hospitals be accompanied by an assessment of its financial impact and the identification of funding sources, along with predictable allocations and compliance with statutory reimbursement deadlines. Investment in infrastructure should be accompanied by staffing and maintenance plans covering the full period of use.

A coordinated pathway between GPs, outpatient services, and hospitals

The CMR proposes strengthening primary care through adequate and predictable funding, as well as expanding prevention activities, early detection, and chronic disease monitoring. Further measures include: the equitable distribution of out-of-hours care centres, updating the tariffs for on-call duties at these centres to 2026 levels, and developing specialist outpatient services through additional staff, equipment, and funding.

For hospitals, the CMR proposes adapting services to the real needs of the population, developing day-case care where medically justified, and reducing avoidable admissions through functional alternatives. Coordination between levels of care should be ensured through clear referral pathways and secure exchange of medical information, in compliance with data confidentiality requirements.

Following discharge, patients should have access, according to their needs, to monitoring, rehabilitation, home care, and palliative care. The CMR emphasises that any reorganisation of hospital capacity must be assessed from the perspective of patient access, safety, waiting times, avoidable admissions, readmissions, and costs.

Alerts for medicine shortages

The CMR calls for the integration of stock reporting and medicine shortage alert mechanisms into a functioning national system, with clearly designated responsible parties and defined response deadlines, in order to prevent situations where patients are left without essential treatments.

The CMR letter also contains proposals regarding the drafting of two new pieces of legislation — the Healthcare Act and the Medical Profession Act — as well as changes to the way in which medical liability is regulated.