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As Belarus deals with a potential election controversy, the Czech Republic is facing a possible medical crisis. Fed up with shockingly low pay and long hours, doctors are threatening to leave the country en masse. More than a quarter of all Czech physicians have signed a declaration threatening to emigrate to better paying European countries unless the Czech government addresses their concerns by the end of the year. So far, the cash-starved health ministry is ignoring the warnings and moving ahead with cost-cutting plans.

From Decin, NPR's Eric Westervelt reports.

ERIC WESTERVELT: Thirty-three-year-old Dr. Peter Igaz has taken a leave of absence from the emergency room and these days, spends his time like some medical troubadour driving a surly old 1975 ambulance across the Czech Republic. He has a simple message: pay doctors more than a street sweeper. Keep us here. Painted on front and back of the battered ambulance are the words in Czech: thank you, we're leaving.

(Soundbite of a door opening)

WESTERVELT: Dr. Igaz is taking his message to hospitals and town squares, urging citizens to support the efforts of the doctors' union to change how physicians are treated and convince people that the threat to leave is real. He says smaller hospitals could be forced to close. He blames Czech government corruption, incompetence and communism's bitter hangover for the doctors' problems.

Dr. PETER IGAZ (Gastroenterologist): Doctors are so sick and tired of this situation. We are riding this ship to the bottom of ocean for long enough.

WESTERVELT: Over coffee at a cafe along the Elbe in the border city Decin, the gastroenterologist says nearly a decade into his career he makes only about 700 euros or $900 a month - enough to pay rent on a modest flat and food but not much else. The doctor often works 80 or more hours a week. The starting salary for a doctor in the Czech Republic is only $11,000 a year. It's a prestigious job, but we can't eat prestige, Igaz says, and warns that the Czech health system is falling apart.

Mr. IGAZ: I see that if I don't leave my job, I will just accept these terrible conditions and I will see the system collapsing with me. And this is the last call of desperate people who are still left here. Let's do something about it before it's really too late.

(Soundbite of people speaking foreign language)

WESTERVELT: In Decin's cold, snow-dusted town square, Dr. Igaz and another member of the doctors' union attract passersby with offers of free blood pressure screening. Next to a folding card table and two chairs stands a large cardboard cutout of a doctor with a clicking digital clock that reads -countdown to exodus.

(Soundbite of people speaking foreign language)

WESTERVELT: Anna Korlova, a heavy-set woman, takes advantage of the screening. She says she supports the doctors' reform efforts.

Ms. ANNA KORLOVA: (through translator) I'm afraid that more and more educated Czech people are leaving and moving abroad. I think the authorities should think about this and do more to help them stay. They should be paid more.

WESTERVELT: The Czech government largely dismisses the threat as a gimmick. Government officials say they want to raise salaries, reduce hours and improve conditions, but they say that's just impossible right now given the financial crisis.

Vlastimill Srsen, spokesman for Czech Health Minister, even sees a silver lining in the health care crisis: more work but additional pay for those who stay.

Mr. VLASTIMILL SRSEN (Spokesman, Czech Health Minister): (through translator) Yes, it's a problem if doctors leave but it will also allow us to raise the salary and benefits of those who do stay, not only of other doctors but of nurses and other hospital workers, too. I must say also that many are just threatening to leave, and we don't foresee that many will actually go.

WESTERVELT: But many, especially young physicians, insist they are serious. And with a current shortfall of 7,000 doctors, German health authorities are champing at the bit. At a recent recruitment fair in Prague, representatives from some 30 German and Austrian hospitals showed up, offering Czech doctors up to five times their salary for about half the hours.

Dr. Alexander Zaverka has worked for a dozen years as a gynecologist at Decin's big public hospital. He'd like to see more of his wife and two kids and a get a decent salary.

Dr. ALEXANDER ZAVERKA: What can I do? If I do nothing now, I will stay at this level for the rest of my life.

WESTERVELT: Dr. Zaverka says he's getting ready to send out resumes to hospitals in Germany, the U.K. and maybe Sweden. He says he'll likely give notice January 1st - thank you, I'm leaving.

Eric Westervelt, NPR News, Decin, Czech Republic.

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