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All right, so just curious, would you give us written permission to convert your matter into energy patterns and reassemble you at, say, random travel destinations? Margaret, are you building a teleporter? No. Yes. SAP Concur helps your business move forward faster. Learn more@concur.com hello, and welcome to Business Daily from the BBC World Service. I'm Joel Dummigan. Today we're heading to Bulgaria. It's a great honor and pleasure to welcome you to today's graduation ceremony of Class 49. The Eastern European country is establishing itself as a training centre for doctors from Europe and around the world. We have students from Greece, Turkey, then Italy and Germany, Canada, United States. Increasing numbers of students, particularly from the uk, are studying in Bulgaria because university places in their own country are so difficult to access. I got interviews, but I didn't get offers. So I just decided instead of taking a gap year and reapplying that I'd look at options abroad. But at the same time, the country's battling with a huge brain drain of clinicians, leaving its own health service short. At least a quarter of the students being trained in the field are leaving the country straight after the graduation. So as international competition for healthcare workers grows, what needs to be done to keep the world's hospitals and surgeries staffed in the future? That's all coming up on today's program. But we're not starting in Bulgaria. We're actually in a convenience store on a busy street in Bolton, a town just north of Manchester in the northwest of England. It's the sort of place you see on every other street corner here, and it's got everything from fruit and veg to cookware and crucially, a large selection of South Asian spices. Just before I go back, we normally shop around probably the more traditional cuisine stores. Mohammed Adnan Patel stocking up before heading back to Plovdiv in southern Bulgaria. In Bulgaria, the spices are more traditionally for them. So a lot of stuff that we make here and we take over just so we can get a taste at home. Mohammed's about to start his fifth year of his six year degree at Plovdiv Medical University, one of the best regarded institutions of its type in the country. It was a big shock to my family that I was not only studying medicine, but I was also studying it abroad. It's such a big step to be able to study medicine within the uk and then now I'm going abroad, living independently, doing it all without my family being around me. So were they worried about you? Yes, initially my mother was very worried. My father wanted me to stay strong and independent, but the rest of my family didn't know what to expect. Mohammed originally applied to medical schools in England, but he didn't get the grades to get in. Like many countries, Britain restricts the number of domestic students who can begin a medical degree each year because they're so expensive to fund. Even though each student pays fees in the uk, the estimated cost to the state to train each doctor is more than a quarter of a million pounds, around US$330,000. So because so few places are available each year, the competition to get one is intense. So I applied for universities here and I didn't get any offers. I got interviews, but I didn't get offers. Freya Mandapali lives in Preston, a small UK city, about half an hour from Mohammed. She's about to start her second year at the same Bulgarian university. So I just decided instead of taking a gap year and reapplying, that I'd look at options abroad. So I found Plovdiv through some family friends who are already studying there. Lots of international students tend to go there to study medicine and the course seemed pretty hands on from the start. Freya and Mohammed have joined an increasing number of students going to Eastern Europe and particularly Bulgaria to study medicine. Plovdiv is one of Europe's oldest cities. It's famous for its Roman ruins and it's quite a big tourist draw. Lots of pavement cafes and street performers. And about a 20 minute walk from all of that, there's the medical school. So I'm sitting in the middle of the campus. It's really pleasant, very green, lots of trees. A couple of cats lying about for some reason. Of course. Lots of students, many of them talking in English, but also other languages. Because this place attracts people from around the world. I'm from Canada. Whereabouts in Canada? Close to Vancouver. I'm from Germany, from Karlsruhe. I'm originally from India and I live in Dublin. I lived in Dublin all my life. So what's your name? Reina Hassegauer. And where are you from? Rin. Japan. That is a long way from Bulgaria. Yeah, exactly. It will take like 19 hours by flight. There are more than 7500 foreign medical students studying in Bulgaria and more than 1700 of them here in Plovdiv. We have students from Greece, Turkey. These are the neighbouring countries then Italy and Germany. Professor Vasilina Garanova is the Vice Rector for Education at the Medical University of Plovdiv, Canada, United States. But most of the students, about 40% come from UK. That's possibly not surprising given that the classes for international students are held in English rather than high grades. This institution requires applicants to pass an entrance exam. It's a six year course, the norm in Europe, but one year longer than in the uk. The diploma of the Medical University in Polit is recognized in Europe and in UK we have trained physicians and dental physicians and pharmacists who teach our national and international students and it's a strict regime. This morning I've come along to an anatomy class. It's looking at the workings of the nose and throat and the teachers busy demonstrating what's what on an embalmed head. It's one of several similar classes running now along this corridor. Attendance is compulsory and it's 7.30am there's some very early starts, aren't there? Yeah, for people that live further away from the university. We have to leave the house at seven to get here on time and we're usually in School till 6pm but we do have breaks that are two hours or three hours long in which we can go home or get something to eat. It's certainly not putting anyone off. This faculty takes on around 470 international students a year. Three years ago there were 700 applications. This year it was 1200. The fees are around €10,000 a year, just over US$11,500. It's a relatively small amount compared to costs for foreign students in many countries, but far more than Bulgarians pay. And that's proving a handy source of income for the university. The sound you can hear behind me is building work. They're going up everywhere here because this university is expanding rapidly. Everywhere you look, there's someone hammering or sawing. Danny Karunadas from Ireland, just starting his fifth year here and says it used to be very different. Over the past like five years, I've noticed that the university has constructed a new department for hygiene. It used to be a very, very small place. And the language department as well, that's also been done recently. They're constructing a new library. So the new students that do come along, they'll enjoy that a lot. That building boom extends well beyond the campus. Walk out in the streets which surround it and you can see new apartment blocks going up and all the adverts in English, 2000 people. They are mostly young people coming from Europe. They have better spending power, let's say. And then all the cafes and restaurants are filled by them around here. Erkan Altensoy works with New Vision Services, a lettings agency, finding homes for medical students. These apartments that we market here are higher in terms of the price level, but they are also well furnished because they want an apartment that they can move right in without having to look for some furniture or other things. So these are ready made apartments, from one bedroom to three, four bedrooms, because some prefer to share. And so there are different levels of luxury, if you like, from simpler to more luxurious. And do foreign students expect more luxury than Bulgarian students? Yes, of course, but also they can afford it because they have bigger budgets. The letting agents often work with other companies which have sprung up to help the new students navigate life in a foreign country. The countries that we work with are Bulgaria, Romania, Georgia, latvia, Poland, Malta. Dr. Mohammed Hamza works with MedConnect Europe. It's based in London, but we're speaking in the company's office in Plovdiv. Shortly before he's due to fly to Malta to look after another group of new arrivals, we get them in touch with the estate agents, we book the flights for them. Our representatives will be at the airport to collect them, take them to the hotels. We help them with shopping. So buying beddings, cutleries and essentially WiFi mobile SIMs, setting them up because they don't know the language. And we have representatives in each country that do know the language. It becomes so much easier. These agencies are now so widely used that students like Freya, who we met at the start of this, go through their whole university career in classes, decided by which group they flew over with. The agency put us in the groups of 12 and yeah, just stay with that group for the next six years. Does that make things easier because you've got that group of people right for the start? It does because we all got along from the start and, yeah, it worked out pretty well. This is the agency's peak period, the start of the academic year, when thousands of students are flying into Eastern Europe to begin their studies. Tonight, the team from MedConnect are welcoming a new batch fresh off the plane from London, along with their parents. So if I son wanted to do dentistry, he applied last year. Unfortunately, he was unsuccessful, but he got in this year. So I think he's apprehensive, but he's looking forward to it. And he knows a couple of boys here already. Barley Ryan, her son, have made the trip over from Derby in England. It was hard to get in the uk. It's very, very hard. Too competitive. It is good. It's taught in English. There's no conversion to do when you go back home, so. Or compliance. And now people speak quite highly of it, to be fair, when you read up about it. So, yeah, thought, yeah, he'll give it a go. And now it's come to the big moment. How do you feel? I feel more nervous. But no, I think it's the right decision. He can spread his wings and it's something that he wants to do. And I think if you want to do something and you're in the right place, achieve it. I'm sure you will. You're listening to Business Daily from the BBC World Service. And Doug, here we have the Limu Emu in its natural habitat, helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally, Doug. Uh, limu is that guy with the binoculars watching us. Cut the camera. They see us. Only pay for what you need@liberty mutual.com Liberty Liberty, Liberty Liberty Savings. Very underwritten by Liberty Mutual Insurance Company and affiliates. Excludes Massachusetts. Hiring isn't just about finding someone willing to take the job. You need the right person with the right background who can move your business forward. If you want candidates who truly match what you're looking for, trust Indeed sponsored jobs. With INDEED sponsored jobs, your post stands out to quality candidates who actually fit the role. According To Indeed data, 90% are more likely to be hired and trusted by 1.6 million companies. Spend more time interviewing candidates who check all your boxes. Less stress, less time, more results. Now with Indeed sponsored Jobs and listeners of this show will get a $75 sponsored job credit to help your job get the premium status it deserves@ Indeed.com podcast13 just go to Indeed.com podcast13 right now and support our show by saying you heard about Indeed on this podcast. Indeed.com podc13 terms and conditions apply. Hiring DO it the Right Way with Indeed. I'm Gill Dunmigan and today we're in the Eastern European country of Bulgaria, looking at the number of international students coming to study medicine and at concerns about staffing the country's own healthcare service. The Bulgarian government's keen to attract lucrative international students like these. Over the past decade, the percentage has doubled to more than 1 in 12 of all students. But while that's a success story in boosting the economy, the country's own healthcare service is proving more of a challenge. That's the sound of a protest by healthcare workers in front of Bulgaria's parliament building in the capital Sofia in June. There were similar demonstrations around the country and they've been going on ever since. The nurses. We were the first to demonstrate that we won't work anymore with such low salaries. Until recently, Milka Vasilova led the main union representing nurses and other healthcare professionals in Bulgaria, and the young doctors went with us together in front of the parliament to tell them that this must be changed. The model must be changed. The average monthly pay for a nurse at a state run hospital is around 1500 leuvres, about US$900. For a junior doctor, it's just under US$1200. That's far less than they can earn in neighbouring European countries. And so inevitably, many are voting with their feet. Even today, at least a quarter of the students being trained in the field are leaving the country straight after the graduation. Ralit Saganev is an associate professor at Sofia University with a special interest in the global competition for healthcare workers. They left the country because of the pay gaps, the workload, the equipment, the limited career paths. This combination of thriving healthcare education but poor worker retention is happening around many countries in Eastern Europe. And to fully understand why, you need to look to the past. I've just climbed more steps than I want to think about to the top of Plovdiv's most famous viewpoint. Fortunately, it's worth the effort. The whole city's laid out in front of me, the old town and the new. And looking out over it all is the statue Alyosha, the symbol of the Soviet Red Army, a reminder of Bulgaria's communist past. Communism provided free universal healthcare run by the state, and that calls for a large workforce. But at the same time, those communist principles meant that the wages for healthcare staff were modest compared to Capitalist countries where they could demand more. Under communism, Bulgaria spent decades and a lot of money building large stocks of nurses and doctors in a hospital centred state allocated system. When communism collapsed at the end of the 80s and a free market allowed free wages, many healthcare workers left for more lucrative jobs or for other countries. A process accelerated after 2007 when those same countries joined the EU. So since CEO accession mobility is easy money, go to Germany and France. And Germany now employs 68,000 foreign doctors. That's 15%. And in France that chair is 11, 13%. The result is a huge shortage of healthcare staff in Bulgaria, particularly younger workers. Here's union leader Milka Vasilieva. Again the number is about 30,000 nurses lack in Bulgaria. About 50,000 nurses are working in the richer countries. In Bulgaria now we have about 20,000 nurses working, but one third of them are in pension age. Which means that if tomorrow they decide to leave the system, the health care will collapse. The shortage is most acute in nurses and midwives. So to try to improve the situation, the government's made nursing degrees free for students and. And from this year they can also get bursaries for living costs from hospitals in return for agreeing to work for them for a certain number of years. They are signing the agreements right now. We have to wait for when they graduate and see how this will actually work. Professor Gannifer was one of those who advised the government to adopt the policy. Are you hopeful that all of this will help? I am Indeed. Today it's St. Sophia Day and her three daughters, Faith, hope and Love. Love. So I'm hopeful. But that still doesn't address the pull factor from other countries. Back in Plovdiv, the Medical University's vice rector for education, Professor Garanova, says that's trickier to solve. Every year we increase the number we. I mean in Bulgaria, all the medical universities increase the number of the students in nursing who are enrolled. For instance, when I started two years ago there were 80, now there are 150. But this is only the first step. And when they become nurses, get their diplomas, maybe they are disappointed from the conditions they work in the hospitals, the money they get for their job, and look for realization in different fields. The global population's aging, the demand for healthcare increasing, particularly in the richer countries. But economist Professor Alitz Aganeva says they're not the ones producing most of the workforce. Many rich countries chose for decades to under finance medical training. They have decided to rely on attracting doctors and nurses trained abroad. Everybody's fighting over the same people, aren't they? Yes, they are. This isn't just Bulgaria. It's a global race for clinicians. So I would say that in the next decades, nurses and physicians will be among the most valuable assets in global markets. Good news for the medical students here in Plovdiv. Maybe less so for the rest of us. Thanks for listening to this episode of Business Daily. It was produced and presented by me, Jill Dunnigan. And to listen to more episodes, just search for Business Daily wherever you get your BBC podcasts. And Doug, here we have the Limu Emu in its natural habitat helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally, Doug. Uh, limu is that guy with the binoculars watching us? Cut the camera. They see us. Only pay for what you need@libertymutual.com Liberty Liberty Liberty Liberty Savings Variation underwritten by Liberty Mutual Insurance Company affiliates excludes Massachusetts.