Young doctors in Luxembourg demand reforms

Luxembourg is facing a growing shortage of doctors, and increasingly the problem is being linked not only to demographics but also to the conditions under which specialists are trained. According to the Association of Doctors in Specialisation in Luxembourg (Association Luxembourgeoise des Médecins en Voie de Spécialisation, ALMEVS), about a third of Luxembourg medical students do not return to their home country after completing their studies abroad. The key reason cited is the specialisation stage — the final four to six years of training, when doctors are already working with patients but are still formally continuing their education.

There are currently around 250 young doctors undergoing specialisation in the country – in hospitals, outpatient centres, at the University of Luxembourg or in private practices. However, as ALMEVS Vice-President Yoon Penning points out, they do not have a clearly defined professional status. Some are employed as salaried staff, others as self-employed, yet they perform identical duties and bear comparable responsibilities. As a result, their working conditions, working hours and pay levels vary considerably.

The problem is particularly acute given the high cost of living in Luxembourg. According to Penning, returning to the country is becoming more a matter of personal motivation than a rational choice for many doctors. At the same time, the workload can reach 40, 60 and even more than 100 hours per week, depending on the department, and additional payments for on-call duty and overtime vary from hospital to hospital.

ALMEVS insists that young doctors should not be considered students. Despite the presence of a mentor, they are often the first, and sometimes the only, doctors that patients turn to at night in emergency departments. However, there is still no clear list of rights and responsibilities, and the mechanisms for protection in the event of conflicts or labour disputes remain vague.

The consequences are already noticeable: even in popular fields, there are still unfilled positions. Last year, according to the association, there were more positions offered in general practice than there were applications or successful exam results. This contrasts with the situation in a number of other European countries, where competition for residency positions remains high.

Since March last year, ALMEVS has been negotiating with the Ministry of Health to establish a single agreement for doctors in specialisation. Key requirements include standardised working hours, transparent rules for on-call and overtime pay, and equal access to educational opportunities, including funding for conference attendance.

A separate dispute concerns salaries. The association is seeking to have them linked to category A1 of the civil service — the highest level in the civil service pay scale, intended for positions requiring a master's degree. "We all studied for four to six years at university. This corresponds to level A1. But our positions are paid significantly less," Penning emphasises.