ISTANBUL — Anxiety rose after an assistant doctor died last fall when she plowed her car into the back of a truck after a long shift.
Then there were the growing cases of violence. An assistant doctor abandoned his career after a patient stabbed him in the stomach and hand. A pregnant nurse was hospitalized after being kicked in the belly.
The worsening economy and soaring inflation, which has reduced some doctors’ salaries close to the level of the minimum wage, has brought many to a tipping point, driving them in growing numbers to search for better opportunities abroad.
Their departures are a sad indictment of President Recep Tayyip Erdogan, who burnished his own reputation by expanding universal health care over his 18 years in power. It was one of his signature achievements. For many of his supporters, that action alone remains their main reason to support him.
But the strains of those overhauls wrought by Mr. Erdogan, in addition to those brought by the pandemic — and now galloping inflation — have undermined the very professionals on whom the health system depends.
Doctors complain of a grinding workload, diminishing returns for their work, a drastic loss of respect for the profession under Mr. Erdogan, and an increase in physical violence from their own patients.
More than 1,400 Turkish doctors left their posts to work abroad last year, and 4,000 over the past decade, according to the Turkish Medical Association, the largest association of medical professionals in the country. Many more are preparing applications and have requested certificates of good standing from the organization, officials said.
“This is a result of long-accumulating issues,” said Bulent Kilic, a professor of public health at Dokuz Eylul University in the western city of Izmir. “In the last 20 years, there have been serious changes in the name of reform, and I think the heavy workload in the pandemic was the final straw.”
For a long time, the changes that Mr. Erdogan introduced bore fruit. Turkey has long prided itself on the quality of its medical schools and its medical professionals, and in recent years, it has developed a thriving private health industry catering to thousands of international as well as Turkish patients. Fifteen new large city hospitals were built to expand the health service while access was broadened for the public.
The health minister recently praised the president’s foresight, saying the system held up well during the worst days of the pandemic and facilities were never overwhelmed.
But the system is no doubt stressed, leaving doctors feeling overburdened and underpaid. The steady erosion of their income and status has been too much for many doctors to bear.
“Three years ago, I would have said the salary was fair, but now it is not,” said Dr. Furkan Cagri Koral, 26, a junior doctor who left Turkey only two years after graduating. “Doctors in Turkey are working at the level of slave labor considering the workload and the risks they are taking.”
He went to Germany, where, after 11 months of language training, he found a job as an assistant doctor in the town of Chemnitz and is preparing to take an equivalency exam that will allow him to practice. Dr. Koral said he was already encouraging colleagues and his sister, a medical student, to follow suit.
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“It is not only low salaries” driving health professionals away, said Dr. Sebnem Korur Fincanci, the chairwoman of the Turkish Medical Association. “It is the devaluation of the profession, over many years, since the beginning of the rule of the A.K.P.,” she said, referring to Mr. Erdogan’s Justice and Development Party.
The opening up of access to all hospitals on demand, without a referral system, overloaded them, while hospitals were encouraged to raise patient numbers and financial returns. At the same time, Dr. Fincanci said, Mr. Erdogan embraced a policy of privatization of health care and a performance pay system that has led to a focus on quantity rather than quality.
“There were too many appointments, too many operations, some not necessary,” she said. Patients were happy at first, but the open-access system was not sustainable. Hospitals began raising their prices and shortening appointments. A centralized system allows only 10 minutes for appointments, and in some cases only five minutes, which creates tensions all around.
Violence against medical professionals has risen sharply in the past two years — mostly in emergency departments — often in an explosion of anger at the system. More than 13,000 health professionals lodged complaints that they had been subjected to violence at work in 2020, according to the Turkish Medical Association.
“People are not tolerant enough,” Dr. Fincanci said.
“Since they are unhappy in their workplace and houses, and values are deteriorating, violence becomes a problem,” she added.
Other issues, including gender discrimination, nepotism and cronyism in management and an increase in lawsuits against medical practitioners, have made doctors lose hope, she said.
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“They do not think the situation will change,” Dr. Fincanci said. “It is not only the health system, but the general environment.”
There are ways to remedy the health system, Dr. Kilic, of Dokuz Eylul University, said, including raising budgetary expenditure on health and increasing the proportion of spending on preventive care. Turks also need to be weaned off their high level of visits to hospitals and use of tests, he added.
But retaining doctors and other medical personnel is equally vital, he said, because Turkey has a far lower level of trained professionals in proportion to its population than most European countries.
Mr. Erdogan and Dr. Fahrettin Koca, Turkey’s health minister, have both acknowledged the problem of Turkey’s brain drain but have offered little practical respite. “Don’t forget, our physicians are the best-trained physicians, and the richest countries have their eyes on them,” Dr. Koca told Parliament in a speech in December.
Parliament recently raised the penalties for violence committed against health workers, and Dr. Koca appealed to the assembly in December to consider salaries and other rights of health sector workers.
For Dr. Dogan Can Celik, 29, who works at a public hospital in Istanbul, it is not enough. He is planning to leave for Britain as soon as he completes his residency in about six months.
“I love my country, and especially Istanbul, but in the last four years, it really changed,” he said. He said the working hours and poor remuneration were his main reasons for leaving. “When I see our professors and mentors, I think I don’t want to be in their situation because after 40 years as a professor, they get really low salaries.”
Unlike previous waves of Turkish workers heading to Europe, those emigrating these days have little intention of returning and are leaving to give their children better opportunities, according to several people working in the business of relocating doctors.
Ekin Ay set up a business teaching medical German to Turkish doctors five years ago and has seen demand double in the past two years. One-fifth of her students are over 40, and some are over 50, she said. “They are not leaving for economic reasons but because of their families,” she said.
Dr. Cemal Altuntas moved to Germany three years ago and plans to start working full time as a consultant for relocating doctors. He said there had been a huge increase in requests from doctors in the past six months.
“It’s not a luxurious life that we want,” he said. “We want the normal life that we deserve.”
Safak Timur contributed reporting.