On Thursday, the Lithuanian parliament voted to create additional state-funded medical residency positions, but with a binding condition: junior doctors who accept them must sign a contract committing to work for five years in a region facing a shortage of healthcare professionals after completing their training. The move has sparked immediate backlash from the country's junior doctors, who plan to take the case to the Constitutional Court.
“The chosen measure is populist,” Laurynas Maciulevičius, president of the Lithuanian Junior Doctors Association, told Euronews Health. While acknowledging the goal of improving access to care in underserved areas, he argued that the policy “does not answer the fundamental question: why do doctors choose, or choose not, to work in regional areas?”
A choice with limited options
According to Orinta Leiputė, a Social Democrat MP and one of the initiative's sponsors, junior doctors can still opt for residencies without the rural obligation. “This is a possibility to choose,” Leiputė said in a press release. “If a young doctor does not want studies with obligations, they simply will not choose them and will apply for the places that already exist without an obligation.”
Yet the number of such unencumbered places is minimal. Only 20 of the 385 state-funded residency positions across Lithuania will be free of the five-year regional assignment. Leiputė noted that the current number of state-funded places without obligations remains unchanged. Junior doctors can also pursue non-state-funded positions, but those are far fewer and often less accessible.
Lithuania currently has more doctors per 10,000 citizens than the WHO European Region average, ahead of Switzerland and just below Germany. However, the overall number of doctors is declining across Europe due to ageing populations and unattractive working conditions. Leiputė warned that Lithuania will face a shortage of 269 family doctors, 207 internal medicine doctors, and 146 paediatricians by 2032. The challenge of eliminating so-called medical deserts in rural areas is a struggle shared by most European countries.
Root causes ignored?
Junior doctors agree that regions need better access to healthcare, but they argue the policy misses the point. “What regions need is not doctors assigned for five years, but a system in which doctors want to stay,” Maciulevičius said. He added that no analysis of underlying causes, impact assessment, or clear justification has been provided to show why a five-year service obligation would be the best measure.
Leiputė acknowledged that the new rule is not a silver bullet. She described it as an addition to existing initiatives such as scholarships, relocation grants, and housing support. “Consideration is also being given to how regional positions can be made more attractive to older physicians who may no longer wish to work in university hospitals or major medical centres, where workloads are particularly demanding,” she said.
Liberals in parliament have condemned the changes, warning they could backfire. “The parliamentary majority has undermined the constitutional principle of the individual’s freedom of self-determination,” the chair of the Liberal Movement said in a press release. “You cannot create forced equality in healthcare; on the contrary, coercion will only push even more doctors to leave and emigrate.”
European comparisons
Several European countries have adopted different strategies to address healthcare worker shortages in underserved regions, according to a WHO report. In Finland, authorities have improved access by adjusting the geographical distribution of medical training places, expanding the role of nurses, and offering incentives such as higher pay and more flexible working arrangements to encourage doctors to settle in remote areas.
Latvia has taken a different approach. Medical schools give preference to applicants who commit to working in rural areas after training. Doctors practising in underserved regions can also receive monthly bonuses, higher capitation payments, and additional financial support, including funding for professional development.
The new Lithuanian rules are expected to take effect from 2027. The Junior Doctors Association's constitutional challenge may delay or alter the implementation, but the broader debate over how to staff rural clinics is unlikely to fade. As Lithuania's political landscape shifts—following the recent formation of a new coalition after a populist split—the controversy over medical obligations adds another layer of tension to the country's healthcare policy.
