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Czechs resort to unusual perks for nurses: plastic surgery

Incentives aimed at retaining talent in dire shortage

By Dan Bilefsky
New York Times / June 14, 2009
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PRAGUE - When Petra Kalivodova, a 31-year-old nurse, was considering whether to renew her contract at a private health clinic here, the offer of special perks helped clinch the deal: complimentary German lessons, five weeks of vacation, and free liposuction and silicone breast implants.

"I would rather have plastic surgery than a free car," said Kalivodova, who could not have afforded cosmetic surgery on her monthly salary of about $1,400.

As the Czech healthcare system faces a dire nursing shortage, clinics and hospitals are resorting to some unusual incentives to retain talent, including free or reduced-price plastic surgery.

While such perks do not appear to have been embraced by other countries with nursing shortages, they hardly seem out of place in a post-communist culture that is obsessed with beauty pageants.

Healthcare managers here consider free tummy tucks or remodeled breasts no different from a free trip to the Bahamas, one-shot bonuses that cost less than salary increases.

At Iscare, the clinic where Kalivodova works as a surgical nurse, the plastic surgery offer helped increase nurse applications by 10 percent in the past three months, said Jiri Schweitzer, the managing director. Nurses can choose from an assortment of procedures, including a $2,013 tummy tuck or a $1,836 face-lift, if they sign a three-year contract.

"It helps to improve the morale of both our employees and our patients," he said, and it has proved far more popular than the free German lessons.

But critics say the offers of cosmetic enhancement demean what remains a largely female occupation.

"If any institution offers this incentive, then it has lost all credibility," said Jirina Siklova, a gender studies expert and sociologist. "I would expect such behavior from an erotic salon, not from an institution devoted to health care."

Doctors and nurses say the nursing shortage is hurting patient care and potentially risking lives. Health care analysts estimate that the Czech Republic has a shortage of 5,000 nurses in the public sector alone.

A nurse's average monthly wage in the Czech Republic is about $1,270, less than that of a bus driver. In the past year, nearly 1,200 nurses migrated to countries like Germany or Britain in search of better wages, according to the Czech Nurses Association.

Irena Pejznochova, spokeswoman of the Czech Nurses Association, said she saw nothing wrong with such offers. "There is nothing degrading in this kind of benefit," she said.

She argued that innovative incentives were being introduced because nurses worked 12-hour shifts, were underpaid, and could not even prescribe an aspirin without a doctor's permission.

Dana Juraskova, the Czech minister of health and a former nurse, said there were other ways to motivate nurses. For example, the recent introduction of a fee of one euro, or about $1.40, for visiting a doctor - which spawned a national outcry in a country accustomed to free health care - has translated to helping improve pay for nurses, she said.