20 PERSPECTIVES ON BUSINESS AND ECONOMICS | VOL 44 | 2026 atia’s four medical schools are located exclusively in major cities (European Observatory on Health Systems and Practices, 2023). Physicians trained in urban centers are less likely to relocate to rural areas, contributing to unequal allocation of human resources. Without effective health-care management and staffing in rural regions, it becomes increasingly difficult to establish and sustain large general hospitals or LTC centers. Due to the scarcity of medical professionals in rural areas, a vicious cycle ensues. Physicians and nurses are often overworked, worsening staff continuity because of burnout and limited work-life balance. Vedran Stipišić, a family medicine resident working at the Split-Dalmatia County Health Center, describes both his and his colleagues’ experiences delivering care in the Imotski region of southern Croatia in 2024. Fewer patients are seen per day in rural clinics compared with clinics in urban areas. Despite the lower patient volume, physician shortage persists and often is remedied by doctors covering two clinics at once and working exceptionally long hours. Dr. Stipišić (personal communication, October 3, 2025) emphasized the administrative burden physicians carry on top of seeing patients, resulting in longer wait times, limited availability specialists, and traveling significant distances for basic medical care, a particular hardship for an aging population. Overall, the insufficiency of medical professionals in rural areas burdens health-care workers and elderly patients alike. Challenging working conditions and low compensation Poor working conditions are seen in both urban and rural regions. Health-care workers have reported excessive overtime—totaling 3 million hours—and inadequate residency structures (Doctors in Croatia…, 2023). Even with working overtime, the average hourly wage for a physician is €32 compared to €81 in Germany (Economic Research Institute, 2025). Physicians in residency are among those facing low compensation and long work hours. Laura Mayer, a sixth-year medical student at the University of Zagreb, indicated that a resident doctor is paid €7.30 per hour and expected to work an overtime schedule (Doctors in Croatia…, 2023). These conditions push young health-care workers to pursue medical school and practice abroad—particularly in Germany—for better pay and more manageable schedules. These issues are intensified for physicians in rural areas. Rural health-care personnel find limited professional guidance, few employment or educational opportunities for spouses, and little personal time due to overwork (OECD, 2023a). Because most job opportunities and social activities are concentrated in urban centers such as Zagreb, Split, and Rijeka, their absence makes rural areas less attractive to newly graduated professionals and young people starting their careers. The shortage of physicians in rural areas consequently limits development of collegial support and camaraderie. To draw attention to these deterrents, healthcare workers organized a major protest in Zagreb on March 18, 2023. Urologist Mirjana Livojević said she and her colleagues demanded a change in working hours and staff ratios and increased control of the quality of doctors’ work. Mayer highlighted that many medical students are reluctant to pursue careers in primary health care, despite that it is one of the most needed fields given Croatia’s aging population, largely due to limited mentorship from senior colleagues and a stronger pull toward work in large hospitals. They also stressed the lack of mentorship for students and of collegial cohesiveness among the medical professional community (Doctors in Croatia…, 2023). Seasonal population surges with tourism Seasonal tourism strains urban health-care capacity, indirectly affecting rural access when seniors must travel for care. Staff in urban centers are stretched thin by tourist-related emergencies. As shared by a doctor from the University of Split School of Medicine, all nonemergency procedures between May and November, including surgeries for Croatian citizens, are postponed because of the surge in emergency cases among tourists (J. Krstulović, M.D., personal communication, May 28, 2025). When large cities in Croatia face health-care shortfalls, rural communities have even fewer options. Seniors requiring extensive care may be forced to seek treatment in urban areas, where tourism-related pressures create further limitations, making timely treatment and preventive care difficult. Inadequate rural training A study assessing the attitudes of medical students toward practicing in a rural community revealed that they did not feel there was adequate education tailored to medical care in rural communities because of limited resources and minimal professional support. Of 690 total students from Split, Rijeka, Zagreb, and Osijek medical schools, 55.9% said they would consider working outside of a major urban area; however, 55.4% did not believe their program
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