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Original article

Advantages and disadvantages of the integration to the European Union: the survey among medical freshmen in Serbia

Milena Šantrić-Milićević1, Jovana Todorović1, Želјka Stamenković1, Aleksandar Stevanović1, Janko Janković1, Zorica Terzić-Šupić1, Aleksandra Jović-Vraneš1, Bojana Matejić1, Bosilјka Đikanović1, Ivana Sotirović1, Jovana Vidojević1, Marija Zdujić1
  • University of Belgrade, Faculty of Medicine, Institute of Social Medicine, Belgrade, Serbia

ABSTRACT

Aim: The study aimed to identify factors associated with pro-integration attitudes to the European Union (EU) among Serbian medical freshmen to promote integration.

Methods: In the period from 2010 to 2021, within the scope of the distance learning module “Medicine & Society”, a total of 1333 freshmen of the Faculty of Medicine of the University of Belgrade (1333/1940, i.e., response rate 68.7%) has responded to the semi-structured questionnaire inquiring their perception of the EU integration advantages and disadvantages.

The association of the pro-EU attitude (vs cons-EU / undecided) with perceived advantages and disadvantages was presented using the odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 48.5% of respondents were pro-EU integration, 42.7% were undecided and 8.9% were cons-EU (i.e., 585, 525, and 107, respectively) integration of Serbia. The pro-EU attitude was 55% more likely among male respondents (OR: 1.55, 95% CI:1.14-2.10), among respondents who were able to identify advantages of EU integration such as easier mobility (OR: 2.87, 95% CI: 1.80-4.57), variety of job opportunities (OR: 2.06, 95% CI: 1.45-2.93), and among those for whom competition at the EU healthcare market is not a disadvantage of the EU-integration (OR: 8.56, 95% CI: 1.79-40.92). The pro-EU attitude was less likely among respondents who identified high emigration of medical doctors as a disadvantage of the EU integration, by 45% (OR: 0.55, 95% CI: 0.36-0.84)

 Conclusion: During the last decade, the share of Serbian medical freshmen with pro-EU and undecided attitudes suggests the need for a stronger international initiative of EU and national actors. Advantages such as easier mobility, competition in the EU healthcare market, and a variety of employment opportunities promote an integrationist attitude, in contrast to the large emigration of medical doctors.


INTRODUCTION

Less than three years passed from the submission of the application to the confirmation of Serbia’s status as a candidate country by the European Council in March 2012, and the explanatory and bilateral screenings in autumn 2013 [1]. After the start of [2] accession negotiations in January 2014, 12 out of 35 chapters have been opened so far, and two have been temporarily closed (chapters 25 - science and research and 26 - education and culture). However, negotiating chapters 2 (Freedom of movement of workers), 19 (Social policy and employment), and 28 (Consumer protection and health) have not yet been opened [1].

The general attitude in Serbia towards integration into the European Union (EU) oscillates according to the dynamics of the European integration process, from positive to negative [2]. The highest level of general support for EU integration was recorded in 2009 after the population experienced the liberalization of the visa regime, but this support dropped significantly in the following years, as only 41% of respondents in 2012 and 55% in 2018 had a positive attitude [1]. The current international policy of Serbia is in favor of European integration [3], and the government’s rhetoric discusses the possible benefits of harmonizing the domestic regulatory and legislative framework with the acquis of the EU, that is, the entire legislation of the EU.

A significant portion of non-EU-medical students is contemplating working in some of the EU countries upon graduation [4]. Their main reasons for working in the EU are the problems they face in the country, such as dissatisfaction with the standard of living, the high unemployment rate of young health workers in Serbia, relatively low wages, and overtime work. In search of a better life, greater freedom of movement, professional advancement, and enjoying the benefits of a wider healthcare market than in Serbia, young medical graduates could see the EU as an attractive opportunity to live, study, and work [5]. A similar influence on pro-EU attitudes was observed in other EU-candidate countries, such as Turkey [6]. Therefore, the knowledge of the dynamics of the negotiation process with the EU can influence the formation of the attitude of the health workforce towards EU integration. The study aimed to identify factors influencing the attitude of pro-integration to the European Union (EU) among Serbian medical freshmen to promote integration.

METHODS

The attitudes toward EU integration were surveyed among freshmen at the integrated medical studies at the Faculty of Medicine of Belgrade University (FMUB). The survey was conducted during the most dynamic period of EU integration in the period from 2010/11 (application for EU membership) to 2021/2022 [1].

The overall response rate was 68.7% (that is 1333 respondents out of a total of 1940 freshmen). Respondents were all freshmen who attended the distance learning module ‘Medicine & Society’ at medical studies at FMUB (approximately between 50 and 150 freshmen per year).

The survey instrument was a semi-structured questionnaire, with two main questions: 1. ‘Define your attitude regarding the EU integration of Serbia: are you pro, cons or undecided and why’ and 2. ‘Think about your expectations from joining the EU from different perspectives and describe the advantages and disadvantages of EU integration’. The content analysis was applied to group freshmen into three groups representing the number of students with pro-EU, cons-EU, and undecided attitudes. Then, explored were sex (males and females), and the six broad categories of the advantages of EU integration (easier mobility, educational opportunities, access to innovative health care technologies, participation in the EU projects, variety of job opportunities, and better health care accessibility), and disadvantages of EU integration (difficulties to protect local cultural values, threats to health safety due to relaxed cross-border control, difficulties to protect national finances, enabled emigration of medical doctors, strong competition at the EU healthcare market, and demanding administration at the EU healthcare market).

In addition to descriptive statistics, bivariate and multivariate logistic regression analyses were performed, using the pro-EU attitude as an outcome variable versus the cons-EU / undecided attitude. Significant variables from the bivariate analysis were tested in the multivariate regression model to identify factors associated with the pro-EU attitude. The results of regression analyses were presented as odds ratios (OR) with a 95% confidence interval (CI) and they were considered significant if the p-value was less than 0.05. The analyses were done by IBM SPSS Statistics software package version 22.

RESULTS

In the most dynamic period of EU integration, 36.6% of respondents were pro-EU, while 49.4% were undecided and 14.0 % were con-EU (i.e., 488, 658, and 187, respectively) integration of Serbia.

Table 1 shows that male freshmen were by 52% more likely (OR: 1.52, 95% CI: 1.15-2.03) to have a proEU attitude. The pro attitude was more likely among freshmen who identified advantages of EU integration such as easier mobility (OR: 2.14, 95% CI: 1.36-3.37), better healthcare access in EU (OR: 2.89, 95% CI: 2.05- 4.06), variety of job opportunities in EU (OR: 2.38, 95% CI: 1.17-3.19), and better access to healthcare technologies in EU (OR: 1.99, 95% CI: 1.25-3.19). The pro-EU attitude was less likely among respondents who perceived disadvantages of the EU integration such as difficulties in protecting national finances and enabled emigration of medical doctors by 46% (OR: 0.54 95% CI: 0.36-0.82), and by 48% (OR: 0.52, 95% CI: 0.33-0.81) less likely to have pro-EU integration attitude.

Table 1. Explanatory variables of medical freshmen’ attitude pro integration of Serbia vs cons/undecided in the European Union (n=1333)

Table 1. Explanatory variables of medical freshmen’ attitude pro integration of Serbia vs cons/undecided in the European Union (n=1333)

DISCUSION

In this study, more than one-third of the respondents were explicitly pro-EU, in contrast to one-eighth of the cons-EU. The finding that almost half of the respondents are undecided about the integration of Serbia into the EU indicates that they either avoid “politically charged discussions” or are “not sufficiently informed to have an explicit position”. Another recent study also shows that a minority of physicians consider advocacy fundamental to medical professionalism [6]. However, lessons from history are that ‘medicine is a social science, and politics is nothing else but medicine on a large scale’ [7] and that ‘while many doctors, scientists at heart, find political advocacy uncomfortable, it is a required part of the job’[8]. This study’s findings suggest that much has to be done to better inform about the benefits that EU integration could bring to medicine as a science, health care as a practice, and health workforce development. We suggest seizing the momentum to further promote EU integration, as by now, Serbia has opened 22 chapters out of a total of 35. With this study, we advocate stepping out of medical echo chambers and experiencing medicine and public health as fields of social action for sustainable development in this uncertain environment.

Advantages such as easier mobility and greater job opportunities in the EU are particularly important for the future development of young professionals, who seem eager to acquire modern knowledge and skills and gain new experiences that keep them pro-European, as, a high number of physicians from Romania and Bulgaria emigrated to EU after these countries joined EU[4]. Freshmen with a pro-EU attitude do not expect the failure of Serbian business in the EU health market, showing confidence either in established regulations or in the good performance of domestic companies. However, according to the latest report from the European Commission, the Serbian economy is only moderately ready to be competitive in the European market[9].

The findings of the study should not be generalized, because the sample included only freshmen enrolled in online courses, so freshmen without personal computers and who prefer learning in the classroom are excluded. However, the examined link between the pro-EU attitude and the perceived advantages and disadvantages of EU integration showed that medical students need to build competencies to be active in promoting the right to quality health care such as in the EU.

In conclusion, during the last decade, the share of Serbian medical freshmen with pro-EU and undecided attitudes suggests the need for a stronger international initiative of EU and national actors. Advantages such as easier mobility, competition in the EU healthcare market, and a variety of employment opportunities promote an integrationist attitude, in contrast to the large emigration of medical doctors. Given the need to consider the characteristics of the domestic context for the progress of European integration [10] and grand theories of European integration for understanding the identity politics of the accession EU countries[10]. To be able to better inform the course of action for aligning the Serbian legal framework with the healthcare quality and the EU labor market, further study should explore the healthcare students’, patients’, and health workers’ expectations from harmonization of the national regulation with the EU body of law.

Ethical approval:

The study was approved by the Ethical Committee of the Faculty of Medicine, University of Belgrade (No. 1322/III-6).

  • Conflict of interest:
    None declared.

Informations

March 2024

Pages 21-26
  • Keywords:
    EU, student, attitudes, Serbia
  • Received:
    06 March 2024
  • Revised:
    11 March 2024
  • Accepted:
    15 March 2024
  • Online first:
    25 March 2024
  • DOI:
  • Cite this article:
    Šantrić Milićević M, Todorović J, Stamenković Ž, Stevanović A, Janković J, Terzić Šupić Z, et al. Advantages and disadvantages of the integration to the European Union: The survey among medical freshmen in Serbia. Serbian Journal of the Medical Chamber. 2024;5(1):21-6. doi: 10.5937/smclk5-49691
Corresponding author

Jovana Todorović
Institute of Social Medicine, Faculty of Medicine, University of Belgrade
Dr Subotića 15, 11000 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


1. Pjevović D, Subotić S. Stavovi građana Srbije prema EU. Politika. Beograd; 2019.

2. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):1–26. [HTTP]

3. Stojković D, Glišić M. Odbrana i ekonomija mira u Srbiji: Da li je vojna neutralnost ekonomski korisna? Ekonomija odbrane i mira. 2018;00(00):1–17.

4. OSF. Working Together to Address Health Workforce Mobility in Europe Recommendations for Action. 2020.

5. Buchan J, Wismar M, Glinos IA BJ, editor. Health professional mobility in a changing Europe: new dynamics, mobile individuals and diverse responses. Copenhagen: World Health Organization; 2014.

6. Bonica A, Rosenthal H, Rothman DJ. Physician activism in American politics : The opposition to the Price nomination. PlosOne. 2019;e0215802.

7. Virchow R. Der Armenarzt. Med Reform. 1848;18:125–7.

8. Winslow CE. THE UNTILLED FIELDS OF PUBLIC HEALTH. Science. 1920 Jan;51(1306):23–33.

9. European Commission. Serbia 2020 Report. Brussels; 2020.

10. Herfs PGP. Aspects of medical migration with particular reference to the United Kingdom and the Netherlands. Hum Resour Health. 2014;12(59):1–7.[HTTP]


REFERENCES

1. Pjevović D, Subotić S. Stavovi građana Srbije prema EU. Politika. Beograd; 2019.

2. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):1–26. [HTTP]

3. Stojković D, Glišić M. Odbrana i ekonomija mira u Srbiji: Da li je vojna neutralnost ekonomski korisna? Ekonomija odbrane i mira. 2018;00(00):1–17.

4. OSF. Working Together to Address Health Workforce Mobility in Europe Recommendations for Action. 2020.

5. Buchan J, Wismar M, Glinos IA BJ, editor. Health professional mobility in a changing Europe: new dynamics, mobile individuals and diverse responses. Copenhagen: World Health Organization; 2014.

6. Bonica A, Rosenthal H, Rothman DJ. Physician activism in American politics : The opposition to the Price nomination. PlosOne. 2019;e0215802.

7. Virchow R. Der Armenarzt. Med Reform. 1848;18:125–7.

8. Winslow CE. THE UNTILLED FIELDS OF PUBLIC HEALTH. Science. 1920 Jan;51(1306):23–33.

9. European Commission. Serbia 2020 Report. Brussels; 2020.

10. Herfs PGP. Aspects of medical migration with particular reference to the United Kingdom and the Netherlands. Hum Resour Health. 2014;12(59):1–7.[HTTP]

1. Pjevović D, Subotić S. Stavovi građana Srbije prema EU. Politika. Beograd; 2019.

2. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):1–26. [HTTP]

3. Stojković D, Glišić M. Odbrana i ekonomija mira u Srbiji: Da li je vojna neutralnost ekonomski korisna? Ekonomija odbrane i mira. 2018;00(00):1–17.

4. OSF. Working Together to Address Health Workforce Mobility in Europe Recommendations for Action. 2020.

5. Buchan J, Wismar M, Glinos IA BJ, editor. Health professional mobility in a changing Europe: new dynamics, mobile individuals and diverse responses. Copenhagen: World Health Organization; 2014.

6. Bonica A, Rosenthal H, Rothman DJ. Physician activism in American politics : The opposition to the Price nomination. PlosOne. 2019;e0215802.

7. Virchow R. Der Armenarzt. Med Reform. 1848;18:125–7.

8. Winslow CE. THE UNTILLED FIELDS OF PUBLIC HEALTH. Science. 1920 Jan;51(1306):23–33.

9. European Commission. Serbia 2020 Report. Brussels; 2020.

10. Herfs PGP. Aspects of medical migration with particular reference to the United Kingdom and the Netherlands. Hum Resour Health. 2014;12(59):1–7.[HTTP]


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