Feeling unappreciated is the most common cause of stress among medical staff in Bulgaria. Nadezhda Dimitrova of the National Centre for Competence Assessment at the Bulgarian Industrial Association (BIA) presented data from seven hospitals showing that 63% of those surveyed cited it.
Almost all of them, 97%, see a way out in a fair appraisal system, better planning and organisation, and less needless administration and paperwork.
The results were presented at a forum called "Stress and burnout among medical professionals: challenges and solutions", which the BIA held as part of its "Together for Sustainable Employment" project. The Ministry of Labour and Social Policy and the Confederation of Independent Trade Unions in Bulgaria (CITUB) are partners in the forum.
The study is a peer review of policies and ways of dealing with workplace stress in the human healthcare sector. In all, 111 people were surveyed between April and June 2026.
After lack of recognition, medics named the mood among colleagues (55%), workload (51%) and the way work is organised (51%). Some 38% say their work-life balance is upset.
More than half work in an atmosphere of tension, rumours, conflict and intrigue. And 37% keep quiet about a different opinion or disagreement for fear of bad consequences for themselves.
Some 78% have to hold back their emotions and always be polite and helpful. And 67% work too hard or do several tasks at once, while 62% deal with needless paperwork. Some 41% have to stay on after the end of the working day, and 57% think work is shared out unfairly.
Monitoring the emotional climate, and regularly reviewing and adjusting workloads, would help, according to 95% of those surveyed. They want mental health to be a priority when managers make decisions.
Dimitrova says the mental and emotional strain in the sector is growing, and the problems are built into the system. The risk of burnout does not come only from the nature of the medical profession, she explained. Chronic stress builds up from outside and organisational factors, including pressure from society on the profession.
Dimitrova says the mental wellbeing of staff is part of the health system's ability to cope. The sooner work stress is spotted and curbed, the better the results will be for medics and for the system.
She puts the high tension down to a shortage of staff, the stigma around stress and the belief that it is a normal part of the job. She added patients' changing expectations, heavy pressure from the media, work by "rules and limits" and a lack of long-term care units.