Sonia Papiu started her first year of residency as a psychiatrist in the Romanian city of Cluj in January, but she plans to move abroad within the year, seeking better learning opportunities and hospital conditions. She will not be alone. “I don't think any of my colleagues are planning to stay,” she said. “I think I could learn more abroad. You have higher responsibilities as a resident there.”

In the Romanian system, doctors go through six years of medical school and then three to five years as a hospital resident, treating patients while working under the supervision of senior staff. Finding a job abroad will be easy. Cluj, one of Romania's largest cities and a university and business hub, hosts several agencies recruiting for western European hospitals.

Romania has bled out tens of thousands of doctors, nurses, dentists and pharmacists since joining the European Union a decade ago, lured abroad by what the country lacks: significantly higher pay, modern infrastructure and functional healthcare systems. France, Germany and Britain are among the most popular destinations. The consequences are dire. Romania is one of the EU states with the fewest doctors. Nearly a third of hospital positions are vacant and the health ministry estimates one in four Romanians has insufficient access to essential healthcare.

“Medical staff leaving Romania at an almost massive pace deepens the problems of the healthcare system,” former health minister Vlad Voiculescu has said. “Entire hospitals are facing a major personnel deficit and entire towns don't have a family physician.” This is despite the fact that Romania is a leading EU state when it comes to the number of medical graduates. But the system – ridden with corruption, inefficiencies and politicised management – has been unable to motivate them to stay. The shortages are even starker in rural areas.

The Romanian healthcare exodus Show all 19 1 /19 The Romanian healthcare exodus The Romanian healthcare exodus A surgical ward is seen in the hospital in Borsa, in the Transylvania region of Romania Reuters The Romanian healthcare exodus Students study at the Medicine and Pharmacy University in Cluj-Napoca, Romania Reuters The Romanian healthcare exodus Sonia Papiu, 25, poses for a photo in her room in Cluj-Napoca, Romania Reuters The Romanian healthcare exodus A doctor and a volunteer medical student who work for SMURD, part of the emergency rescue service, hug before the night shift at their office in Cluj-Napoca, Romania Reuters The Romanian healthcare exodus Medical staff work in the emergency ward (UPU) in Cluj-Napoca, Romania Reuters The Romanian healthcare exodus Women stand in front of the church during the Epiphany Mass, in Bogdan Voda, Romania Reuters The Romanian healthcare exodus Women stand in front of a traditional wooden gate after the Epiphany Mass, in Bogdan Voda, Romania Reuters The Romanian healthcare exodus A monument to doctors who worked in Sacel from 1938 to 2016 is seen next to the village practice, in Maramures county, Romania Reuters The Romanian healthcare exodus A hallway is seen at a medicine student dorms in Cluj-Napoca, in Transylvania region of Romania Reuters The Romanian healthcare exodus A nurse gestures at doctor Andreea Kis's medical practice of in the village of Tureni, Romania Reuters The Romanian healthcare exodus A mother and her daughter are treated in the paediatric ward in the hospital in Borsa, Romania Reuters The Romanian healthcare exodus Medical equipment is seen in the delivery room at the hospital in Borsa, Romania Reuters The Romanian healthcare exodus A mother holds her newborn baby in the hospital in Viseul de Sus in the Transylvania region of Romania Reuters The Romanian healthcare exodus Patients wait to be seen by doctor Gabriela Dromereschi, at her practice in the town of Salistea de Sus in Romania Reuters The Romanian healthcare exodus Doctor Gabriela Dromereschi does an ultrasound on a patient at her practice in Salistea de Sus, Romania Reuters The Romanian healthcare exodus Doctor Andreea Kis, a family doctor, treats a patient at his home in the village of Tureni in Transylvania region, Romania Reuters The Romanian healthcare exodus A mother holds her baby during a home visit from doctor Robert Ganea (not in the picture) in the village of Sacel in Romania Reuters The Romanian healthcare exodus Snow lies on roofs in the village Salistea de Sus, Romania Reuters The Romanian healthcare exodus Doctors who are part of the emergency rescue service bring a patient to the Emergency Unit in Cluj-Napoca, Romania Reuters

“Because we have one doctor per section for most specialties, when a doctor goes on holiday we need to close down the section,” said Cristian Vlad, the hospital manager in Viseul de Sus, a small town near the Ukrainian border. Mr Vlad said three hospitals in the region shared one anaesthetist until last year, when his hospital brought in another from neighbouring Moldova. “I live in hope that our resident doctors will change their mind and stay in smaller hospitals, too,” Mr Vlad said. Romania is taking steps to address the issues. Pay has risen significantly, although it still does not measure up to Western standards. The net average monthly wage for the healthcare system stood at 2,609 lei (£500) at the end of 2016, nearly double what it was three years ago.

In 2016, the health ministry created a multi-year plan for the medical profession, including a simpler recruitment process, education reform, better promotion opportunities, and subsidies for physicians willing to move to remote villages. The strategy has yet to be approved by the two-month-old cabinet of Social Democrat Prime Minister Sorin Grindeanu. “Measures to improve healthcare are in place, but the system suffers from inefficiencies, limited accessibility and corruption,” the European Commission said last month.

Yet not all doctors shy away from remote areas. From the village of Tureni, Andreea Kis has been serving as a family doctor for five villages for nearly five years. “I chose to be a family doctor because this is compatible with family life,” said Ms Kis, a mother of two. “People in the villages preserve their humanity better.”