Romanian leader’s surgery abroad panned Questions are being asked about why Victor Ponta traveled to Istanbul for a knee operation.

If your own prime minister travels abroad for an operation, what does that say about your country’s health care system?

It’s a question on many Romanians’ minds since Victor Ponta chose a hospital in Istanbul for a knee operation.

“Why didn’t you undergo surgery with Romanian doctors in a public hospital so you can see the conditions we, the taxpayers, have to endure?” Facebook user Rozi Rozina wrote on the prime minister’s page, responding to a post a day after his June 15 surgery.

Over 600 people responded to Ponta’s post, some criticizing him for going abroad, and others wishing him a speedy recovery. The move led to a buzz of media coverage, with many Bucharest outlets analyzing whether he could have easily had the same surgery in Romania.

The Social-Democrat, in power since 2012, responded on Facebook that he fully trusts Romanian doctors, but he chose Turkey to get rest he would not have gotten in Bucharest.

The Romanian prime minister’s decision contrasts with one made by the wife of the Dutch Ambassador to Romania, Matthijs van Bonzel, who had an orthopedic operation in a Bucharest hospital a day after Ponta’s procedure.

“Nicu Banicioiu (the Romanian Health Minister) told me that there was a whole floor reserved in the hospital for Mrs. Ambassador of the Netherlands,” Ponta acknowledged to Antena 3 in his first interview since having surgery.

“You have great doctors here. That surprised me. You possibly need to do a little bit more with the infrastructure in the hospitals. But the doctors, they are excellent.”

The heated debate about Ponta’s choice for a Turkish surgery versus Cristina van Bonzel Gomez’s decision to stay in Romania comes amid long-standing frustrations of Romanians with their publicly-funded health care system.

The starting salary for a doctor in Romania is some €250, among the lowest in the EU, and the highest salary tops out at about €500, according to Gheorghe Borcean, president of the Romanian College of Physicians and a former hospital director.

This makes tipping almost everyone in a public hospital, from the guards to the doctors, a common practice in Romania. Many patients fear that otherwise they would not receive the same care from medical staff.

Ponta, for his part, is also facing charges of corruption and critics have said he used the surgery to sidestep the probe. Earlier this month, Romania’s National Anti-Corruption Directorate alleged that while working as a lawyer in 2007, Ponta was paid roughly €40,000 for work he didn’t do by another lawyer who later became a cabinet minister in his government.

Ponta told Antena 3 that he chose to leave the country to avoid TV crews at the hospital door, but also certain privileges that he would have been given if hospitalized in Bucharest.

“I think that, for me, there would have been two floors reserved at the Military Hospital (in Bucharest),” he said. “I didn’t want this to happen, because I would have felt really bad towards the other people who have the same right as I do,” Ponta said.

This led to a flurry of “who does he think he is” comments on social media and in national media outlets the next day.

Borcean of the doctors’ group said that establishing a security area around the room of high-level dignitaries was normal practice.

Ambassador van Bonzel told POLITICO he did not want to engage in a polemic with Ponta. “Please check with the hospital, better not comment,” he said.

Public money is not enough to cover a hospital’s costs, Borcean said. According to his calculations, the public health care budget provides what he calls a paltry €250 per year for each Romanian citizen.

“This money needs to cover hospitalization costs, the emergency ambulance system, medicines,” and most of doctors’ salaries, he said.

Faced with the prospects of working long hours in under-financed public hospitals, thousands of Romanian doctors choose to leave the country each year.

Overworked and underpaid

Last year, 2,450 of them asked for a professional certificate from the Romanian College of Physicians so they could practice abroad. Most were family doctors, but gynecologists, surgeons, psychiatrists, pediatricians and other specialist doctors also headed to other countries.

In January 2015, there were only 13,521 doctors left in Romanian hospitals, which is almost half of the number needed.

Romania has historically committed a relatively low share of its GDP to health care, according to the World Bank. Official figures show the country spends a little less than 6 percent of GDP on health, compared with the EU average of almost 10 percent.

“Romania is facing several challenges, including lagging health outcomes, user dissatisfaction, lack of access to quality care by the poor and other vulnerable groups, and weak financial performance,” the World Bank said in a report.

Ponta is not the only Romanian politician who chose a foreign country for his medical needs. Former president Traian Băsescu went to Austria for a surgery in 2006. The current president of the Romanian Senate, Călin Popescu-Tăriceanu, had a knee surgery in France in the same year.

Ambassador van Bonzel told POLITICO it was the third surgery his wife has had in Romania. In an interview with Antena 3 in January, she said that she felt at home in Romania and that doctors there were giving her more time and attention than in the Netherlands.

“You have great doctors here. That surprised me,” van Bonzel Gomez said. “You possibly need to do a little bit more with the infrastructure in the hospitals. But the doctors, they are excellent.”