Through hospital corridors, unnoticed but constantly present, echoes a sentence that is written nowhere, yet known to everyone inside the system. It survives every reform, every change of minister and every new generation of doctors:

“Stay quiet. It has always been this way.”

A sentence as heavy as life itself, because it follows almost every young doctor trying to find their place in the system. It is used to justify almost everything: years of unpaid work, waiting for a job that may never come because there are no guarantees, and the fact that after six years of study, young doctors once again find themselves in a position resembling that of a student. Without security, without a regular income, and with a future that depends on someone else’s decision, connections or simply waiting.

Even during their studies, future doctors become aware of what it means to look for work in a healthcare system that has managed to present unpaid labour almost as a privilege. If you have connections, employment seems much closer and more certain. If you do not, volunteering can easily become what awaits you immediately after graduation.

Young doctors enter a system in which they are expected to work for free, supposedly with gratitude, “for the experience”. To volunteer in the hope that one day they might receive a specialization. To accept conditions that would be difficult to describe as normal in almost any other profession.

Imagine an engineer graduating from university and being told: “Work for a year. Two. Three. Maybe even nine. Without pay. And then we will see whether there is a position for you at all.”

In another profession, such treatment of a young worker would probably raise serious questions about how the system functions. In medicine, it has existed for so long that it is often treated as tradition.

And tradition can sometimes be nothing more than injustice that has lasted long enough for people to stop questioning it. In this case, it is not even particularly well disguised. A young person is offered hope that years of unpaid or poorly paid work will eventually pay off, while there is no real security that this will ever happen.

Generations of doctors have therefore been taught to accept something that should never have become a normal beginning to professional life.

In such an environment, many young doctors turn to what is presented to them as the better option: voluntary specialization.

The phrase itself sounds like a bad joke from a system accustomed to cheap labour. You pay in order to work. You work without a salary. You have no certainty that a job will be waiting for you once the specialization is completed. And throughout all of this, you are expected to be grateful for being allowed to gain experience at all.

Under the excuse of gaining experience, volunteers are used to the limits of endurance. The system finds it much easier to consume someone’s ambition, dream and motivation than to provide proper compensation for their work.

The desire to become a doctor who actually does the job they spent years training for turns into a resource that is used almost for free.

All of this produces a very concrete daily reality. A beginner spends the first half of the day at a clinic, completing specialist training, and the second half doing a job that allows them to pay for that same specialization and cover basic living expenses.

Private practices. Temporary shifts. Night duty. Additional jobs. Sometimes even work that has nothing to do with medicine.

Someone who has spent years learning to take responsibility for other people’s health and lives leaves the hospital at the end of the day and goes to another job simply to finance the possibility of one day working in the profession they trained for.

Such a rhythm can last for years. Until the specialization is completed, or until overwork, stress, uncertainty and constant pressure begin to take their toll.

A person who is supposed to care for the health of others can quickly find themselves without the time or space to care for their own.

If you do not have a family that can support you financially, connections within the system or some other kind of safety net, then after almost a decade of education you enter your career already at a disadvantage.

Medicine then becomes a profession financed through your own exhaustion.

Society often calls this “investing in your career”. But investing in a career implies at least some realistic prospect that what you are investing will eventually turn into a stable professional life. Here, even a job is uncertain.

There is no guarantee that years of volunteering will lead to employment. No guarantee that specialization will open a position. No guarantee that someone who has given years to the system will be given the chance to live normally from their work within that same system.

That is why some young doctors leave.

They leave because they do not want to spend their thirties waiting for someone to approve their right to basic professional security. They do not want to spend years proving that they deserve a salary, a contract, a day off and the ability to plan their lives beyond the next month.

Perhaps the saddest part is that many of them no longer even dream of particularly good conditions.

They dream of a contract.

A regular salary.

One job they can live from.

A free weekend.

A life in which they do not have to calculate every month how much longer they can endure.

A little dignity.

A particular problem is the moral and emotional exploitation that allows such a system to continue functioning. Hospitals and healthcare institutions can rely on people who remain silent because they are afraid someone else will replace them the moment they say they can no longer continue.

There is fear that if they give up, all the years already invested will have been wasted.

Fear of losing the specialization.

Fear of being labelled difficult.

Fear that someone will remember that they asked for what they were entitled to.

Fear that someone else will appear, someone willing to work more, remain silent longer and ask for less.

All of this becomes fuel for a system that has little reason to change as long as there are people motivated enough to accept its conditions.

A doctor who asks for normal working conditions can easily be labelled “ungrateful” or “not dedicated enough to the profession”. As if a willingness to endure determines how good a doctor someone is. As if love for medicine must be proven by sacrificing one’s own life.

And when someone does point out the injustice, the answer is often:

“We went through the same thing.”

That sentence perhaps best explains how the system reproduces itself.

People who themselves endured humiliating working conditions can begin to see them as the natural path that those coming after them must also follow.

Suffered injustice becomes justification for new injustice.

If I worked without pay, you can too.

If I waited for years, you should wait too.

If I stayed quiet, you should stay quiet too.

As if the fact that something has existed for years automatically means it should continue to exist.

As if time can turn a bad system into a good one.

As if the suffering of previous generations proves that the next generation has no right to demand different conditions.

This is how a model of work based on guilt, fear and the hope that everything will eventually pay off is maintained.

You do not have to chain someone if you convince them for long enough that they will lose everything they have already invested if they leave.

For young doctors, that investment is enormous.

Six years of study. Practical training. State examination. Specialization. Years of work. Years of waiting. The sacrifices of families that often financed the entire journey. A life organized around the idea that one day a “real career” will finally begin.

The more time invested, the harder it becomes to leave.

And it is precisely at that point that the system gains enormous power over a young person.

It can tell them to wait a little longer.

To volunteer for one more year.

To accept one more night shift.

Not to ask too many questions.

To be grateful.

Not to cause problems.

That their time will come.

And the years pass.

The problem is not limited to money. Financial insecurity is enormous, but the consequences extend much further than salary.

A person without stable employment struggles to plan a family, housing, a loan, relocation or anything else that requires even a minimum of predictability. Private life is postponed along with professional security.

While society expects young people to build their lives, the healthcare system expects some of them to spend years in a kind of waiting room.

And then we wonder why they leave.

The departure of doctors is often presented through cold statistics. How many have left the country. How many certificates have been issued. How many are missing from a particular institution.

Far less is said about the moment when someone decides they have had enough.

The moment when they realise they can go somewhere where their work will be paid from the first day.

Where a contract will not be treated as a privilege.

Where specialization will not depend on years of waiting and uncertainty.

Where asking for normal working conditions will not automatically be interpreted as a lack of gratitude.

Leaving then stops being a question of insufficient patriotism or insufficient love for the profession. It becomes a rational decision by a person who no longer wants to spend their life waiting for the system to recognise the value it demands from them every day.

The greatest paradox is that we expect an almost impossible level of responsibility from doctors.

We expect them to remain calm when we are frightened. To stay focused when we are in pain. To make decisions when someone’s health or life depends on them. Not to make mistakes. To be available. To be empathetic. To be professional.

At the same time, as a society we have accepted a system that keeps some of them without basic security at the beginning of their careers.

Doctors are expected to protect the health of others while trying to protect their own lives from complete uncertainty.

They are expected to be responsible for other people’s lives, while institutions often avoid responsibility for the conditions in which they work.

And this is where the sentence from the beginning regains its full meaning:

“Stay quiet. It has always been this way.”

Perhaps it is the most effective mechanism for preserving the entire model.

It requires no law.

No regulation.

No decision by a minister.

It is enough for each generation to pass on to the next the idea that they have no right to expect better simply because the previous generation did not have better.

As long as this relationship to work is presented as a necessary part of becoming a doctor, the system has little serious reason to change it.

Young doctors enter it knowing that one day they will be responsible for other people’s lives, but without knowing whether they will be able to live normally from their own work.

And when they finally say they cannot continue, the system still has the same answer ready.

“We went through the same thing.”