Dean Juraj Payer: Young medical specialists want to work in good conditions
Dean of the Faculty of Medicine of Comenius University and head of the 5th internal clinic of the Faculty of Medicine and the University Hospital in Bratislava, Professor Juraj Payer received this year’s Crystal Wing award in the category of medicine and science. The jury recognised his exceptional contribution to endocrinology and the treatment of metabolic bone diseases. We interviewed him and he told us about the best ways of preventing osteoporosis or the widespread thyroid disorders. He also gave us his opinion on the government's decision to increase the number of medics at medical faculties.
What does the Crystal Wing award mean to you?
Everyone is pleased to see appreciation of their work. However, to me this is not just my award, it is an award of all the people I work with - in teaching or in medicine. The award was a recognition of our various activities in Slovakia and abroad, through which we are trying to help patients with osteoporosis and other diseases.
You are a top expert in the field of endocrinology and osteology in Slovakia. What draws you to these fields?
When I was in the fourth year of my university studies, I decided I wanted to learn more about hormones and I achieved that goal, because I have been working in endocrinology all my life since. Hormones affect everything that’s happening in the body. Bones are one of the targets of their activity.
What causes osteoporosis?
Its most common cause is a lack of female sex hormones. It is the most widespread endocrine disease and we estimate that roughly every third woman will suffer an osteoporotic fracture after the age of 50.
How can osteoporosis be treated?
The basis of any treatment and prevention is sufficient intake of vitamin D, calcium, and ample physical activity. We also have anti-porotic drugs that prevent bone loss or help build up bone. Some medicines are administered as infusion once a year, some by a subcutaneous injection twice a year, others in tablet form once a month. We have a large portfolio of medicines, but treatment takes a long time, around 5 years, often more.
Is there any prevention of this disease?
Prevention consists of building up bone mass, which is formed by the age of 25. In women, the risk increases around the age of 50, in men the decline occurs later. Your chances of getting osteoporosis are lower if you have greater bone density at an advanced age. Genetics also play a role, but can be compensated to an extent by taking enough calcium, vitamin D, exercising sufficiently, and not smoking. One of the most important factors in prevention is maintaining an adequate body mass. From the point of view of cardiovascular diseases, it is advisable to maintain a lower body mass, but it does not entirely help in this case. Even younger women who suffer from anorexia have very low bone density.
Vitamin D is an important hormone that we normally get from the sun, while the amount obtained from food is small. It is therefore necessary, especially in the winter months, to supplement vitamin D in medicinal form. A few years ago, we did a study in which we measured the levels of vitamin D in women after the summer. Their levels were lower even though we expected higher values at such time. Currently, blood levels of vitamin D in the population are higher due to the preventive administration of vitamin D during the Covid pandemic.
The silver lining of the coronavirus was an elevated level of vitamin D, because everyone started taking it during the pandemic.
When is it necessary to see a doctor to diagnose osteoporosis?
At present the standard examination method is densitometry, i.e. a way of measuring bone density. If a patient has decreased bone density but is still above a certain level, we speak of osteopenia, while osteoporosis begins with a greater decrease. Every woman after menopause should undergo this examination. Slovakia has enough densitometers and very good therapeutic options.
Thyroid disorders are the most commonly occurring endocrine disease. How do they present themselves and when should you visit a doctor?
There are many types of thyroid disorders. Increased thyroid function leads to enlarged pupils, heart palpitation, increased sweating, diarrhoea, sexual or menstrual disorders, fractures. Reduced thyroid function, on the other hand, makes the patients less energetic, increases cholesterol levels, raises the risk of cardiovascular diseases, constipation or skin issues. In addition, the thyroid may exhibit a normal level of activity, but its size may be abnormal. If a patient feels pressure in the throat, feels an enlarged node or pain, they should definitely see the doctor. Of course, as with other organs, cancer is a possibility.
How to prevent thyroid disorders?
Endemic goiter, i.e. an enlarged thyroid gland, is caused by a lack of iodine in the diet. Sufficient iodine is important for prevention. Fortunately, thanks to iodization, endemic goiter has not been encountered in Slovakia since the 1950s. If someone already has a thyroid disorder, particularly elevated activity, smoking is a negative factor. However, genetics also play a big role.
In addition to your contributions to research, your greatest achievement is the construction of the largest internal clinic in Slovakia – the 5th internal clinic of the Faculty of Medicine and the University Hospital in Bratislava. Which medical facilities do you consider to be the most advanced, and why?
Ours is the largest internal clinic in Bratislava and I am very glad that we managed to create and maintain it. The most advanced facilities include the Osteocentre and the centres for endocrine diseases - the Centre for the treatment of growth hormones, the Center for Rheumatology, workplace of associate professor Zdenko Killinger, long-time chief specialist of the Health Ministry in rheumatology. He and his team also work on biological treatment of rheumatological diseases. We have a top-notch gastroenterology department led by associate professor Koller, where we perform biological treatment of chronic inflammatory bowel diseases, and a cardiology department led by associate professor Kamenský. My deputy, Dr. Števlík, is a heart pacemaker implant expert. In addition to these, we have a high-quality diabetology unit led by the vice-dean, associate professor Jackuliak, where we created the Centre for the treatment of diabetes with insulin pumps. The clinic also includes 20 outpatient units, a large inpatient unit with three sizeable wards, and an intensive care unit. On top of all this, we are active in high-level research. Two years ago we received an award of the Ministry of Education as the best research team. I am pleased that the Faculty of Medicine employs top research experts. This is absolutely crucial to maintaining the high profile of our faculty.
The government recently presented several measures aimed at increasing the number of medics at medical faculties. What do you think of them?
At present, we are getting much less money per student than the study actually costs us. During the government of Peter Pellegrini (2018-2020), we accepted more students and were promised a budget increase as a result. The government did hold its end of the bargain in the first year, but the next government cancelled the additional funding. We have now agreed to take in 45 more medics at our faculty. We can accommodate them without making changes to our tuition. We are supposed to receive extra funding for these students with the promise that the money will keep coming throughout their studies. In addition, and perhaps most importantly, the government promised funding for investments that we can use for simulation medicine or the renovation of theoretical institutes. While we may take in more students, the renovation of these institutes means they can study in higher quality facilites.
What are the most common issues related to teaching?
We make sure we have the best students and then provide them with the best possible education. Our students can find jobs anytime, anywhere, they are in demand and become top medical specialists. We believe in quality education and we want to stay competitive. We may not have the best equipment at our theoretical institutes right now, but we still manage to provide high quality tuition in them. A Special Institute for the Teaching of Simulation Medicine was established, at which students can practice various types of surgery. Clinical classes are difficult to teach because we do not have as much control over them as with theoretical subjects. Clinical classes take place in ten hospitals. The biggest issue is the condition of the hospitals where students perform their practice. It is necessary to build a new university hospital with an adequate research section.
By increasing the number of medics, the government wants to increase the number of practicing medical specialists. Where, in your opinion, does this government measure fall short?
I don't think that training more medical students will solve the shortage of medical specialists. Slovak healthcare faces another pressing issue: we need to make sure that our students do not want to leave the country. The main reason is the conditions in our hospitals. Salaries have increased, but they are still not comparable to neighbouring countries. Young people want to work in a good environment.
| Professor MUDr. Juraj Payer, PhD., MPH, FRCP, FEFIM |
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| is a leading figure in Slovak medicine in the field of endocrinology and osteology. He is the chief expert of the Ministry of Health in endocrinology and the trendsetter in the development of the strategy of endocrinology, osteology and internal medicine in Slovakia. He is involved in the introduction of new, state-of-the-art diagnostic and treatment methods for internal diseases. |
In February you signed a memorandum with the University of Uzhhorod and with the University of Vienna. How can such international cooperation benefit your students and researchers?
In the case of Uzhhorod, we wanted to show our partners that we stand by them in these difficult times. The rector of the university is a neurosurgeon and we agreed that students from Ukraine can travel to Slovakia under Erasmus. We discussed scientific collaboration at the level of laboratory medicine. In addition to the memorandum with the Sigmund Freud University in Vienna, we have also signed a memorandum with New York University, the workplace of one of our most distinguished alumni, microbiologist Ján Vilček. He participated in the research of the drug infliximab, that is the basis for the biological treatment of severe rheumatic and gastroenterological diseases. For this research, he received a prestigious award from then-President Barack Obama, and donated a part of the award money towards a collaboration between our faculty and the New York University. On top of that, he also established a fund to support our university. We cooperate with the Hungarian Medical Association of America, which is headed by another of our alumni. This cooperation enables our students to travel for stays in the US. A memorandum of cooperation with the Masaryk Faculty of Medicine in Brno is due to be signed shortly.
What would you like to change at the Faculty of Medicine, what are your plans for the future?
We are planning to renovate the building, that is now the property of the University Hospital in Bratislava. It is located between the dean's offices and our theoretical institutes, and we are doing everything to get this building under our management. In addition, we acquired another building in Moskovská Street, so we are expanding our theory teaching premises. We are also expanding tuition through collaborations and memorandums with hospitals – we started to teach at the Bory Hospital. Students complete internships in stages there, e.g. in surgery and gynaecology. We also want to allow those, who are in the sixth year and just before final state exams, to complete their practice outside of Bratislava. This way, a student from Žilina can practice in Žilina, in their home town. We believe that this measure will increase the number of medical students in Slovakia. They would only need to come to Bratislava to complete the required practice at specialized institutes. We are also modifying the curriculum to reflect the changes in health care in recent years. I feel that we have constantly been piling up work for students, not taking it away. The first years of medical studies have been largely about memorization. However, we want our students to learn cutting edge medicine, including artificial intelligence. Therefore, we reduce the theory to retain more learning capacity for modern technologies. In addition, we are changing the selection process of students so that we get the highest quality people. We are also doing our best to make sure that a new University Hospital gets built as quickly as possible. We work on various committees, and hope to accelerate things that way. Without good conditions in hospitals we can never produce good medical specialists.
Radka Rosenbergová