Information about Cyprus Andreas TANOS Immediate Past President Cyprus Association of Orthopaedic Surgery and Traumatology ( CAOST )

Cyprus is a small island of 9.251 sq km CYPRUS IN GENERAL Cyprus is a small island of 9.251 sq km The most eastern and Southern point of the European Union

On 1 May 2004 the Republic of Cyprus became a full member of CYPRUS IN GENERAL On 1 May 2004 the Republic of Cyprus became a full member of the EU and in January 2008 Cyprus joined the Eurozone.

Population (2013) = 858,000 (on Government’s controlled area) CYPRUS IN GENERAL Population (2013) = 858,000 (on Government’s controlled area) MALE 417,500 FEMALE 440,500 0-14 years = 16,3 % 15-64 years = 69,8 % 65 years and over = 13,9% Life Expectancy : FEMALES = 84,8 years MALES = 80,0 years => Men die Younger

Persons per doctor (any specialty) = 330 CYPRUS IN GENERAL Persons per doctor (any specialty) = 330 Persons per Ortho doctor (practicing in Cy) = 10 000 Persons per hospital bed = 286 Hospital beds (2012) = 2,999 (1552 public + Private 1447 ) Health personnel (number) Medical = 2.630 Nursing = 4.163 Total expenditure on health services (2012) as % of G.D.P. = 7,1

Public expenditure on education as % of G.D.P. = 7,3 Literacy rate (2011) = 99% Tertiary education : Tertiary level students = In general, Cyprus has a high percentage of tertiary education attainment (46.7% in the 30-34 age group, for 2013), exceeding the national target, and achieving a percentage that is higher than the EU28 average of 36.8%, and one of the highest percentages in the world. Public expenditure on education as % of G.D.P. = 7,3 CYPRUS IN GENERAL

Cyprus Unemployment Rate : 3.20 percent in May of 2008 CYPRUS IN GENERAL Cyprus Unemployment Rate : 3.20 percent in May of 2008 16.90 percent in October of 2013 After 2013 Troika’s intervention ( invasion ) Unemployment to people of less than 25 years of age = 40.2%

GENERAL HEALTH SYSTEM ( ΓΕ.Σ.Υ. ) Since 1970 the government tries to design the best health system. Numerous fruitless attempts were made to get the different plans approved by the Parliament and get the acceptance of all parts involved.

GENERAL HEALTH SYSTEM ( ΓΕ.Σ.Υ. ) When Troika in 2013 asked for an immediate implementation of a health plan, government technocrats behaved just like Dr Frankenstein : they sutured together the best parts of each National Health System in Europe thus, creating a non – functional system, which yet has not been accepted nor implemented.

GENERAL HEALTH SYSTEM ( ΓΕ.Σ.Υ. ) Doctors - both in public and in private sectors - have their objections and their suggestions for the improvement of the last proposed plan but, the technocrats prefer not to understand

CYPRUS HEALTH SYSTEM ( or NO system ) NOW : Cyprus has a dual System on health Care Delivery Public Sector ( funded by taxation and some user charges) Controlled and monitored by the Ministry of Health Private Sector (funded by user charges, private health insurance ) Approved, licensed and Monitored by the Ministry of Health Note : Public Hospitals are CLOSED Hospitals = No doctor from the private sector can treat patients in the public hospitals.

ORTHOPEADIC MANPOWER Orthopaedic patients can be treated by 23 Orthopaedic surgeons in all 5 Public general hospitals ( 1 clinic per hospital – 1 hospital per district ) Also They can be treated by 62 Orthopaedic Surgeons in 57 hospitals or polyclinics or clinics of the private sector, scattered around the 5 districts After 2013, 60% of the population visit the public Orthopaedic clinics and only 40% visit the private

ORTHOPEADIC MANPOWER NOTE : Although public hospitals are funded almost entirely by the government, they are understaffed and not adequately equipped. On the other hand, private clinics / hospitals have invested a great deal on equipment, so there can be no examination nor treatment that cannot be done by them (especially in Orthopaedics)

Cyprus Orthopaedic Association ( COA ) est 1970 ORTHOPEADIC MANPOWER CAOST Cyprus Orthopaedic Association ( COA ) est 1970 CYPRUS ASSOCIATION of ORTHOPAEDIC SURGERY and TRAYMATOLOGY ( renamed CAOST in 2005 ) 95 Registered Members (first female member 2005) 23 working on government hospitals,62 on private, 10 are pensioners 13 Trainees

CAOST & ITS ROLE IN EDUCATION ORTHOPEADIC MANPOWER CAOST & ITS ROLE IN EDUCATION Average a CAOST member can accumulate locally 48 points of C.M.E. every year (based on an hour/point) FROM : ONE General Orthopaedics Conference annually(3)days duration. ONE Paediatric orthopaedics conference annually one day duration FOUR one-day specialty symposia annually

CAOST & ITS ROLE IN EDUCATION ORTHOPEADIC MANPOWER CAOST & ITS ROLE IN EDUCATION In 2011 CAOST founded the MedFORT (=Mediterranean Federation of Orthopaedics and Traumatology) and organised and hosted the first Mediterranean Trauma Conference

3rd Mediterranean Trauma Conference Larnaca, Cyprus 23, 24, 25 September 2016

3rd Mediterranean Trauma Conference Larnaca, Cyprus 23, 24, 25 September 2016 With the collaboration of EFORT and with an EFORT FORUM included in the program Chairman of the Scientific Committee : Prof P. Yiannoudis Participants AND Speakers are coming from most Mediterranean countries and from central and west Europe

3rd Mediterranean Trauma Conference Larnaca, Cyprus 23, 24, 25 September 2016 TOPICS of the Congress : 1)Poly trauma.   2)Pediatric 3)Ankle 4)Upper Limbs 5)Elbow 6) Non Unions- Infected -Aseptic 7) Lower Extremity 8) Pelvic and Acetabular Injuries 9) Wrist and hand injuries

You are all Welcome 3rd Mediterranean Trauma Conference Larnaca, Cyprus 23, 24, 25 September 2016 You are all Welcome

ORTHOPAEDIC TRAINING in Cyprus First University medical school in Cyprus started in 2013. Yet there is NO University Medical School providing medical specialty. => All of our medical physicians and surgeons get their specialty qualification by university authorities abroad (mostly from Greece).

ORTHOPAEDIC TRAINING in Cyprus In Greece: The specialty training can be completed either at the university’s affiliated hospitals or at any other hospital which is approved by these Universities and the Government’s authorities but, the final exams must be carried out by the universities and their supervising authority – the Government (Prefecture).

ORTHOPAEDIC TRAINING in Cyprus Based on the provision of the agreement between Cyprus and Greece in the sector of Public Health, both Cypriot and Greek citizens can do part or the entire internship required to obtain a specialty in one of the hospitals or medical schools in Cyprus which are recognized by Greek and Cypriot authorities and obtain a title of medical specialty from Greece. The selection of the candidates is made after a written and oral examination in Cyprus.

ORTHOPAEDIC TRAINING in Cyprus So, Some Orthopaedic trainees have their training in Cyprus, and that is recognised as equal to the training followed in any of Greece’s (recognised for such training) hospitals. The trainees however, must sit for their final exams in Greece, together with their colleagues who have been trained in Greece. The exams are carried out by 3 directors of different orthopaedic surgery Departments with at least one of them to be a professor of orthopaedic surgery. This way the trainees are granted the Specialty title in Orthopaedic Surgery from the Greek Government.

13 Trainees in 2 Ortho clinics approved by Greek Universities. NOW in Cyprus : 13 Trainees in 2 Ortho clinics approved by Greek Universities. Ratio = 1 Trainee : 1 Trainer

ORTHOPAEDIC TRAINING in Cyprus Training in Greece and, consequently in Cyprus, lasts for a total of 6 years. Trainees must follow : a one-year training in General Surgery at the start of their training, a one-year training in Paediatric Orthopaedic Surgery, one 6-months period of training in Neurosurgery or AngioSurgery and one 6-months period of training in Plastic/Reconstructive surgery – not during their last year of training. The General Orthopaedic Surgery training lasts 3 years. Trainees are obliged to hold a log, which is inspected and signed by their Department’s director.

ORTHOPAEDIC TRAINING in Cyprus Trainees in Cyprus depend their tutoring entirely up to the discretion of their Department’s Director, although there are Ministry’s guidelines for the training that can be followed if wished to. Regrettably, there have been cases noted where training is limited to the absolutely most necessary and guided only by the needs of the department. No lectures – No tests to evaluate the training process and the progress – No hands-on workshops – No supervision by the state or any other authority upon the training during the training.

ORTHOPAEDIC TRAINING in Cyprus One can understand that it lies entirely to the trainee to study hard enough so as to be on the same level of knowledge and competence as their colleagues / co-candidates trained in Greece, for them to be successful.

ORTHOPAEDIC TRAINING in Cyprus All specialty tittles, either granted by Greece or by any other country – European or not - must be recognized and approved by THE MEDICAL BOARD which is independent from the health ministry, so as the specialist can then be added in the SPECIALISTS REGISTRY. The Medical Board consists of physicians and surgeons elected by the General Assembly of our National Medical Association and follows regulations and laws passed by the parliament.

ORTHOPAEDIC TRAINING in Cyprus NO REGULATION EXISTS FOR THE RE-QUALIFICATION or the RE-VALIDATION or the RE-CERTIFICATION OF ANY MEDICAL SPECIALTY IN CYPRUS

ORTHOPAEDIC TRAINING in Cyprus Cyprus Association of Orthopaedic Surgery and Traumatology (CAOST) is exerting pressure to the ministry of health to be granted permission for assisting, monitoring and supervising the training in Cyprus ( even without control), to ensure at least the minimum requirements and syllabus.

CYPRUS AND UEMS Nicosia October 2003

CYPRUS AND UEMS Protaras September 2012