One of the most pressing issues in the Polish healthcare system is the deficit of medical personnel. In 2019, Statistics Poland indicated that approximately 125,000 doctors were working directly with patients [1]. According to OECD data from 2020, there were 3.3 physicians per 1000 inhabitants, placing Poland among the lowest-ranking European Union countries (EU-27 average 4.0 per 1000 population) [2]. The number of medical graduates has been increasing lately, however this growth is still insufficient considering the health needs of an aging Polish society [3]. Comparing data from 2014 and 2020, there has been an increase of 24.21% (2,953 vs 3,663 graduates, respectively). In terms of currently enrolled students, numbers have also risen from 20,837 in 2014/2015 to 29,667 in 2020/2021 representing a change of 8,830 active students, resulting in an increase of 42.37% between the years analysed [3].

The Polish government aims to address shortages observed among most medical professions, mainly among doctors and nurses. This effort is especially evident in the increase in admissions to medical degree (MD) programmes. In June 2013 there were 12 universities offering programmes for medical degrees while in October 2023 the number of institutions rose to 36. Among these, 10 are not universities but are classified as higher educational institutions called “Applied Sciences Academies” (ASA, Polish: Akademia Nauk Stosowanych) [4,5]. Many controversies have arisen, including instances when the Minister of Education and Science granted permission to start MD programmes at institutions that have received negative opinions from the Polish Accreditation Committee (PAC) for not meeting educational standards [6,7]. The abrupt and impetuous decisions to launch new programmes lacking appropriate resources adversely affect the quality of teaching, as seen in the PAC's opinions [8,9], with a lack of foresight and “surgical precision” required [10,11]. The topic has been commented widely by representatives from the National and Regional Medical Chambers, medical resident associations, universities authorities and the Conference of Rectors of Academic Medical Schools (Polish: Konferencja Rektorów Akademickich Uczelni Medycznych, KRAUM). Nevertheless, additional institutions willing to open medical degree programmes are currently waiting for the Minster's approval. During the 2022/2023 academic year alone, the Polish Minister of Education and Science approved the opening of MD programmes at 14 Higher Education Institutions. When comparing the quotas for 2013 and 2023 it becomes evident that there has been a substantial growth in the admission limits for MD programmes. The number of available admissions has increased from 5,352 to 10,289 (3,991 and 8,460 respectively for programmes taught in Polish), representing an increase of 4,936 places in total and 4,469 for programmes in Polish (+92.25% for 2023/24 to 2013/14; +111.98% for programmes in Polish). [4,5,12]

As indicated earlier, currently the main strategy for improving access to healthcare services is to increase the number of graduates from MD programmes. A recent proposal to abolish the mandatory postgraduate internship, a longstanding and integral component of medical doctors' training, has also returned. These actions suggest that the main goal of the authorities is to increase the number of practicing doctors in the Polish healthcare system, regardless of training quality, without adequate foresight or long-term policy concerning medical education and employment in place. The main goal of this article is to analyse the currently applicable legal regulations and the organization of the postgraduate internship with consideration of the opinions and positions of various stakeholders.

The methods applied included desk analysis of Polish regulations, opinions and statements presented by health system stakeholders as well as consultations with key informants. The main sources used in the initial phase of the analysis were government regulations, guidelines, scientific papers, and statements published on the official websites of organizations involved in medical training. To further explore different opinions and perspectives in the second step of our research, the first author contacted experts representing the key stakeholders. These experts were selected based on their expertise in medical training and their involvement in the analyzed topic. Information from the stakeholders was collected during individual consultations (in person or on-line). The key stakeholders of medical training in Poland are shown in Figure 1, which are grouped according to their influence and willingness to implement changes (defined as a statement regarding their specific recommendations and proposals) based on the analysis of formal regulations [14,[16], [17], [18]], statements presented on official websites [22], and opinions expressed by particular stakeholders during consultations.