At 90, Bulgarian rural doctor keeps seeing patients amid GP shortage

Kiril Apostolov, a 90-year-old doctor in southwestern Bulgaria, is still visiting patients in and around the mountain village of Skrat, near the borders with Greece and North Macedonia.

Apostolov turned 90 in May and still walks up a steep village street most days with his medical briefcase. He has more than 1,500 patients across several villages at the foot of the Belasitsa mountain range.

His work reflects a wider problem in Bulgaria, where many general practitioners continue after retirement age because replacements are scarce, especially outside cities. In 2023, 54.5 percent of doctors in Bulgaria were aged 55 or older, the highest share in the European Union, according to Eurostat. For general practitioners, the average age is now above 61.

Bulgaria also has the lowest life expectancy in the EU, at 75.8 years in 2024, compared with an EU average of 81.5 years, and one of the bloc's highest rates of preventable mortality, according to the Organisation for Economic Cooperation and Development. The OECD links part of the problem to doctor shortages, which can mean later diagnoses and weaker management of chronic disease.

Apostolov starts his day at about 7:00 am, driving around 16 kilometres from his home in Petrich to his office in Skrat in a 20-year-old Peugeot. Patients are often waiting when he arrives, including people seeking help for high blood pressure and diabetes. He opens the practice at 8:00 am, sees patients in the old brick building, then leaves around midday to visit people who cannot travel. In the afternoon, he drives to nearby villages.

Apostolov said he feels well and plans to continue while he can do the work and while patients are satisfied. He also said he would step aside if another doctor wanted the post, but young doctors are not coming.

Apostolov began practising medicine in 1962 as a district doctor. He later led a hospital department in Petrich and ran a cardiology practice. He moved to Skrat in 2000, when he was already over 60.

The OECD says Bulgaria has a relatively high overall number of doctors, but that primary care remains underdeveloped, underfunded and undervalued. Gergana Nikolova, vice president of the Bulgarian National Association of General Practitioners, said many young doctors avoid general practice, particularly in rural areas, because of bureaucracy, limited career prospects and low pay. She said she is still proud to have encouraged several younger doctors who are now training with her, and said she herself trained with Apostolov more than 20 years ago.