Medicine in Russia: Doctors and patients are horrified by beautiful reports from officials

Attracting so many people to the healthcare system is a very difficult task. But even so, the provision of doctors per 10 thousand people will be almost a quarter less than, for example, in Georgia.

In reality, the task is even more difficult, because some doctors are leaving - they also need to be replaced by new people. According to estimates by Deputy Prime Minister Tatyana Golikova, the healthcare sector's need for qualified personnel is several times greater than these 70 thousand people.

— Taking into account the age characteristics in the perspective up to 2030, in order to replace the personnel leaving due to age and attract additional young personnel to the industry, we need 496 thousand medical workers with secondary specialized and higher education: 276 thousand doctors of various specializations and 220 thousand workers with secondary specialized education. This is almost 100 thousand medical workers annually.

The Ministry of Health's plans to increase the supply of doctors by attracting young specialists seem obviously unrealistic. In the period up to 2030, it is necessary to recruit 55 thousand doctors annually, but in 2022, for example, only 35 thousand students entered the first year of medical universities. Some of them will drop out, some will finish their studies, and many more are studying in faculties other than medical ones. Some will not work in their profession at all...

As a result, more than a third of graduates do not work in the state health care system. And as a result, we get about 20 thousand young doctors per year instead of the required 55 thousand. Many of them will subsequently face the realities of working in state medical institutions and will soon quit.

The Ministry of Health plans to solve the problem of providing medical institutions with young specialists by forcibly distributing graduates . The State Duma is already considering a bill to triple the fines for graduates who refuse to work off their mandatory work.

The distribution of graduates in itself, according to experts , is a dubious undertaking. It can scare off applicants and provoke rampant corruption: a referral to a prosperous hospital closer to Moscow instead of a rural clinic can be expensive.

But this is at least some attempt to patch up the personnel gaps. But there are no attempts to keep the existing doctors on the job. Often, medical officials act exactly the opposite.

In Rostov-on-Don, mass layoffs of ambulance doctors began at the end of 2024. During the pandemic, in order to eliminate the shortage of ambulance workers, the Ministry of Health allowed the hiring of medical call graduates with valid accreditation. People came to the profession, gained colossal experience over several years, but now they find themselves on the street - according to the new rules, only graduates of residency in the specialty of "ambulance doctor" should work in the ambulance. And 111 employees quit the city hospital in Pervouralsk last year due to a conflict with the management.

The first and most obvious problem that doctors face is low salaries. Formally, the May decrees on average salaries of doctors are being implemented. But at what cost! In the Jewish Autonomous Region, for example, doctors work an average of 1.7 full-time positions.

Doctors can receive acceptable payments only if they work themselves to the point of exhaustion. In addition, commercial methods of financial management have penetrated into state medicine. Dmitry Privalov, head of the trauma department of the Pervouralsk hospital, said that each department has its own revenue plan: in traumatology, it has grown from 5.5 million rubles to 6.5 million rubles. And all this affects incentive payments, which make up a significant part of doctors' income.

Readers of NI, among whom are doctors, confirm that the real incomes of medical workers in state institutions are often very far from what they would like.

Doctors are lucky to have any chance of receiving bonuses and incentive payments. In the village of Selikhino in Khabarovsk Krai with a population of 15,000 people, the entire ambulance crew quit due to low salaries and high workload. According to the head of the Higher School of Health Organization and Management, MD Guzel Ulumbekova , the ambulance workers are in an extremely disadvantageous position.

— Paramedics and emergency doctors did not receive any new bonuses at all. Emergency doctors still received a bonus of 11.5 thousand rubles, paramedics of teams — seven thousand rubles, and for paramedics working in dispatch centers, the amounts were reduced to 4.5 thousand.

Let's imagine that medical schools will be filled with applicants from a fairy-tale world, ready to work solely for the idea, and they are not interested in money at all. And even in this case, it will be difficult to retain specialists.

Doctors are faced with a daily mass of bureaucratic red tape and paperwork that distracts them from their main tasks and leaves no free time.

Doctors have accumulated especially many complaints about the certification system: since January 1, doctors have to pass exams on their knowledge of new clinical guidelines that describe the treatment process.

According to surveys conducted by the professional social network “Doctors of the Russian Federation,” 80% of doctors notice that their colleagues only pretend to work according to clinical guidelines, but in fact have not changed their approaches.

Such resistance to innovations is explained not only by the harmfulness and stubbornness of doctors, but by the fact that standardized procedures do not provide for the individual approach necessary for effective treatment. And often there is simply no diagnostic equipment.

It turns out that a thorough study of new recommendations and certification of doctors is a waste of time and effort. But officials can report on the implementation of innovations.

Another reason why doctors do not stay in state institutions is their complete lack of protection. Often, both management, insurance companies, and patients themselves demand the impossible. And there is nothing to counteract doctors with, NI readers note.

A pediatrician from Chelyabinsk talks about similar problems.

— In conflict situations, the management blames you, because there is an unspoken rule "the patient is always right", this is a system that has been built up over the years, which can only be broken by the state. It turns out that we are not a service for helping people, but a service for serving. Initially, as altruists, we go to help people, then because of this, altruism fades.

The situation is quite unpleasant: the healthcare system in the Russian Federation is not at all oriented towards retaining specialists. Doctors have become expendable material, and their numbers will be replenished by distribution, just as mobilization replenished the number of military personnel.

At the same time, doctors themselves have long ago formed their list of demands that will help turn the situation around. But medical officials are more busy with paperwork to improve efficiency, which is not reflected in real work. This means that healthcare will continue to lose more specialists than attract new ones.