26% of surveyed doctors want to leave medicine due to constant overwork

Russian healthcare workers are chronically overworked – this was revealed by a survey of professional services Aktion Medicine and Doctors.rf. Because of this, 26% of the doctors surveyed want to leave medicine—most of them are therapists and anesthesiologists-resuscitators. The trade union of medical workers “Action” points out that excessive workload leads to professional burnout, psycho-emotional and physical fatigue. The State Duma recognizes the problem and believes that health workers need to compensate for the time spent by increasing payments. The Russian Ministry of Health is critical of the survey results and points to existing social support measures.

The Aktion Medicine service (part of the Aktion group) together with the closed professional social network Doctors.rf surveyed healthcare workers about overtime. The questions were answered by 2113 respondents, of which 73% were doctors, 25% were representatives of nursing staff, 1% were chief physicians and their deputies, and 1% were employees of clinical diagnostic laboratories. At the same time, 43% of respondents work in clinics, 42% in hospitals; 81% are representatives of public medicine, 12% combine work in public and private clinics, and 7% work in private clinics.

Doctors were asked whether it was customary in their organization to work more than one position. 33% of doctors and 38% of nurses responded that more than 75% of their colleagues work this way in their institutions. The main reasons for this decision were an attempt to increase income (38%) and a shortage of medical personnel (37%).

For 33% of surveyed doctors, the work standard per week is 39 hours, for 28% – 36 hours, and for 19% – 40 hours. For 40% of the respondents from among the nursing staff, the work standard per week is 36 hours, for 30% – 39 hours, for 18% – 40 hours.

Doctors also reported that they had to stay late at work to complete paperwork. “There is not enough time to fully complete the entire appointment in 15 minutes, since it is delayed due to patients who come in out of turn and the poor performance of the EMIAS program (Unified Medical Information and Analytical System.— “Kommersant”),” the survey authors quote from one of the respondents. Only 9% of respondents from among doctors do not work above the norm. And the range of overtime in the answers was from 2 to 250 hours per month. Thus, 24% of surveyed doctors work up to 20 hours, 19.4% – from 20 to 40 hours; from 40 to 60 hours – in 12.8%, and over 60 hours – in 25.3%.

Among nursing staff, only 6% of respondents do not work more than normal. 18.8% of respondents work up to 20 hours; 15.7% – from 20 to 40 hours, 14% – from 40 to 60 hours, and 31.1% – over 60 hours.

Only 8% of respondents are ready not to notice fatigue – “the main thing is that they get paid extra.” 78% of doctors surveyed responded that they were tired of overwork, and 51% would like to work less. 26% want to leave medicine altogether, and among them 16% are young specialists under 35 years of age. More than others, therapists (28.3%) and anesthesiologists-resuscitators (28.7%) want to change their profession due to overwork.

Co-chairman of the medical workers’ union “Action” Andrei Konoval says that the employer has a wide range of legal options for attracting workers beyond the norm. The most common type of overtime is registration of part-time work under an internal agreement. In medicine, by agreement with the employee’s representative – the Trade Union of Healthcare Workers of the Russian Federation – part-time work can reach up to two rates. But in reality, says Mr. Konoval, up to 2.5–3. In addition, job sharing, expanding the service area during regular hours (for example, when a therapist takes on several areas) and working on weekends are used. “The employer is thus covering the shortage of personnel with the bodies of doctors. And since salaries leave much to be desired, the employee has no choice but to agree,” comments Mr. Konoval. The usual work rate per month is 160–168 hours, he continues, but there are often cases when doctors work 200 and 250 hours: “And there are also 320 hours, but the person already really lives at work.” Such workload, according to Mr. Konoval, leads to professional burnout, psycho-emotional and physical fatigue.

Leading expert at Aktion Medicine Natalya Zhuravleva adds that the shortage of both doctors and nurses is exacerbated by the demographic crisis of the 1990s. In addition, during the coronavirus pandemic, many older and younger doctors have decided to leave the profession. “The current geopolitical situation is also aggravating the shortage of workers in the healthcare sector,” comments Ms. Zhuravleva. “The famous medical saying “There is nothing to eat with one pay, but there is no time for two,” judging by the results of our survey, still remains relevant.”

The head of the State Duma Committee on Health Protection, Badma Bashankaev, cites data from last year’s study – then 6.5 thousand doctors were interviewed for the Human Rights Council under the President of the Russian Federation. It turned out that approximately 35% of respondents work at one rate, and the rest work at two or three rates. “It is not surprising that in such a situation, 84% of specialists talk about professional burnout, and some leave the profession,” comments Mr. Bashankaev. “A tired doctor who constantly works beyond normal is unlikely to be able to concentrate all his efforts on treating the patient.”

According to the deputy, increasing wages could improve the situation. “One of the steps here is special social payments to primary care and ambulance workers. From January 1, 2023, doctors receive them monthly. Another step should be a system of unified remuneration for health workers. It is planned to be introduced as a pilot project in 2025. Undoubtedly, further efforts are needed to resolve this multifaceted issue,” says Badma Bashankaev.

Director of the Institute of Health Economics at the Higher School of Economics Larisa Popovich points out that, according to objective statistical data, the level of part-time work among doctors is already decreasing. If earlier it averaged 1.5 rates per doctor, now it is 1.2 rates. “We need to understand what respondents mean when they talk about “recycling.” Perhaps they are simply tired or burned out and are not interested in the work they are doing. Then the extra ten minutes in the office will feel like overtime,” comments Ms. Popovich. In her assessment, such surveys should be conducted “more carefully and in more detail.”

The press service of the Ministry of Health also noted that the sample for the survey was “quite small” – only 2,213 doctors out of a total number of 1.8 million people. “According to departmental statistics, the part-time ratio for doctors in the Russian Federation was 1.3 in 2020, 2021 and 2022, for paramedical personnel – 1.2 annually,” the ministry said. “In some regions these indicators are higher, which in mainly due to staff shortages. In connection with this, the regions are introducing additional social support measures, primarily to provide housing, including for students of targeted training.” The press service reminded that overtime work not provided for by the Labor Code of the Russian Federation is not allowed. “As for labor standards, including time standards for receiving patients, including processing medical documentation, in accordance with the Labor Code, they are established at the level of the establishment by the employer, taking into account its own organizational and technical conditions and taking into account the opinion of the representative body of workers – the trade union,”— concluded by the Ministry of Health.

Natalia Kostarnova