Doctors support the idea of ​​allowing interns to work with patients, but do not want to be responsible for them

Almost 80% of Russian doctors support the idea of ​​allowing trainee doctors to work with patients. At the same time, the same number of potential mentors do not want to bear responsibility for the possible mistakes of their mentees. The Doctor’s Directory service decided to find out the opinion of representatives of the professional community about the new practice, which, according to the adopted legislative amendments, will begin to operate on April 1, 2024. At the same time, only 2% of experienced doctors are willing to serve as mentors to young doctors for free. The Ministry of Health assured Kommersant that the work would be paid, but did not provide specifics.

At the beginning of 2023, President Vladimir Putin instructed the Ministry of Health to introduce the position of trainee doctor in hospitals – this will allow second-year residents to work in clinics in their specialty. The department has developed amendments to the legislation. The federal law on the procedure for admitting residents to work in medical organizations as trainee doctors will come into force on April 1, 2024. Young specialists can be allowed to work provided that they have completed the residency training program for at least one year and have successfully passed the initial and intermediate certifications. Doctor-mentors should supervise their work in medical organizations.

The professional service “Doctor’s Directory” conducted a survey from October 14 to 25, in which 2,865 doctors took part, about how they felt about the initiative. Note that 24% of respondents were residents, that is, potential trainees.

Among those doctors already working in hospitals, 78.5% approve of the move, provided that the trainee will work exclusively under the guidance of a mentor doctor. 11.7% believe that residents can work as doctors even without a mentor, 6.2% believe that allowing interns to work is unacceptable. The Physician’s Handbook asked the same questions to the residents. Among them, 87.3% believe that trainees can work under the supervision of a mentor, and only 1.7% believe that this is unacceptable.

51.9% of medical specialists responded that a second-year resident has enough knowledge, but lacks practical skills to work in a hospital, 21.8% believe that both are lacking. Among residents, only 11% think so. And 34% of future trainees believe that they have enough knowledge and skills to be a trainee doctor.

The majority of medical specialists said that a doctor with more than five years of clinical practice experience (46%) and more than ten years (30%) could become a mentor. Among trainees, there is a higher proportion of respondents who believe that mentoring can be done by any doctor, regardless of length of service (27.3% versus 14%). But potential trainees and mentors agreed that for this, a doctor does not need to have teaching experience (87% of respondents in both groups think so).

About 80% of the doctors surveyed do not want to be held responsible for the mistakes of trainees: 34.3% believe that the trainee himself should be responsible, 33.7% – the medical institution, 10% – the university where he studied. Among residents, the opinion that responsibility for mistakes lies with the trainee turned out to be even more popular – 43.6% of respondents think so. The share of those who would place responsibility on a mentor is also higher—33% versus 21.9%.

Most doctors are in favor of a salary bonus for mentoring: at least 20% of the average salary (23.2%), at least 40% (30.9%), at least 60% (16%), at least 80% (9 .20%), a twofold increase in wages (13.2%). Only 2% of doctors are willing to work as mentors for free. And it was “acceptable” wages that doctors most often cited as a condition under which they would agree to become mentors (72%). There were multiple choices. The second most popular answer: a reasonable investment of time (58.4%). Third: an objectively high level of knowledge and skills of the trainee (36.6%). The next option is: lack of responsibility for the actions of the trainee (29.1%). 10% of doctors would not agree to be mentors under any circumstances.

8% of all doctors surveyed admitted that they would refuse mentoring due to fear that a trainee would take their place. Half of them explained that, “essentially, they are training their competitor, so such an outcome is very likely.” Another quarter believe that young doctors have their own ideas about fairness and can “go over their heads.” However, most of the respondents were positive. Among those doctors who are not afraid of losing their jobs, 37.4% believe that they are training a competent colleague for healthy competition; 30% are confident that a young doctor will need more than one year to compete with experienced specialists; 20.9% said that their medical institution has a lot of free rates.

60% of the surveyed residents intend to work as trainee doctors. Another 30% “will see how the implementation of the law will develop in practice.” Among the reasons for working as a trainee doctor, respondents cited the desire to gain experience under the guidance of a mentor (52.5%), the need to earn money (14.3%), the desire to understand whether such work is suitable (1.9%), the motive “everyone is going to and I’ll go” (0.2%) and all options at once (30%).

31.3% of residents believe that a trainee should receive the full salary of a doctor in the region, and only 1.3% are willing to work for free. 2.1% of surveyed residents think that an intern is entitled to at least 20% of the average doctor’s salary in the region; at least 40% – 8.9%; at least 60% – 25.2%; at least 80% – 31.2%.

The head of the State Duma Committee on Health Protection, Badma Bashankaev, says that the problems of personnel policy cannot be solved with the help of residents alone, but the new law can definitely make a significant contribution to the situation. “As for salaries for such young specialists, paying people for their work is fair. The Ministry of Health is currently preparing by-laws that will regulate the labor relations of trainee doctors with medical organizations and issues of bonuses. So, certainty in this area will appear soon,” Mr. Bashankaev assured.

The medical department told Kommersant that when preparing the document, the practice of involving residents in providing care to patients with COVID-19 was taken into account – as a result, they “made a significant contribution to the fight against the pandemic.” The department noted that doctors studying in residency already have qualifications and specialties, have passed primary accreditation and are allowed to practice professionally. “Taking into account that the position of “trainee doctor” is included in the nomenclature of positions for medical workers, as well as in the professional qualification groups of positions for medical workers, residents in these positions will be included in the staff of the medical organization and, in accordance with the employment contract, will receive wages, as well as compensation and incentive payments established in accordance with the regulations on remuneration adopted by the medical organization,” the Ministry of Health stated.

The department added that mentoring is also an additional labor function that does not negate the specifics of the employee’s work and benefits under the employment contract, including additional payment due to an increase in labor functions and the volume of work performed. Incentive issues can be provided for in collective agreements, industry agreements, taking into account the specifics of specific organizations, as well as industry-specific regulations. And based on the results obtained during testing of mentoring models and analysis of best regional practices, a decision will be made on the regulatory legal framework for mentoring issues in the healthcare sector, the Ministry of Health assured.

Natalia Kostarnova