In most regions of Russia, there is an acute shortage of hematologists

The chief hematologist of the Ministry of Health, Elena Parovichnikova, said that in 65 regions of the country there is a lack of “qualified personnel” in hematology. Mrs. Parovichnikova explained the problem by the “many times” difference in the salaries of doctors in Moscow and in other cities. According to a study by the Tinkoff Family Foundation, in 2021 there were only 448 hematologists in Russia – this is an average of only five doctors for each subject of the Russian Federation.

In most regions, outpatient medical facilities are understaffed with hematologists, said Elena Parovichnikova, chief freelance specialist hematologist of the Russian Ministry of Health, general director of the National Medical Research Center for Hematology. The situation with a lack of qualified personnel, according to her, is observed in 65 regions. “The salaries are vastly different. A hematologist in Moscow receives 140 thousand rubles, in Yaroslavl – 25 thousand. The tariff in territorial programs for an outpatient appointment with a hematologist differs by an order of magnitude – from 140 to 2 thousand rubles. There are no specialists at the outpatient stage. Why? They are not paid any money,” Medvestnik quoted Ms. Parovichnikova as saying.

She also drew attention to the need to create an infrastructure for day hospitals. They are not available in 28 regions, and hematological patients are hospitalized in regular round-the-clock rooms. Specialized hematological centers operate only in 11 subjects, their absence leads to a lengthening of the waiting time for the start of treatment, Elena Parovichnikova emphasized. This is especially critical in hematopoietic stem cell transplantation. The procedure is effective only if the technological process is continuous. “And we have an interval between the diagnosis of leukemia and transplantation in the federal center is 7-8 months,” said Ms. Parovichnikova. According to her, it is necessary to approve the procedure for dispensary observation of patients with diseases of the blood system, introduce an outpatient tariff, as well as “immerse accompanying therapy into compulsory health insurance” and review the use of the introduced clinical and statistical group (CSG) for the treatment of complications after transplantation, which is now limited by a time limit in 100 days. In many patients, complications develop within a year, that is, they still have to be hospitalized, the expert explained.

The conclusions of Elena Parovichnikova are confirmed by the socio-economic study “Oncohematological care for the adult population in Russia”, which the Tinkoff Family Foundation (FTS, provides systemic support for the development of oncohematology in Russia) conducted jointly with the Higher School of Economics, the Center for Strategic Research and the New Economic Growth partnership. According to the study, in 2021 there were only 448 hematologists in Russia, which is an average of five doctors for each subject of the Russian Federation. In fact, in some regions there are simply no such specialists. At the same time, the standard for providing only outpatient services is one hematologist per 200,000 attached population. “If we make a simple calculation, then there should be at least 730 doctors in primary care. The shortage of primary care hematologists is 40%,” says FTS Director General Konstantin Tikhomirov.

The result is a long wait for an appointment, an increase in the timing of diagnosis, diagnosis, a late start of treatment, continues Mr. Tikhomirov. The routing of patients is significantly disrupted – both to the center of highly qualified care, and in the opposite direction, when the patient has completed treatment and needs timely monitoring of health indicators and rehabilitation. The absence and shortage of hematologists in the outpatient department in a number of regions leads to domestic medical tourism, which in turn leads to an overload of federal medical organizations and large regional medical institutions in their profile, which actually become interregional centers.

Hematologist, medical expert of the Federal Tariff Service Andrey Abrosimov adds that the problem of shortage of personnel “is more systemic” than just the difference in the incomes of doctors in the regions and in the capital and federal institutions. “Of course, salary plays a role. However, in addition, this is the underdevelopment of the social infrastructure, which does not allow retaining young specialists in the field, difficulties in acquiring housing, – says Mr. Abrosimov. – An important factor is the significant burden on the outpatient hematologist in the region, which does not correlate with the low level of payment work, does not allow to qualitatively and continuously improve the educational level. In turn, the lack of self-development for a doctor means a decrease in the quality of medical care, a slowdown in the introduction of innovations into practice, and a lack of career growth.”

The lack of hematologists and doctors of related specialties, paramedical staff, their low qualification, lack of rehabilitation, low level of infection control for oncohematological patients, according to Andrey Abrosimov, lead to the fact that only 2 thousand hematopoietic stem cell transplantations are performed in Russia per year with the need for 10 thousand operations.

To solve the problem of shortage of personnel, according to Konstantin Tikhomirov, the FTS has launched a program of professional retraining of doctors of any specialty to become hematologists and conducts regular internships for existing specialists. Earlier, the Ministry of Labor established a list of specialties for foreign citizens and stateless people with higher education who can obtain citizenship in a simplified manner – this list includes oncologists and hematologists.

Natalya Kostarnova