In Russia, the number of doctors has catastrophically decreased
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The number of medical staff of Russian state clinics last year decreased by 50 thousand people, of which almost 10 thousand are doctors, and the rest are nurses. At the same time, layoffs and layoffs continue. In addition, a new order “On approval of the nomenclature of positions of medical workers and pharmaceutical workers” may come into force in September, according to which many specialists popular in polyclinics will be outlawed.
According to the Central Research Institute of Organization and Informatization (TsNIIOIZ) of the Ministry of Health, the number of medical workers in public sector institutions in 2022 decreased in the vast majority of Russian regions (79) and continues to decline. According to Nadezhda Nesvetailo, deputy head of the statistics department for analytical work at TsNIIOIZ, this trend has been observed over the past two years, it is most pronounced in the Southern Federal District (only in 2022, the number of nurses there fell by 4.7%). In 22 regions of the country, the expert called the shortage of medical personnel “significant”. Among the leaders are Kaluga Region, Chukotka Autonomous Okrug, Chuvashia, Tuva, Mari El, Kalmykia, Khakassia, Tatarstan, Chelyabinsk, Bryansk, Lipetsk, Kemerovo Regions, Krasnodar Territory. There are significantly fewer doctors in these parts than is required to fulfill the territorial program of state guarantees for the provision of medical care to their residents. In addition, there is a colossal imbalance in the staffing between the polyclinic and the hospital. We have to involve doctors from federal and private clinics, but this does not always help.
In another 7 regions of the Russian Federation, there is an “extremely low” number of nurses, and the staff shortage is assessed as deep. Among them are the Nenets Autonomous Okrug, Kostroma, Amur, Magadan regions, Chuvashia, St. Petersburg and Khakassia. But in 11 regions (among them – the Krasnoyarsk Territory, Moscow, Voronezh, Tver, Astrakhan, Kirov Regions, etc.) doctors are in surplus. And there is a surplus of paramedical workers in 18 regions of the country.
“The reduction of medical specialists is far from new, we have been observing this trend for the last 10 years, since the adoption of the May Decrees,” Andrey Konoval, head of the medical workers’ trade union Action, told MK. – It is curious that the decrees set the task of increasing the personnel potential of the industry, but over the years there has been a reduction in the number of medical and junior medical staff. The only exception is 2020, when covid surcharges were introduced and the staffing table began to expand. But this concerned only the positions of doctors and junior medical staff, which has been reduced so far: from 2013 to 2020, it has decreased from 700 thousand to 300 thousand. People were fired, transferred to working professions – cleaners, orderlies. However, already in 2021, the staff drain resumed in all categories. The fact that for the year the reduction amounted to 50 thousand people is a gigantic figure, taking into account the already existing deficit!
The expert notes that the reduction in the number is due to the fact that in the first half of 2022 they began to tighten the regime of federal covid allowances, and in July they were completely canceled: “Before the introduction of allowances, many regions cut the salaries of doctors, but those who had “covid surcharges” (and there were many of them), they turned a blind eye to this. And after January 1, 2023, a widespread cut in stimulating floating allowances began, somewhere below zero. And all this against the background of the fact that from July 1, 2022, a new system of remuneration for medical workers was to be launched in the country, designed to raise and equalize salaries and which had been expected since 2019. But the government postponed its start to 2025, that is, for an indefinite period. They tried to sweeten the pill by introducing social benefits for nurses and doctors, who at first promised 1.3 million specialists, but it turned out that only 800 thousand doctors can count on them, and this is about a third of all who work. As a result, the dissatisfaction of health workers is growing.”
Market experts believe that the shortage of medical personnel will continue to worsen. At the same time, it is expected that on September 1, an order on a new nomenclature of medical specialties will come into force. De facto, about a dozen medical positions, including district specialists, will be removed from the current nomenclature. But something will be added: there will be more administrators, sports doctors and doctors … without a medical education. This is done, as stated in the explanatory note to the draft order, “in connection with the need for its (nomenclature. – Auth.) actualization.”
From September 1, there will probably no longer be left in Russian clinics: obstetrician-gynecologists, therapists of the local shop medical section; city (district) pediatricians; teenage therapists and psychiatrists, teenage precinct psychiatrists; district psychiatrists-narcologists; sexologists; audiologists-prosthetists; disinfectologists; clinical and laboratory mycologists; ophthalmologists-prosthetists. And although the explanatory note to the order notes that the positions canceled from September 1 will be retained by already working doctors, it is not clear how to implement this in practice. Because the law does not contain a mechanism for retaining a specialist in a position that does not exist.
But in the district outpatient clinics, new positions will open: for a doctor of an ambulance team; doctor and senior doctor for sports medicine of the sports team; medical speech therapist. As well as specialists who do not need a higher medical education at all: a neuropsychologist, a specialist in physical rehabilitation (kinesiospecialist) and an occupational rehabilitation specialist (ergospecialist). In addition, new administrative units will appear: “the head physician (head) of a separate division of a medical organization” with deputies, as well as “the head nurse (head nurse), head obstetrician (head midwife), head paramedic”, and also – trainee doctor. There will also be positions for several options for a nurse, including a nurse for palliative care, for prevention, and even for providing medical care to students. “We did not analyze the entire list, but some of the specialties that are being removed are very narrow. There are no ophthalmologists in polyclinics now, what kind of ophthalmologists-prosthetists are there, ”says Andrei Konoval. Meanwhile, one doctor, who wished to remain anonymous, told MK that kinesiotherapists and ergorehabilitologists in polyclinics are somehow too much: “We are waiting for bioresonance therapists, urine therapists and old midwives!”
Newspaper headline:
The doctors flew away
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