The State Duma proposed increasing the appointment time for pregnant women in antenatal clinics
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State Duma deputy Yana Lantratova asked the Ministry of Health to increase the standard for visiting a specialist doctor for pregnant women. Now the appointment should take 22 minutes, and this, according to Mrs. Lantratova, is clearly not enough. Experts interviewed by Kommersant admit that pregnant women are often examined faster than current standards, and suggested that they first achieve compliance with them. The Ministry of Health indicates that specific standards for appointment time and workload for a doctor are set by his employer “at the institution level, taking into account its own organizational and technical conditions.”
First Deputy Head of the State Duma Committee on Education Yana Lantratova (A Just Russia – For Truth) proposed to Health Minister Mikhail Murashko to increase the time frame for pregnant women to visit a specialist doctor. Ms. Lantratova published a letter to the minister in her Telegram channel. In it, she recalls that the Ministry of Health has approved standards for patient visits to certain categories of doctors. Thus, 15 minutes are allotted for an appointment with a local pediatrician and a general practitioner, a general practitioner (family doctor) – 18 minutes, a neurologist – 22 minutes, an otolaryngologist – 16 minutes, an ophthalmologist – 14 minutes, an obstetrician-gynecologist – 22 minutes. But the deputy believes that some patients “for objective reasons” need more time, for example pregnant women.
“The 15–20 minutes established for appointments in clinics, as a rule, for pregnant women due to their special physiological condition is critically insufficient,” Ms. Lantratova states in a letter. “Fixing the condition of a pregnant woman requires additional actions: weighing, measuring the size of the abdomen, pressure, checking for the absence of hypertonicity. However, due to lack of time, the doctor cannot always perform these actions. In addition, women experiencing pregnancy for the first time require special attention.” Therefore, the deputy considers it expedient to fix an increased period of visiting a specialist doctor for pregnant women in the amount of 130–150% of the current time standards. “In the future, in the course of testing the effectiveness of this standard, similar standards can be established for other special categories of patients, for example, patients with disabilities,” writes Ms. Lantratova.
Kommersant asked the Russian Ministry of Health to comment on the deputy’s proposal. The department’s press service responded that labor standardization systems, including time and workload standards, in accordance with the Labor Code of the Russian Federation, are established by the employer “at the establishment level, taking into account its own organizational and technical conditions.” At the same time, “for the purpose of state assistance to the systemic organization of labor standards,” federal departments “may develop and establish standard labor standards.”
In the case of the timing of an appointment with a medical specialist, “the basis for the development of standard industry time standards… is the weighted average time of the number of visits, obtained on the basis of time-keeping studies conducted in medical organizations of the constituent entities of the Russian Federation for average organizational and technical conditions.” Therefore, in different medical institutions, appointment times “vary, taking into account living conditions and the age and gender composition of the population, the level and structure of morbidity in the population.” But in any case, they “must be adapted at the level of the medical organization,” the Ministry of Health emphasizes.
Director of the Institute of Health Economics at the National Research University Higher School of Economics Larisa Popovich points out that admission standards are just a “unit of account.” This time is needed to formulate the so-called function of a doctor’s position, that is, “certain standards for the workload on a doctor, which also includes wages.” And the actual reception time may be more or less than the standard, the expert says, depending on the situation, “therefore, there is no need to confuse the planned reception standards with the real ones.”
The chairman of the primary organization of the interregional trade union of healthcare workers “Action”, obstetrician-gynecologist Maria Gubareva confirms that the standard admission of 22 minutes is actually not observed, and to a lesser extent. “In Moscow, a gynecologist must take 15 minutes (this standard was established by order of the Department of Health dated June 30, 2023.— “Kommersant”). Therefore, before adding 130% or 150% to the intake time, you need to try to comply with the standards of the Ministry of Health,” says Ms. Gubareva. According to her, the problem of lack of time for consultations with pregnant women does exist, especially when it comes to the first appointment or if the woman has concomitant diseases. In this case, doctors get out of the situation at the expense of the time of the next patients, “but if several pregnant women come in a row, then the appointment will certainly be “scheduled”.”
Mrs. Gubareva believes that the problem can be solved “very simply”: it is necessary to achieve compliance with the current standards of the Ministry of Health on the maximum number of citizens assigned to one medical station, and on the time that is supposed to be allocated for consultations with a specialist. “But since none of these parameters are actually observed, it is still inappropriate to talk about increasing time standards,” she states.
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