Treatment and labor will grind everything

The Liberal Democratic Party promised to return to Russia the mandatory placement of graduates of medical universities. The issue, according to party leader Leonid Slutsky, is being worked out jointly with the government. Thus, the deputies expect to eliminate the shortage of personnel in health care. The experts with whom Kommersant spoke doubt the viability of the idea: the problem of a shortage of doctors requires “more systemic and comprehensive solutions,” and young professionals will evade forced employment in every possible way. The Ministry of Health announced that they intend to solve the problem of shortage of personnel by expanding the opportunities for targeted training and fines for non-fulfillment of such contracts.

“Now we are conducting a dialogue with the government about the mandatory distribution for graduates of medical universities – a year and a half to the Far East and new territories, for the rest – three years, and for medical colleges. Otherwise, we have this colossal shortage (personnel.— “b”) we will not overcome,” Leonid Slutsky said on Monday. He referred to the statistics of the Ministry of Health of the Russian Federation, according to which there is a shortage of about 25-26 thousand doctors and about 50 thousand middle-level workers in healthcare. Mr. Slutsky called the situation “strange” when there are not even pediatricians in regional medical institutions, or when there is only one pediatrician for the entire hospital, “and not so far from Moscow.”

In Russia, they regularly return to the idea of ​​forced employment of young doctors. In 2019, the Federal Biomedical Agency (FMBA) prepared a pilot project to restore the distribution system for graduates of medical universities and colleges. As Vladimir Uyba, head of the agency, reported at that time, the initiative was submitted to the Federation Council, the State Duma and the government. First Deputy Minister of Health Viktor Fisenko then said that it was “practically impossible, this is the distribution of Soviet time.” But already in 2022, the deputies of the Kursk Regional Duma again proposed to the federal authorities to return the distribution system for graduates of medical universities studying on a budgetary basis.

Director of the Institute of Health Economics at the Higher School of Economics Larisa Popovich believes that the followers of the idea of ​​mandatory distribution “oversimplify the situation, and the problem requires much more systematic and comprehensive solutions.” She notes that the actual shortage of health workers, based on the staffing table, is much higher than the indicators named by the Ministry of Health. And least of all, “strange as it may seem,” there are not enough therapists and pediatricians. According to the expert, 35,000-36,000 graduates graduate from medical universities every year, and “on the strength of 2,000-3,000 new specialists” appear in the profession. “At the same time, part of the pensioners leave, so the increase goes by a few,” says Ms. Popovich. “Offhand, the reason for the departure of graduates from the profession is the impossibility of professional growth, dissatisfaction with working conditions, overload. Simply distribution, in fact, administrative pressure, which, by the way, is a violation of the Labor Code, we will not solve the issue.” According to her, graduates will evade such employment in every possible way, as they evade targeted distribution: when graduating from a university, some of the “targeted students” prefer to break the contract and compensate the organization for the costs of their education.

Ivan Davydov, a member of the St. Petersburg branch of the Deystviye medical workers’ trade union, the author of the popular Telegram channel Explain for Honey, confirms that graduates and young doctors have an extremely negative attitude towards distribution. “The Soviet distribution, which is taken as the basis for the proposal of the Liberal Democratic Party, should also contain an increased salary for inconvenience in the work and life of a doctor. The then old distribution was part of the planned socialist economy, not only doctors were distributed, but also engineers, teachers, technologists and other specialists,” says Mr. Davydov. depressed regions. This will increase the level of burnout of doctors, scare them away from their specialty. There is a risk of an even greater shortage of personnel.”

If competitive conditions are provided to doctors who have left by assignment, the idea is real, commented Konstantin Khomanov, therapist, founder of the Doctor’s Handbook, a medical decision support system. Under such conditions, he means an increase in the level of wages, when a doctor receives at least 200 thousand rubles in his hands, working at a rate, staffed, where there are all narrow specialists, equipment, “competent” middle and junior medical staff, the possibility of obtaining housing and permanent advanced training. Larisa Popovich believes that, in addition, it is necessary to revise the functions of the medical community: transferring part of the powers of doctors to paramedical staff, creating an institute of paramedics who would take on the non-medical functions of doctors, simplifying the work of doctors by reducing unnecessary reporting forms. It would improve the situation, she continues, and reduce the pressure with criminal prosecution, the possibility of continuing education, a mass campaign to increase the prestige of the specialty. Then, Konstantin Khomanov agrees with her, those who left will be able to return to medicine, hospitals will have the opportunity to choose among specialists, and it will be beneficial for the doctor to constantly improve their qualifications – “this is called healthy competition.”

The mechanism for the mandatory referral of graduates of educational organizations who completed their studies at the expense of federal budget allocations to work in state medical institutions is currently being implemented using targeted training opportunities, Kommersant was told in the Ministry of Health of the Russian Federation. The department assured that “to secure” university graduates in the workplace, “they consider it expedient to fully and more widely use precisely these opportunities.”

The Ministry of Health told Kommersant that healthcare is the only industry where the number of targeted places in scarce specialties reaches 75% (specialist programs) and 100% (residency programs). As an alternative to the introduction of a mandatory distribution system, the Ministry of Health proposes to consider the possibility of increasing penalties for non-fulfillment of obligations under a targeted training agreement: “In addition, it is advisable to expand the practice of targeted recruitment in institutions of secondary vocational medical education.”

Natalya Kostarnova