Carrot without a stick

It will not be possible to force graduates to work for ridiculous money even by distribution, but they want to try in healthcare

Minister Veronika Skvortsova has long called the personnel problem of health care "the most painful place in medicine." She announced a new way to solve it this week: “We have prepared a draft regulation that will allow young doctors to go into commercial healthcare only after they have worked for the state for a certain time.”

This is not the first attempt by the Ministry of Health to satisfy the shortage of personnel in the industry by manipulating medical graduates. The shortage of personnel was called the main problem of the national project "Health", which started in 2006.

Then the optimization of the staff of doctors failed: in March 2008, a new order of the Ministry of Health and Social Development was issued, and the mandatory three-year training before continuing education for in-depth development of the medical specialty was canceled. Authoritative practitioners and heads of medical universities did not allow unfinished doctors to be released to hospitals and polyclinics.

And now, on a new round, again the idea of distribution as a way to solve the problem of personnel. Doctors are indignant at their forums: why force green youth to go into state medicine if experienced doctors have been laid off in the industry in recent years? What is the point of firing some and forcing others to work in state institutions?

There is only one explanation: doctors are not at all “smeared” over the territory of our country in an even layer. According to Rosstat, at the end of 2014 there were 709.4 thousand doctors in Russia, or 48.5 per 10 thousand people. But this is the average temperature in the hospital. According to Rosstat, the average salary for doctors in Russia is 33,078 rubles. And when you look at the vacancies of the central district hospitals on their official websites, it’s a completely different matter, for example, in the Orenburg region, specialists are invited for 7 thousand per month. On such a salary, of course, you can only put a doctor by force.

Nevertheless, the head of the Ministry of Health noted: “In fact, we are starting to train personnel according to the needs of the industry, and this is important.”

In Moscow, for example, there are 64.9 doctors per 10,000 citizens, and in Yaroslavl, half as many. Moreover, “doctor-free zones” are being formed – these are remote, rural settlements with poor infrastructure. How can these “zones” be provided with doctors? According to human logic, it is necessary to give worthy money, housing, benefits. According to ours, it’s just to send a young doctor there to work for a penny.

Here is what a resuscitator from Kursk writes to us: “Salary for 1.25 rates for September 2015, together with an advance payment of 22,980 rubles. 37 kopecks, but they promise to reduce it even more.” Maybe there are an abnormally large number of resuscitators in Kursk? Or do they expect to close the gaps with graduates who will be forced to work according to distribution and who can be paid less?

There are now half of the state-funded places in medical universities. Obviously, the initiative of the Ministry of Health concerns only them. But it is not yet clear whether it is planned to introduce working hours for graduates in 2016, or will this decision be relevant for those who are just going to enter medical school?

And what do they think in private clinics, where they want to ban graduates from working immediately after graduation?

Sergey Misyulin, Chairman of the Board of the National Union of Regional Associations of the Private Health System, says: “Many leading private medical organizations begin to take care of their personnel reserve in advance and interact with universities. Looking for the strongest students. There are heads of private clinics who teach at universities specifically for the education of personnel. It is important for private traders to take young specialists before they are spoiled by indifference at state health facilities. If there is a restriction on the work of graduates in private organizations, there will be no motivation to spend money on their fine-tuning.” “The economic formation has changed, and socialism in healthcare,” complains Sergey Misyulin. “As a minister, the chief physician will say how much to pay the doctor, in what conditions to make him work, that is the law.”

Professionals on their forums joke bitterly: everything happened, and we will survive it, if only those graduates who do not want it are not forced to work as doctors. Let them go into business, anywhere, but not to patients.