On the fast track to inequality

How doctors and hospital directors ended up on different edges of the class society

Some time ago, it became known about the plans of 26 doctors of the Research Institute of Pediatric Oncology and Hematology, which is part of the Cancer Center named after. Blokhin, to resign in protest against the policy of their new leadership, who took office last summer. Instead of addressing years of problems, including the poor condition of hospital facilities, the administration has moved to place specialists close to it in key positions, the protesting doctors said.

This news, however, is not unusual. What happened is not a sensation, but just another episode from the routine practice of the Russian labor market. Many readers learned in this episode what they may not have had to face personally, but they probably heard about it from relatives and friends.

Class as a feature of society in Russia does not disappear anywhere, it only changes its form, comfortably located in the administrative vertical established in the country. An administrator and an ordinary employee in a Russian organization are people who are strictly hierarchical, with distinct distinguishable attributes that indicate the jobs they occupy.

The higher the position in the hierarchy, the larger and better furnished the office, the more expensive the company car, the more numerous the office and, most importantly, the salary, which differs by a greater number of orders from the median for the organization.

Investigations into corruption episodes give the impression that inequality in Russia is mainly the result of the manipulation of budget spending.

However, a significant part of Russian income and power inequality is formed differently: behind the doors of corporate, hospital, school and other offices.

Many people dream of a successful administrative career. Seeing the huge difference in income between line and boss positions, employees understand that administrative positions are a rare chance to solve their family's long-term financial problems. In order to effectively use this chance, which may turn out to be short-lived (that is, by maximizing the rent), it is necessary to form an administrative team of trusted people so as not to waste time resolving disagreements between managers.

That is why the migration of the administrative elite from one organization to another often destroys the professional destinies of those managers who have made an administrative career for many years in a company that has new bosses. There is no place for them in the plans of the new administration, which needs to quickly surround itself with trusted people.

In developed countries, an alternative to the vertical, i.e. administrative career, is a career horizontal. If we talk about medicine, then it lies in the fact that the doctor successfully performs increasingly complex operations, conducts his own research, publishes the results in academic and popular journals, as a result of becoming more and more known both to his professional environment and to part of society. In many developed countries, it is this career that is often preferred over the nondescript vertical career, where responsibilities often consist of performing responsible, but not overly complex managerial tasks.

However, for a successful horizontal career in Russia, as in many other catching-up economies, some important ingredients are missing. One of them is technological development. In many developing countries, technology is not widespread enough, sometimes present only in a few organizations. A small town may have a single hospital; there are more in a larger city, but there will almost certainly be only one good one.

A serious horizontal career can only be made in a good hospital, among the latest equipment and trained colleagues.

In other places, there are simply no opportunities for it.

Another reason is the exposure of staff to management even where the opportunity for a horizontal career exists. And in these places, alas, there is no effective counterbalance to the decisions of managers.

In the past decade, when a positive image of unions was all but taboo in economic discussions, experts have suggested the establishment of supervisory boards as a solution to the administration's imbalanced power. Those, however, were formed from friends of top managers who were not motivated to seriously fulfill their duties. The latter also generously paid for the indifference of observers.

Distrusting the grassroots organization of protecting the rights of workers and transplanting foreign experience without taking into account the peculiarities of the catching up economy, the experts thus only strengthened corporatism. Now trade unions are becoming an increasingly frequent and welcome guest in economic discussions.

And a real, that is, created and managed by workers, trade union does not need to be specially motivated, because a higher share of workers in the income of the organization serves as a sufficient incentive for it.

Economic development is a long process that takes decades. High competition for a worker, caused by the steady complication of the economy and economic growth, will not soon become a reliable protector of the interests of workers in Russia. The creation of a trade union movement, although by no means a simple task, still requires much less time.