The smell of carbolic acid

It is impossible to cope with the personnel shortage in medicine using modern methods. The forgotten old ones are called to help. Mandatory work after training is one of them

According to the Ministry of Health, the country lacks more than 23 thousand doctors and 63.6 thousand health workers with secondary education. The shortage of narrow specialists is most noticeable. In the first eight months of 2025 alone, 18 thousand medical vacancies were published on the “Work in Russia” portal. And even in private clinics a year earlier there was an outflow - almost 10% for the first time in several years. At the end of last year, the President of the Russian Federation signed a law on compulsory service for medical students (in a more euphonious formulation - on mentoring). It is designed to solve the problem of personnel shortage in public health care, which the State Duma calls the most acute, and the ongoing reform of the specialist training system is large-scale.

Stethoscope and gingerbread

When discussing the adopted law with various people, I remembered the once popular movie “The Big Scam.” Which, however, is not surprising. After all, all conversations about training inevitably came down to one thing: how to attract a graduate so that the obligatory becomes conscious. Oddly enough, the plot of the film, which unfolded in a fishing village abroad, is somewhat similar to the situation in our country. Only the scale is different.

In the film, the whole world is trying to do the literally impossible to keep a visiting doctor in their godforsaken settlement. A variety of options for “seduction” are used - from organizing a cricket field in areas that have never seen such a game in their lives, to planting banknotes that the doctor finds on the road every time he returns from the bar. The visiting doctor is accommodated in a nice house and kept busy, lining up for appointments with imaginary illnesses. All to show how much a doctor is needed.

A Russian doctor I knew, after listening to this story, only smiled condescendingly. Although he admitted that the organizers of luring the doctor followed the right and quite promising path. But one of the participants in the specialized forum spoke very categorically about the already real “gingerbreads”. They say that they are moving more and more towards young IT specialists; they have serious preferences in the form of the same preferential mortgages and serious salaries. But with regard to doctors, it was decided to use methods of a different nature. And such a reaction is completely justified. It’s unlikely that you can explain everything by staff shortages. There is a shortage of specialists not only in medicine.

There are not enough doctors, there is too much workload

Information from the Central Research Institute for Organization and Informatization of Health Care indicates a decrease in the number of workers in hospitals and clinics under the jurisdiction of the Ministry of Health over the past 20 years. For example, the number of nursing staff in its institutions has fallen by 16% since 2000. According to Rosstat, in 2024 there were 1.4 million mid-level doctors in the country. That is, 96.3 people per 10 thousand population. This is the lowest figure since 1960.

Other figures are also very eloquent: only 63% of doctors in state medical institutions are treating patients. This means that every third of them is not involved in diagnostics and prescriptions. That is, it does not work directly with the patient. It’s just that the statistics include not only practicing doctors, but also, for example, employees of the sanitary-epidemiological service or teachers of university clinics.

The supply of doctors has fallen and the workload on them has increased. The dependence is direct. Today, one emergency doctor is forced to serve 16 thousand people, but 9,500 are supposed to. Four out of five ambulance teams in Russia are paramedics. They are the ones who often respond to calls that fall within the doctor’s competence. What to do if the latter are in short supply.

According to a Medvestnik survey, a third of doctors want to leave state medicine. The main reasons are low wages and high workload. Plus - a conveyor flow of patients. When 15 to 20 minutes are allotted for one patient, it is easy to calculate how many patients pass through in a day, and then multiply by the work week. After a couple of years in this mode, complaints about emotional burnout look natural.

Today, a local therapist accounts for 65% more patients than established by standards

(platform information “To be precise”). But we must clarify: the work of a therapist has its own specifics. In European countries, such a doctor takes care of 80–90% of calls. A local therapist in Russia is mostly a coordinator. He rarely treats himself, but rather refers patients to specialized specialists and performs a number of bureaucratic duties (referrals, discharges). Visitors to district clinics know: the road to most specialized doctors lies through a therapist. Alas, the attempt to introduce an institute of general practitioners who have additional competencies in various fields of medicine did not lead to tangible results. Things also somehow didn’t work out with the specialists providing primary multidisciplinary medical and social assistance to the family.

How much do you need and how much do you have?

Now the average age of a Russian health worker is 44.5 years. Every second doctor and nurse is over 50 years old. Such figures were announced by Deputy Prime Minister Tatyana Golikova at the board of the Ministry of Health. The trend is alarming, and the need for young forces is obvious. The Ministry of Labor calculated that it is necessary to somehow arrange for the entry of up to 100 thousand new doctors into the industry annually. In total, Russian medical institutions need to attract almost half a million medical workers with secondary specialized and higher education by 2030. One way to achieve this result is to increase the number of applicants. Last year, according to the forecast of the Ministry of Health, the number of graduates should have increased to 78 thousand people. The figure is serious, but it is less than what healthcare needs. It must be borne in mind that not everyone with a medical diploma makes it to the doctor's office. About one in four, Medvestnik reports, goes into related commercial industries. The growth in the number of medical graduates is largely due to those who come to study for a fee. Whether such an increase is possible in the light of the new law remains to be seen.

The law on compulsory service for graduates of medical universities and colleges studying in budget places comes into force on March 1, 2026. It applies to those who enter residency after this date. Let us briefly recall the essence of the document: after graduation, public sector students must work in a medical organization that is part of the compulsory medical insurance system, under the guidance of a mentor, from one to three years. In addition, residency training will become completely targeted. The Russian Ministry of Health will establish specific terms for mentoring and a list of specialties in which graduates will work. Minimum (1–1.5 years) - for doctors who will go to rural areas and small towns. It will not be possible to avoid working out completely. Certain measures are provided in this regard, including for medical institutions that refuse to employ their target. The law is designed to provide public health care with qualified personnel, increase the availability of medical care and improve its quality - this is how parliamentarians and health officials optimistically see it.

Muscovite Anna is 24 years old, she is graduating from the dental faculty of one of the medical universities in Moscow. She started working part-time after her second year of study, first as an assistant. And this summer I spent two months independently performing basic functions. She plans to return to the clinic where she practiced after graduation, and the mentoring period has already passed - in the process of part-time work and on a voluntary basis.

“Mentoring for us dentists is an absolutely useless idea, since 90% of students at the Faculty of Dentistry begin working as assistants by the 2nd or 3rd year, and by the end of the 5th year they find mentors,” says Anna. — And by the beginning of residency, the more courageous guys begin to see patients on their own. I can’t answer for all hospital workers, but it seems to me that for them this is much more logical, since after graduating from university, roughly speaking, they have nowhere to go. For normal work, a narrow specialization is needed, so everyone enters residency. But even after that, finding a job doesn’t become any easier.”

Who will become a mentor...

On the one hand, there is a shortage of personnel. On the other hand, it’s difficult for beginners to get a job. What are the reasons for the head of a medical institution, all other things being equal, to choose not an experienced doctor, but a yesterday’s graduate? Much is said about the social responsibility of the latter, but for some reason they are required to demonstrate it only where they are sent. Complete contradictions.

“Everyone wants to work in Moscow, or at least in big cities,” continues Anna. “And this very mentoring distributes students according to some criteria that are not yet very clear. For example, you need a doctor for a small hospital in a distant village. But there may not be a mentor there. And what? They won’t send a young doctor there, and the place will remain empty? Mentoring should have been organized as part of a summer internship, rather than “signing up” people for several years at once.”

Anna’s opponent, Ilya, who has already graduated and worked for a year, on the contrary, believes that it is easier to gain experience in a small hospital somewhere in the region than to fight through the capital’s doors that are closed to a newcomer. He himself followed this path.

Be that as it may, the “few years” of a medical student are indeed tightly scheduled. A general scheme has been published in the TG channel of the healthcare workers’ trade union “Action”: specialty – residency – primary accreditation – training/mentoring – periodic accreditation.

The shortage of personnel in medicine, according to the adopted law, will be filled with the help of recruited graduates. At the initial stage, they will have to work where they are assigned, and under the supervision of the person to whom they will be assigned.

In this situation, the question that our interlocutor has already brought up is inevitable: where do the ideologists of the process have the confidence that they will attract the required number of mentors, and even on a voluntary basis?

“And this is a question directly from the planning system: how many mentors will be needed, what kind, where to get them,” explains Alexander Saversky, president of the League of Patient Advocates, member of the Ethics Council of the Russian Ministry of Health. — I generally doubt that the Ministry of Health has even come close to the problem. If Moscow doesn’t have enough doctors, before it gets to the villages... Everything must be planned and coordinated. For starters, a database of regions and conditions. And the state shifts this entire process onto the shoulders of the students themselves and the authorities who should deal with it locally, but who also do not know how to do this. The distribution we are resuming is actually part of a planned economy. At one time, the entire State Planning Committee with its structural divisions dealt with it. Here, in fact, it is necessary to restore the work on planning the distribution of personnel.”

From all that is happening it follows: there is no long-term planning program in the country. But it is obvious that the process needs to be regulated based not only on the current deficit.

I'll get off at the distant station...

State Duma Chairman Volodin lucidly explained that the document, developed on the initiative of Minister of Health Murashko, was needed to prevent hospitals and first aid stations (FAPs) from closing: “We have a big country. “Many central district hospitals, especially rural ones, lack doctors and paramedical personnel.” On this note, everything becomes somehow more definite. And it’s clearer where exactly workers are needed. While the struggle for personnel was taking place in the capital’s legislators’ offices, local medical institutions were being liquidated.

Back in the spring of last year, the Ministry of Health of the Altai Territory announced the department’s plans to close 32 first aid stations in 10 districts. They should be replaced by mobile medical complexes. Last summer, the Omsk regional Ministry of Health spoke about a shortage of health workers in 43 primary care posts. A year earlier, 18 such points had already been closed in the region. At the same time, a loud scandal caused by the closure of the only hospital for 30 thousand residents occurred in Elektrogorsk near Moscow. The patients were offered treatment in a neighboring town, which is 25 km away. Some time ago, by order of the governor of the Kemerovo region, all clinics located on the first floors of residential buildings were liquidated. He promised that patients would be served by new medical facilities built by 2030, and left for Moscow for a promotion. By the way, officials themselves usually call such closures reorganization.

“Someone will probably have to go to the same FAPs, there is an obvious shortage of personnel, ” we continue the conversation with Anna.

- Yes. It seems logical, but I really feel sorry for these guys. No one sees any 100% benefit from this.

“But with the adoption of the law, the graduate is guaranteed a job. In this sense it has its benefits.

“In the end, all this will again cause insane corruption. And everyone who “can” will remain in Moscow - they will buy off the distribution. Everything is as usual.

— What if housing or substantial lifts are added to the distribution outside the capital?

— So housing will probably be provided only during work. And if it’s a mortgage, then it’s not at all interesting. And what is the point of leaving for those who have an apartment in their city?

— Could a good salary be an incentive?

- Yes, in this case one might think. I myself once wanted to work in a northern region for a solid salary. But family circumstances changed, and she didn’t make it.

Sore subject

Novaya Gazeta, on condition of anonymity, asked for the opinions of other students at various metropolitan specialized universities about the innovation. As expected, almost all of them greeted the government's initiative without enthusiasm.

• Anna, 3rd year : “I learned about this bill from Reels on social networks - there were a lot of memes there. Initially, they generally discussed working for an unlimited period, that the organization itself decides how long you have to work, then they at least limited it to three years, but this did not make it any easier. Then they also wanted to make 100% of residency places targeted, and this already sounds like a total lack of freedom of choice. There was no particular panic at the university; there were some jokes from the teachers, but these were all one-time comments. But inside you feel as if you were quietly confronted with a fact, without the right to vote.”

• Ksenia, 4th year : “I’m 21 years old, and I always imagined that I would give birth to a child before I was 25. And now we just count: we entered at 18, we study for six years - we’re already 24, then residency, on average another three years, and now we’re 27. After residency, three more years of compulsory work - and already 30. As a result, you become a full-fledged specialist by the age of 30+, when gynecologists already call this “starparous”. And where is the notorious demographic policy that deputies love to talk about? My friends and I seriously thought: is it possible to go on maternity leave during this period of work in order to somehow combine career and family? But it turned out that the years of maternity leave will not be counted towards the work. That is, you sit with the child for three years, and then have to work separately for another three years. It turns out that the law does not take women doctors into account at all as people who also want to have children.”

• Ilya, 5th year : “The most annoying thing is that mandatory service also applies to paid workers. I’m already paying a lot of money for training, about three million in total for six years, and I’ll still have to work for three years where I’m assigned. If I don’t want to, they threaten me with fines. At the same time, no one thinks about those who studied for the sake of a crust, and then realized that they could not work in medicine: some were broken by humiliation in the departments, others by difficult cases in hospitals. At the same time, there is another issue that everyone is embarrassed to talk about: housing. If I am sent to work in another city, who will pay for my apartment? Or should I look for myself how to survive on a small salary, part of which will also be withheld? After all, service “ties” you to one place for three years - and it’s not a fact that it will be a city in which you even want to live.”

However, some students try to find positive aspects in compulsory training.

• Dmitry, 4th year: “This is an almost guaranteed job in a narrow specialty. Nowadays, many people cannot find a job after residency in neurosurgery or oncology: they are not hired anywhere without experience, and as a result, people become ordinary therapists, although they studied for complex specialties. The new law provides a clear route: if you do not enter residency, you work as a therapist for three years under a mentoring program, otherwise you will not be allowed to practice medicine at all. If you apply, it’s a targeted residency, you sign a contract with the organization and then work there. For oncologists and surgeons, this, oddly enough, can be a good help. If you work in a clinic in a targeted area and conduct receptions, you can recruit your patients and operate on them in the clinic where you are studying in graduate school. I have a friend, an oncologist surgeon from Vladimir, who does just that: he conducts consultations in his hometown, and operates on patients in Moscow as part of his graduate studies. For a young doctor, this is a real chance to “get his teeth in” and form his own patient base.”

• Sofia, 5th year : “An interesting point - this bill also applies to foreign students who study at Russian medical universities. Among my classmates from Uzbekistan, Kazakhstan, and Tajikistan, many said: “It’s great if the work gives a chance to get a residence permit or citizenship.” For them, this is not only a job, but also an opportunity to gain a foothold in the country where they want to live and develop. From the point of view of the state, there is also logic: we really have a shortage of doctors, especially outside large cities, and graduates settle in Moscow and St. Petersburg because salaries are higher there. If targeted training provides the regions with new specialists, people in these cities will at least begin to see doctors with specialized specialties. The idea doesn’t look completely stupid - but it needs to be “twisted”: raise wages, improve working conditions, invest in hospitals outside the Moscow Ring Road, where Soviet buildings still stand without repairs or normal equipment.”

• Artem, 4th year : “I feel like the reaction among classmates is still closer to negative. Russia is a huge country, and medicine in the regions is much weaker than in the capital. Yes, in this way it is possible to partially close the personnel shortage, but the question of fairness arises: why do doctors have mandatory work, while other professions have nothing similar?

A separate pain is the feeling of lack of freedom. You study, don’t sleep, work part-time in a hospital, stand in operations to gain at least some experience, and at the end of the day they tell you: here are three years of your life that you must give, otherwise there will be fines and a ban on the profession. Many people burn out even before their diploma, because the workload is prohibitive and the gratitude is minimal. For some, this law will be the last straw in order to leave medicine altogether.”

Like behind a stone wall?

To work as a mentor, you must have at least five years of experience in your specialty. And voluntary consent. Ideally, this should be a highly qualified specialist. At one time, the necessary skills could be provided, for example, by an institute for advanced training or the clinical base of the corresponding department. But today the personnel shortage is so serious that it forces events to be forced. Therefore, the details are left behind the scenes. But two main parameters are outlined: mentoring will be done under a separate employment contract and for a fee. There is no doubt that starting a professional activity under the patronage of an experienced colleague is a serious help for a newcomer to the profession.

Commenting on the innovations, speaker Volodin assures that “graduates of medical universities will gain competence and invaluable experience by working in those hospitals where there is a shortage of doctors today.” And this statement again brings us back to the personnel issue, only in a different context: where will a medical institution that lacks specialists find mentors - capable, and most importantly, ready to engage in patronage? It is easy to assume that in an understaffed hospital, a doctor already works at more than one rate. Are health workers ready for additional workload, even at extra cost? Or can something voluntary in certain conditions easily become compulsory? Who, in turn, will control the work of the mentor? And who will guarantee that it will not turn into a formality?

There are too many unknowns to take the idea for granted. Finally, one cannot help but notice a strange imbalance: back in 2024, expenses for the national project “Healthcare” and for the modernization of its primary care were seriously reduced. And today funds have already been found to create a mentoring institute. And Rostrud gave clear explanations on this matter: the amounts and terms of payments to mentors should be no worse than those established by regulations in the relevant area.

The guaranteed employment that the adopted law provides is a significant plus. What about the obligation?

— Your colleagues often say that for some reason the screws are tightened in relation to doctors. Do you really feel this unfair approach? - I ask Anna.

— It’s a sin for dentists to complain. Of course, it’s difficult for us, but not as much as for the clinicians. Yes, such statements were heard from them. But not that often. And the devaluation of doctors is, of course, “in the palm of your hand.” They accuse us of infantilism, but at the same time they decide everything for us.

We miscalculated, you should cover

“Once Zurabov, when he was still the Minister of Health, I asked if it was possible to introduce some legal acts consistently,” Saversky continues. “Why do it all at once—to take it and change people’s lives?” To which he replied: nothing works any other way in Russia. I didn’t argue then, although I thought that people still need to be treated humanely. In this situation, students entered at their own time under certain conditions. They had their own plans. But now to take people’s lives and turn them around 180 degrees is not very right. And those who gave birth to children, whose apartments are on a mortgage - what about them? It is clear that they will look for other solutions or leave the profession. I don’t argue with work in general. But due to the fact that all this is unexpected and unprepared, some students will begin to transfer to other universities. If only because they don’t want to change the city to the village, for example. Whether the law will solve the personnel problem is a moot point.”

Let's try to think practically: the graduate has worked his butt off, acquired that “invaluable experience,” and what can make him stay where he was sent? This means that the place he once occupied will become vacant again? Or will the next graduate come and the system will work like a conveyor belt?

The majority of respondents on the Doctor's Directory application platform do not see positive prospects. 63% of respondents believe that working hours will not be able to fill the shortage of personnel in healthcare. And 42.6% of students said that if mandatory service had existed during the period of their admission, they would simply refuse to enroll.

And again the questions: is the institution of mentoring exactly what can keep a young specialist in the profession and in his assigned place? Not salary, not career prospects, but just this form of adaptation? Obligations are enshrined in law, but what about social guarantees and prospects? As one of the experts said, all this so far does not look like a systematic approach, but like plugging holes.

Opponents of the law believe that

the lack of freedom of choice in employment can play a cruel joke on advocates of social responsibility - lead to a decrease in competition for medical universities, and then to personnel failure.

The main course, residency plus two or three years of mentoring - not everyone will get to independent work a decade after starting.

One of the interlocutors reasonably asks why the decision was made immediately at the legislative level, and not as, say, an experiment to understand whether such a practice is justified enough to consolidate it and spread it throughout the country? In such cases, officials usually say that amendments and modifications are inevitable during the implementation process. And perhaps the crude document will be strengthened with by-laws and orders. But the feeling that he was preparing urgently does not leave.

“There are a lot of unresolved important issues,” says Alexander Saversky. - For example, who will be responsible for any negative consequences - a former student or his mentor? This is an important legal issue indeed. And it's not resolved. Any created (or restored) system requires serious elaboration of regulatory and legal acts. From what I understand, the system is aimed at concluding contracts almost in the first year. But in this case, they must be prepared in detail and supervised by someone throughout the entire period of study. In the meantime, not even a standard form has been proposed. There must be a unified system for managing all these processes, otherwise there will be inevitable problems: several students per place or, conversely, somewhere there will not be enough of them. A lot of preparatory work is needed. But she wasn't there. We didn’t do anything, but that’s what we decided.”

There are no guarantees, but you hold on

Every year, 35% of medical university graduates, even without innovations, refuse to work in public clinics. Deputy Minister of Health Semenova spoke about this recently in the State Duma. Just one example: free healthcare is seriously short of dentists. And they almost en masse strive to get into private medical institutions, which already cover up to 80% of the dental services market.

And lastly, the law states that graduates must be provided with conditions for employment, including additional measures of social support. Which ones and in what volume are not specified. In the regions, there are social guarantees for young professionals: one-time payments, compensation for improving housing conditions or paying for housing and communal services, allowances when moving, etc. Both the forms of preferences and the sizes vary greatly. By and large, these measures have yet to be developed on a national scale. And the deputies who did not support it explain their position precisely by the absence of clearly defined social guarantees for graduates in the law. To put it simply, opponents of the innovation believe that working hours appeared as a way to close the personnel shortage, because there is simply no money for other measures.

By the way, another definition of the adopted law is in use in the professional community - “on the enslavement of doctors.”

Olga Putilova, Erofey Korotkov - for Novaya