In the fall of 2025, the State Duma adopted a law on compulsory service in public hospitals for graduates of medical universities. Now young doctors will need to work in state clinics from one and a half to five years, depending on the specialty and form of residency training.
In fact, the new law prohibits young doctors from working in private hospitals immediately after graduation. Because of this, doctors could lose up to 3 million rubles, “Important Stories” calculated. This money would be enough to buy a one-room apartment with a mortgage or support and raise a child, including his schooling.
Salary difference
Maxim ( the names of the characters in the text have been changed for security reasons ) is studying to become a surgeon at one of the large medical universities in the central part of Russia. He learned about the adoption of the law on compulsory service in the third month of residency training (the last stage of medical education, at which a doctor masters a narrow specialty), sitting right in the resident’s room. “There was no turning back, and we had training agreements in our hands, in which not a word was written about training. Naturally, no one liked it,” he told Important Stories.
Medical university students massively criticized the law and asked State Duma deputies to repeal it, and the deputies themselves demanded that the Constitutional Court check the innovations. The main reason for dissatisfaction among young doctors is the size of salaries in government institutions. “It's not that we don't want to save people's lives. We want to do this under normal conditions and with a good salary, and not survive on pennies,” the medical university student wrote under a video with a reaction to the adoption of the law.
How the labor law affects medical education
Medical education is divided into two stages: specialty and residency. After the specialty, graduates can work as local doctors or therapists. To become a doctor of a narrow specialization, you need to complete a residency.
Previously, graduates of budget and paid programs themselves chose where to go to work. Target graduates were required to work in the medical institution with which they signed a training contract.
The new law obliges all graduates of the specialty to work for three years under the supervision of a more experienced colleague-mentor in a public medical institution. If a graduate of a specialty goes to residency, he will work under a mentor after it.
All budget places in residency will become targeted. This means that it will be possible to study for free only under an agreement with hospitals participating in the compulsory medical insurance system. After completing residency, the target student must work in a medical institution with which he has an agreement for three to five years. From one and a half to three years (depending on specialization) of this period, graduates will work in a mentoring format.
Without mentoring, young doctors will not be able to work in their specialty. If a graduate passes the initial certification (passed immediately after graduation from the university), and then decides not to work in a state hospital and leave medicine, he will have to pay a fine. Specialty graduates will have to pay double the tuition fee, and residency graduates will have to pay the full tuition fee. All graduates of medical universities will have to undergo mentoring, regardless of their type of training - budget, paid or targeted.
Payers were especially dissatisfied. Some specifically chose paid training instead of targeted training, so as not to have to work after graduation in state hospitals.
“They put you in a box and say that you have to [work], although you don’t owe anything to anyone - you paid for your education for six years from your own money,” Marina, a student in the field of Dentistry, who studies on a paid basis at one of the large universities in a city with a population of one million, told Important Stories. “We had a plan for where to work after graduation, but now it’s unclear how much we will be paid in public hospitals during our service. How to plan your life if you don’t know how much money you’ll work for?”
“Important Stories” analyzed median salaries in public and private hospitals for entry-level doctors in the most popular specialties (for more details, see the “What We Believed” section). On average, doctors in private clinics earn twice as much as in public clinics.
The biggest difference is among dentists. After graduating from residency, they are offered 130.5 thousand rubles in private hospitals, and in public hospitals - 2.6 times less, 49.7 thousand rubles. The salaries of ENT specialists, obstetricians-gynecologists, dermatovenerologists, psychiatrists and surgeons are more than twice as high.
What we thought
We have selected the most popular specializations among residency graduates. To do this, we selected educational programs from which more than 500 people graduated in 2024. We have combined similar programs (for example, different types of dentistry or surgery).
We collected data on salaries offered to doctors of these specializations from the vacancy aggregator HeadHunter (for private medical institutions) and the state portal “Russia's Work” (for public ones). Data is current as of the end of February 2026. If the vacancy indicated a salary range, we took the lower limit.
We have selected full-time positions for doctors with no experience or one to three years of experience. According to graduates of medical universities, these are the vacancies they can apply for after graduating from residency. We excluded from the analysis those specialties for which there were less than 50 vacancies. The final list included 13 specializations:
obstetrician-gynecologist;
dermatovenerologist;
cardiologist;
otorhinolaryngologist;
neurologist;
ophthalmologist;
pediatrician;
psychiatrist;
dentist;
therapist;
traumatologist;
surgeon;
endocrinologist
We calculated the difference between the median salary in public and private clinics, and then multiplied it by the number of months of work depending on the specialization to understand how much money residency graduates who will study for a fee could lose due to the new law.
To calculate how much money targeted residents could lose (under the new law, all budget places in residency will become targeted), we multiplied the difference in salaries by 36 months: three years is the minimum period of service under a targeted training agreement.
We analyzed only public vacancies that appeared on HeadHunter and the Russian Work portal, although doctors often find work by asking about vacancies directly in hospitals. According to the doctors we interviewed, the salaries in the vacancies we collected correspond to the money they are offered in reality. We did not take into account bonuses that doctors can receive for their work.
A student majoring in Dentistry, Marina, said that after graduation, dentists mostly go to work in private clinics: “It’s very easy to find a job in a private clinic after graduating from dentistry. We also work there as assistants during our studies.” Graduates of other specialties, such as surgeons, may find it more difficult to get a job in the private sector: it all depends on the availability of vacancies and luck, say students interviewed by Important Stories.
Up to 3 million rubles. Which specialties will lose the most?
To obtain a narrow specialization, after completing a six-year specialty, students must complete residency. The new law makes all budget-funded residency positions targeted, so future doctors are left with two options: enter into a targeted training agreement with a mandatory service period of three to five years, or pay for the training themselves.
But paid training does not exempt you from compulsory work in public hospitals. By law, all residency graduates, including paid residents, must undergo mandatory mentoring from one and a half to three years.
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Mentoring involves working under the guidance of a more experienced doctor; it can only be completed in those medical institutions that operate in the compulsory health insurance system - these are mainly public hospitals. Targets will undergo mentoring in those clinics with which they have an agreement, and payers will undergo mentoring in any institution that operates in the compulsory medical insurance system.
Thus, all residency graduates must work in public hospitals from one and a half to five years, depending on the form of training.
During this time, dentists will lose the most money, most of whom, according to students, went to work in private clinics before the law was adopted. Graduates of targeted training may receive up to 3 million rubles less for three years of work, and paid graduates - 1.5 million rubles for a year and a half of compulsory mentoring.
In second place are otorhinolaryngologists. Depending on the form of training, they will lose from 1.7 to 2.6 million rubles due to compulsory work in public hospitals. On average, doctors in the most popular specializations can lose from 1.4 to 2.1 million rubles.
Two medical students who are planning to enroll in residency, in a conversation with Important Stories, noted that because of their work, they will probably have to postpone the decision to start a family. “We study for 5-6 years in a specialty, then two years of residency, and at graduation you are already an adult, and you are sent to mentorship. I would like to set up my life, maybe give birth to a child and take out a mortgage, as the state encourages us to do, but it’s not clear how to do this if you don’t know how and what money you’ll work for,” says one of them.
Students interviewed by Important Stories are worried that they will have to undergo probationary work. The law does not specify in what position they will work. The admissions committees of medical universities did not answer this question. If medical school graduates actually work as trainee doctors, they will lose even more money, and the need for additional part-time work may last for several more years.
To support themselves, future doctors often work part-time while still studying - for example, in an ambulance, where one work shift lasts 24 hours. “Let’s say I have a shift on Monday, so I work 24 hours – from seven in the morning until seven in the morning on Tuesday. After the shift, I go to study at the residency, where I need to work night duty. After that, it’s back to school and after about 2.5 days I can finally sleep,” says residency student Maxim.
After graduation, he planned to leave the ambulance service and get a job in his specialty, but he was unlikely to be able to support himself on an intern’s salary. “The salary in my city for a beginning specialist is from 100 thousand rubles, and in an internship position I will receive 25-30 thousand. I’ll have to earn extra money somewhere else, not in medicine, of course,” he admits.
As follows from the data of the portal "Russia's Work", state hospitals offer surgical trainees a salary more than half that of accredited specialists, therapists - 1.5 times less, cardiologists - 1.4 times less.
Not just money. Why else do students criticize the law?
During compulsory service in public hospitals, young doctors face not only lower salaries, but also difficult working conditions. “In public clinics there is no comfort for either the patient or the doctor. Banal saliva ejectors, with the help of which we ensure complete dryness of the mouth for installing a filling, do not work. There are no assistants who can speed up your work. You have to work with cheap, usually Russian, materials. There is simply no equipment, for example, an endomotor, with the help of which a nerve is removed,” says Marina, a student in the field of Dentistry.
Some students see advantages in the new law. Thus, thanks to the large flow of people in government institutions, young doctors will quickly gain experience and can gain a base of regular patients who, in the future, will follow them to a private clinic. In addition, salaries in public hospitals are often based on hours worked rather than on the number of visits. This may be a more reliable option for a young doctor who has not yet developed a patient base.
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And yet, most graduates want to work in private hospitals. “Comfortable conditions, calm welcome. In government institutions, the doctor works under pressure, for a huge flow of people,” resident surgeon Maxim told Important Stories.
Another problem of the new law is organizing the training system at the required level. A similar program for residents is available at the St. Petersburg First Medical University. Pavlova, a doctor familiar with the program told “Important Stories,” but the university does not cooperate with all hospitals and creates special conditions for detention.
“In this program you can change your mentor or department. In fact, it’s not a bad initiative, but to implement mentoring you need equipment, simulation of work situations and modern textbooks [which the St. Petersburg University has]. It is unknown how other regional public hospitals will provide similar postgraduate education,” our interlocutor explained. She also noted that the new law could lead to burnout among doctors who will have to serve as mentors. The law does not say where they will get time for additional work with university graduates.
In addition, students are worried about unfair assignments to hospitals in large cities. For residents, all places will become target positions, and graduates will not be able to go to work in another city - they will have to work in the organization specified in their target training agreement.
A graduate of the Medina specialty in central Russia, Yulia told Important Stories that after graduating from residency she planned to look for work in Moscow or St. Petersburg. “Now this is problematic, because [from the region] it will be difficult to conclude a mining agreement somewhere else. If this law had not been passed, I could have gone to Moscow or some other big city, but now they won’t take me there,” she says.
Not all residents remained in medicine after graduation. Now it is simply not possible to go into another field: for refusing to work, they will have to reimburse the full cost of training, depending on the specialization, this is up to 1–1.5 million rubles, as shown by the pricesfor trainingin the largestmedical universities . According to students, only a few can afford such payments.
How to reduce working time
Young doctors may have their working period reduced if they go to clinics in villages or in the occupied territories of Ukraine. Then most specialties will only have to work for a year as part of mentoring, while therapists and oncologists will have to work for a year and a half.
On the state vacancy portal “Russian Work” there were 338 job offers in hospitals in the occupied regions, more than half in the Lugansk region. Most often they are looking for therapists, as well as pediatricians, psychiatrists, surgeons and neurologists.
The median salary in hospitals in the occupied territories is 37.9 thousand rubles, one and a half times lower than in Russia. For pediatricians and neurologists, median salaries differ by more than two times.
To compensate for low salaries, doctors are offered an additional payment of up to 60 thousand rubles for work in the occupied regions of Ukraine. Some clinics, as can be seen from the vacancies on the Work of Russia portal, are ready to provide Russian doctors with places in rooms and dormitories.
None of the medical students interviewed by “Important Stories” mentioned working in the occupied territories in order to reduce the terms of service, but some graduates are ready to consider working in villages.
According to resident Maxim, some young surgeons already have to travel to work from the regional center outside the city due to a lack of beds in city hospitals. And when working in a remote village, young doctors can count on the “ Zemsky Doctor ” program. Its participants go to work in villages or small towns for five years and receive a one-time payment of 1–2 million rubles, depending on the region.
How the law will affect the shortage of doctors
The authorities claim that the law on forced labor will help solve the problem of staff shortages in public hospitals. The number of employees in state clinics (this is not only doctors, but also other employees of medical institutions) has actually decreased over the past 10 years, with the exception of the 2020 pandemic, and in private medical institutions it has increased.
According to the Ministry of Health, 35% of medical university graduates do not go to work in the state healthcare system. This problem has already been tried to be solved. Thus, in 2017, it was made more difficult for future doctors to enter residency: in order to gain additional points and enter the budget, students need to work in primary medical care. In 2020, this process was made even more complicated by making most residency positions paid or targeted.
Because of this, some doctors have to postpone entering residency and work in public hospitals. “I finished my sixth year at the university, but didn’t get into residency because I didn’t have enough points. Now I work in a state clinic - for a year of working as a local therapist they give additional points for admission,” says Yulia, a graduate of the specialty “General Medicine”.
According to the doctor whom “Important Stories” spoke with, in its current form, the law on mentoring does not solve the problem of shortage of medical personnel. To retain young professionals in the public sector, it is necessary to improve working conditions and introduce additional social support measures.
The students themselves believe that innovations will have a negative impact on the medical field. “Most likely, the law will lead medicine towards, so to speak, death. Students [in the specialty "General Medicine"], as far as I heard, have already begun to take away their documents so as not to have to work out. I won’t name the exact percentage [of dropouts], but I know such cases at the university where I myself studied,” resident Ilya told Important Stories.
“You can solve the shortage problem by simply making wages higher. This forced service will not benefit anyone,” says medical university graduate Yulia.
Due to the law on compulsory work in state hospitals, a medical university graduate may lose up to 3 million rubles • Vazhnye Istorii • RIMA — Russian Independent Media Archive
