Who will treat?
Why, despite significant financial injections into the industry, is there still a shortage of doctors in the regions?
The day before, in the approval process Mikhail Mishustin Prime Minister for a second term, Speaker of the State Duma Vyacheslav Volodin wondered how the country's "critical problem" of doctor shortages would be resolved. According to his data, in the 24th year of his rule Vladimir Putin The regions are short of approximately 30 medical specialists. "Large amounts of funding are being allocated, but people tell us: 'We come to the hospital, the walls are new, there's equipment, but there's no one to operate it,'" the speaker lamented. NeMoskva attempted to understand what's happening in regional healthcare, using this example as an example. Perm Territory.
In mid-April, Perm Governor Dmitry Makhonin acknowledged that the region's outlying hospitals are experiencing an acute shortage of medical personnel. Over the past three years, 420 doctors and 170 paramedics have left to work in remote areas of the region. In the next three years, the governor She urged these numbers increase several times:
I instruct the government to recruit at least 1000 doctors and approximately 1500 mid-level medical workers to the sector within three years. I also set the goal of increasing the availability of medical personnel in all municipalities of the Perm Krai within five years.
The possibility of solving this problem seems doubtful, according to experts interviewed by a NeMoskva correspondent.
According to the gorodrabot.ru portal, the average salary of a doctor in the Perm region for 2024 is 60 383 rubleOver the past month, the amount of job postings has increased by 6,1%. Job search service data likely reflects the "hospital average." One of the latest vacancies is for a therapist at a city hospital. Cherdyn — is indeed accompanied by an offer to pay 60,000 rubles, but the surgeon will be in the district center Bolshaya Sosnova looking for a salary from 16 242 rubles.
In commercial medicine, the situation is different. The salary gap can be illustrated using dentistry as an example.
In Perm, a network clinic promises a stable salary for the first two months to a general dentist with at least three years of experience. 150,000 rubles(in the long term - 200,000 rubles). In the municipal Perm clinic, the same specialist can count on 65 rubles.
Every fifth (19,8%) medical student in their final years plans to go to college immediately after graduation. уbe built to work in a private clinic. Meanwhile, half of respondents intend to enter public healthcare: a third (33%) plan to work in hospitals after graduation, and another 17% in outpatient clinics.
Externally, Perm's healthcare system looks good compared to other sectors of the economy.
Following two major medical construction projects at the beginning of the last decade, when the regional perinatal center and the federal center for cardiovascular surgery were commissioned, the region gradually updated the material and technical base in municipalities, built new clinics, and renovated old ones. 2023 has become recordth by the number of medical facilities built.
Over the past few years, the Perm Krai Commissioner for Human Rights has noted a decline in the overall number of complaints about the healthcare system. While in 2022, there were 304 complaints about violations of the right to health protection and medical care, in 2023 there were 197. The top complaints about the healthcare system are... understaffing medical institutions by doctors.
This very issue has been a sore point for the Perm region's healthcare system for many years. Regional programs for attracting specialists provide up to 2 million rubles in one-time payments to professionals coming to the Perm region. Medical workers are prepared to receive monthly compensate rental housing.
However, the rate of growth of personnel does not correspond to the rate of their outflow.
"Situation (with citizens' appeals - editor's note) changed only due to repairs, construction and the introduction of new technologies, — notes a current employee of the regional Ministry of Health. — New equipment is being purchased, making previously unavailable devices available in remote villages and towns. The shortage of personnel remains unheard of. In some areas of the region, for example, within the Kizel coal basin, we can expect to lose up to half of the medical staff over the past few years."
In the fall, residents complained about the lack of specialized doctors. ChusovoyThey are active on social networks. supported representatives of other territories of the region:
"There's no neurologist, no cardiologist, no nephrologist... We've never even heard of an allergist. Building a new clinic is great, but who's going to work there?"
“Over the past 3 months, I haven’t had a single free time with the ophthalmologist.”
"We live in Polazna, we've never heard of specialists, they built a new hospital, but there's no one to work there."
In a queue at one of the Perm emergency rooms, the author of the article met Alexander, a general worker who had come from Berezniki with a serious hand injury. Alexander spoke with pride about not having sustained a single scratch at the "SVO," with bewilderment about the accidental fight, and with irritation about the local doctor telling him, "Go to Perm, I have no idea what to do with you."
“It’s unlikely that the doctor in Berezniki was incompetent when examining the patient,” A surgeon with 30 years of experience later commented on this story, Most likely, he’s just overwhelmed by the enormous amount of work.”
В Kudymkar hospital As of last fall, the Komi-Permyak Okrug was short of virtually every specialist: anesthesiologists/resuscitators, obstetricians/gynecologists, general practitioners, pediatricians, clinical laboratory diagnosticians, surgeons, psychiatrists/narcologists, neurologists, gastroenterologists, cardiologists, infectious disease specialists, dentists, radiologists, ophthalmologists, otolaryngologists, and emergency physicians. Due to the lack of operating room nurses, no elective surgeries were performed in October. In an interview with the local portal Parma News, the situation was frankly discussed. I told head physician Igor Utochkin.
“The region is in dire need of medical personnel,” says a source from the industry to NeMoskva, In Perm, the situation with doctors is still fairly stable. Significant funding is allocated to attract qualified doctors from the regional center to work in the outlying areas. Presidential bonuses under the "Zemsky Doctor" program, regional bonuses, and bonuses that medical institutions themselves are willing to provide don't fundamentally change the situation.
The current staff of district hospitals is aging, and there's no replacement—future doctors are reluctant to work in remote villages. Current first- and second-year students have little understanding of the current federal and regional bonus programs for doctors in remote areas, while fourth- and fifth-year students have heard of such programs, but aren't eager to work in the districts either.
“I barely escaped from my hole anyway,” says Alina, without naming the locality, "Why should I go back there? There are places to go in Perm, there are people to talk to, but what will I find there?"
“A young and active person cannot realize himself in a rural area, — sophomore Evgeniy is confident. — Life is not limited to one job, no matter how much you pay for it."
However, for "reasonable pay," he adds, one could consider interning at a remote hospital. Future doctors consider salaries in the range of 150 to 200 rubles to be reasonable.
“In our profession, for example, a qualified operating specialist with at least ten years of experience receives two hundred thousand rubles (We are talking about a budget clinic – editor’s note.) And even then, not always,” A more experienced colleague comments on the salary expectations of young students.
He quickly adds that it's unlikely to be just a matter of salaries. His thesis is supported by senior medical students. Sergey, a fourth-year student, isn't prepared to travel to the region's remote areas at any price.
"The uncertainty is scary. There's a support program going on now, but it might disappear. It's impossible to plan for the future. Perm isn't my dream either. It's nice here, but if a job opportunity presents itself in Kazan or Yekaterinburg, I'll go there. Those are cities with potential."
The same word “perspective” was used by Elena, a fifth-year student: "If there are no prospects in my profession at all, maybe I'll go to the region to work."
The idea that students are afraid of a sharp decline in quality of life when moving to remote areas of the Perm Krai raised eyebrows among local chief physicians in an informal conversation. He cited the example Gubakha, a ski resort in the Perm region, home to Metafrax, a major city-forming enterprise. It has decent roads by local standards, theater festivals, cinemas, bars, restaurants, and fitness clubs.
But there's a shortage of medical specialists there, too. Coming and skiing is one thing, but staying for five years, tempted by the extra pay, is quite another.
Sergei, a former doctor and teacher, now a successful businessman in the medical field, believes that, among other things, the complexity of calculating additional payments is a thorn in the side of young professionals:
"Everything would be much simpler if it were like this: go to Berezniki and get a monthly bonus of 30 rubles, a million rubles in relocation allowance, and a company apartment; go to, say, Gayny and get a million and a half in relocation allowance and a bonus of 45 rubles. Today, only the official bonus ceilings for federal and regional programs are announced, but in reality, it turns out that everything depends on the region, the hospital, the salary, and the specialty. It's easier to just give up and look for a job in Perm."
Theoretically, the average public sector doctor in a remote area can expect a combined income of approximately 100 rubles per month from their salary and additional benefits. NeMoskva's interviewees, with varying estimates, cited this amount.
Meanwhile, in April it became known that from a rather wealthy village Ust-Kachka Doctors are resigning near one of the major resorts in the Perm region, 30 km from Perm. Officially, it's for family reasons. Unofficially, it's because of low salaries. Job postings mention the need for a general practitioner, a nurse, and a dentist. The opportunity to participate in the federal "Zemsky Doctor" (country doctor) supplementary payment program for doctors is also mentioned. But there's no waiting list for jobs in Ust-Kachka.
Three thousand Russian and one and a half thousand international students study at Perm Medical University annually. More than a third of the students are specialists upon admission. concluded A targeted admissions agreement. This means they were admitted on a priority basis, and their tuition is paid by the medical organization with which the agreement is signed. After graduation, the young professional is required to work for this organization for at least five years. Targeted admissions come from all over the country.
For now, this seems to be the primary option for staffing hospitals in the region's remote areas. But even here, there are pitfalls. The key to targeted recruitment is simplified entry, while the mandatory five-year contract can be circumvented.
"Right now, we're relying solely on targeted students. They should, at least, work their way through their five years. At the same time, it's entirely possible to recoup the money spent on their education. While a targeted student is studying, they can start working and save for the subsequent payment. Then their parents will join in, adding their savings, and there's no doctor in the area... Moreover, few people from Perm will opt for targeted training with subsequent work in Chernushka or Kudymkar. We need to look for local candidates or candidates from other areas. Some agree, many don't." — says a medical worker who is well acquainted with the situation.
The expert notes that almost all the options for specialists to be willing to travel to remote hospitals have been tried. Ideally, the quality of life in the city center and 300 km away should not differ significantly. But, most likely, a simpler scenario will emerge sooner or later:
"It used to be that right after college, you'd go wherever they told you to for five years. Then, family, friends, children, life would improve, you'd settle in and stay put. Now, unfortunately, there's no system for assigning people, which means there's no replenishment. And it's the same all over the country. No one knows how to solve the problem."
