"Wages are at the same level as they were ten years ago"
Ambulance workers in the Jewish Autonomous Region are having their bonuses cut. They're considering striking.
Starting in October, ambulance workers in the Jewish Autonomous Region will lose their bonuses for medical experience and night shifts. The regional Ministry of Health issued agreements to everyone with new salary calculations. Then he unveiled another optimization initiative: starting in August, there will be three crews working a shift, instead of four. Employees say their salaries are the same as they were ten years ago, and if bonuses are eliminated, they simply won't be able to work for that kind of money. They're considering strikes and preparing to quit. NeMoskva reports on how ambulance workers are surviving.
"So, we heard Sashka's gone to Ukraine for the second time!" says Alexey, a "native of Birobidzhan," as he introduced himself. He works as a car mechanic, and we struck up a conversation at a local café where he'd stopped for lunch.
"But he just got wounded, and they took him again?" his friend Maxim asked, surprised.
"He's planning to earn money for a house, he says—he doesn't have enough for the construction yet. He's planning on getting injured again—then he probably won't go back," Alexey reasons.
The Jewish Autonomous Region is small, 21 times smaller than the neighboring Khabarovsk Krai. The regional capital, Birobidzhan, has a population of only about 67. Alexey says there aren't many jobs in the Jewish Autonomous Region. Many people used to travel to China through the border crossing— "helpers"Alexey's mother used to transport Chinese goods to Birobidzhan, and he, as a schoolboy, used to lug bags of things. But now customs officials have stopped letting shuttle traders through, and the "business" has practically dried up. In the south, you can earn extra money with Chinese farmers; they grow soybeans and ship them back home for processing.
There are no major manufacturing plants in the regional capital, so locals discuss the war as a source of income. Residents recall that there were once several factories and a garment industry renowned throughout the Far East. Attempts are currently being made to revive the industry, but Birobidzhan clothing doesn't yet have the same reputation. People work in the service sector and various public institutions—pretrial detention centers, the local Primorsky State University, schools, colleges, a military hospital, and, for example, emergency services.
However, at the end of June, the station's employees were ready to go on strike.
There's talk of a strike.
Elena works as a dispatcher at the station. In June, she recalls, the station's management held a meeting with the staff. There, everyone was informed that a new pay system would be introduced in October. It stipulates that medical workers' salaries will be 15400 rubles, with a 20% bonus for night shifts instead of the current 100%, even though night calls are the most challenging, both in terms of diagnosis and physical demands. An additional 8% bonus will be awarded for hazardous working conditions. An additional 63% will be awarded based on workload intensity, and another 30% will be awarded based on regional and Far Eastern coefficients.
— It turns out that our salary in Birobidzhan will be 47000 rubles, and in the regions it will be 37000 rubles [with average salary "[In the region, it's 65815,3 rubles!]" Elena complains. "And another 13% tax needs to be subtracted from that amount."
Elena co-initiated a letter to the regional Ministry of Health and Putin's office, requesting clarification on the basis of the changes and why salaries would be lower than they are now. Medical workers demanded indexation, which hadn't happened in ten years, maintaining 100% of the night shift bonus and seniority bonuses ranging from 30% to 80%, depending on the length of service in healthcare.
A response arrived, not from Putin's office, but from the regional Ministry of Health, where the letter had been forwarded. The ministry explained that the changes were supposedly necessary to ensure that salaries remained at the same level while maintaining the same workload. The Ministry of Health's response made no mention of increasing them. Officials were the ones taking the lead. recommendations The Ministry of Social Protection and the Ministry of Health of Russia from 2024. They also stated that indexation is carried out regularly: for example, in 2022, payments increased by a whopping 1,04 times.
Elena says that a serious discussion has now begun among the medical staff at the station.
"We're currently debating in our chats whether to sign this document. There's a serious debate going on," says Elena. "Well, situations vary. Some people simply have circumstances, mortgages, or maternity leave plans. There are those who received apartments from the regional Ministry of Health, and they're worried their housing will be confiscated if they quit. There's a debate going on about what to do next. But for now, the majority of people are determined not to sign."
"But that means I'm fired, right?" I ask.
"Well, yes, layoffs. We don't know who will work, and whether they'll do anything is unclear," Elena concludes.
According to Elena—and several other people at the station confirmed this to NeMoskva—the employees are “talking about a strike.”
"They can't get out of these cars."
"Ambulance 68 is working, get out," the dispatcher announces to the entire ambulance station. Not a minute passes before driver Alexander gets behind the wheel. He looks about 50 and has been working in ambulances for over ten years. He pulls up to the porch behind the paramedic, a young woman. She doesn't want to answer any questions—she's rushing to answer the call, waving away the reporter and hiding behind a folder of documents.
In just one hour, the small city of Birobidzhan received three such calls that day. And that was during the day. At night, doctors say, there are sometimes more, sometimes just as many, calls, but they are always more complex—due to the diagnoses and circumstances. There are more intoxicated patients, more seriously ill patients. And it's harder for the doctors themselves to work at night.
"That's how we work," says Alexander, returning from a call. "It seems like it was supposed to be lunch, but what can you do? We're going. Now we'll try to get some rest."
As Alexander explains, while there used to be seven brigades in the city, now there are only four left, and starting in August, another one will be cut.
"There's no one to work! I applied here ten years ago, and we were getting 35 rubles and some change. I thought: 'Well, I'll work here and get an 80% bonus [for length of service].' So what now? Now I'm getting 30. For 15-16 shifts. And there are extras: for those on sick leave, for those who quit," Alexander says. "Now they'll take away the bonuses, and what's left? Before, I'd work three years and get 30%, five years and 50%, and after seven, I'd get an 80% bonus. And at the meeting, they tell us: 'You have nothing to earn from!' What do you mean, nothing to earn from? If there used to be seven or eight crews working for the city, where did the money go? And what about the night crews? How can we get rid of them, I don't understand, if we work nights?"
According to him, management proposed basing salaries on workload intensity. The ambulance workers themselves don't know how to increase this intensity if people aren't getting sick anymore. They estimate the workload is already quite high. In Birobidzhan, ambulances are called even for non-emergency patients.
"The calls used to be more reasonable. But now imagine: he's been drinking for two weeks, and now he calls us, still drunk, asking for an IV, to take him to the hospital, to get him off the binge. But they won't admit him! Or there are people who say, 'Give me a work certificate.' But we don't have any certificates, the ambulance service doesn't issue anything. And so many stupid calls like this happen, and the ambulance crew has to go there, wasting time."
Ambulance crews are required to respond to all calls. Furthermore, people often report symptoms that require emergency care, but in reality, some of them turn out to be fabricated.
Now, according to Alexander, the workload is compounded by retired summer residents. Grandmothers work in the garden during the day, but by evening their blood pressure spikes. "You treat them in the evening, and in the morning they're back to the garden," he says. Alexander is afraid to even speculate about what will happen next—"viruses, COVID." And how three teams will cope with all of this, he also can't fathom. A strike? "You can't abandon people," he says.
The driver says the paramedics are working themselves to the bone, "they can't get out of these cars." And no one wants to work in the ambulance service because "they're not paying."
It is more profitable to poison than to cure
However, there are still young specialists at the station. Daniil is arriving at the station on the next call. He came here on a referral from the Birobidzhan Medical College. He's currently studying at the institute, improving his qualifications. He says they're trying to "retain" young staff at the station, as they do at other medical institutions in the region. program The region is working on attracting medical professionals, promising payments of up to 300 rubles (according to Daniil's colleagues, no one has received more than 200). But he hasn't received any such offers yet—he must first complete three years of targeted work. He still has a year and a half left.
"We're supporting our young staff. They haven't given me anything yet, but I don't know. Maybe they'll give me a room in a dorm first, then maybe an apartment," says Daniil. "Right now, I have to work 1,5-2 full-time jobs for 60-70 thousand rubles. And there's no extra pay, and they're even planning to lay us off. Last December, some paramedics worked 15 days—that's a lot of overtime—and they calculated it at the minimum; instead of double [pay], they gave me bonuses of three to four thousand rubles. I know two paramedics who work at [the liquor stores] Bristol and Krasnoe i Beloe [now] because the pay is higher there. So it's more profitable to poison than to treat now. What's the point of wasting your nerves, losing sleep at night, carrying patients weighing over 100 kg for nothing..."
Vladimir says that in addition to the ambulance, you can go to a pretrial detention center as a medic, to a military hospital, but the most profitable option is to go to the village – to the zemstvo doctors and paramedics pay The federal program provides starting salary, starting from 500 rubles. He also rates the conditions at the Birobidzhan ambulance service as good. Compared to other medical facilities in the region, but not compared to other regions.
"The ambulance is better than the regional hospital. It's scary there—you have to work for five people, both during the reception and at night. Sometimes the regional hospital asks us for medications by the ampoule, but they don't have anything. We have everything: medications, new vehicles."
The new vehicles were purchased in 2023. As reported by regional authorities, this was done with the president's support. Eighteen new vehicles were purchased in March.
In just three years, the fleet, which was 80% worn out, replenished 38 new vehicles. However, not all of them are in use; some are parked in garages. Alexander points to one of them, which has three new vehicles. They have never been called out because the number of crews is getting smaller every year.
In Blagoveshchensk, Daniil says, the fleet is "completely made up of rotten cars." But paramedics' salaries are three times higher. And in Khabarovsk, he says, you can earn twice as much as an ambulance driver: the travel expenses from Birobidzhan to Khabarovsk are covered, and the salary is higher for one position.
"Everything is fine on paper."
Another driver, who wished to remain anonymous, is also dissatisfied with the new system. He has been working as an ambulance driver for almost 25 years, with a short break.
"Our city buses are also a municipal enterprise. And their drivers earn 60 rubles a month. Ours is half that. And yet, we work nights, and we carry people, pardon the expression, wet and shit-covered," the driver says.
The situation is roughly the same in the districts, except the vehicles there aren't new Gazelle vans, but old UAZs. Other vehicles wouldn't be able to navigate the local terrain. An ambulance driver, Vladimir, came from Leninsky village to the station in Birobidzhan—130 kilometers away—to have his car repaired. He says he received 25 rubles last month—after deducting alimony.
"So, I have a 10-ruble advance, and about 15 left in salary. How am I supposed to make that much with this kind of schedule?" the driver is perplexed. "Well, we've written and asked about it. But it's no use, no decent answers. And we have to do village calls—up to 70 kilometers one way. Sometimes, by the time we get there, they're already telling us they weren't expecting us... By the time we get there, it's time to get there on the gravel roads, especially after the rain."
— There are probably a lot of complaints about you?
"What complaints!" Vladimir says with a grin. "Everything's in order on our paperwork, everything's complete, right? And if anyone thinks otherwise, they should take a closer look at the paperwork."
Jewish Autonomous Region Governor Rostislav Goldshtein discusses "healthcare development plans" at a meeting with ambulance station staff. The staff doesn't seem enthusiastic, although they don't yet know what awaits them in 2024. Screenshots from a RIA Birobidzhan video, March 2023
Unanswered demands
The ambulance staff are wondering where to go if they decide to quit—they need medical staff at the local pretrial detention center and the military hospital. They could always head to neighboring Khabarovsk, which also has a medical staff shortage.
In July, the head of the Jewish Autonomous Region's Department of Health, Valery Zhukov говорилThe region is short of approximately 300 doctors and 118 nursing staff. The region's medical staffing level is 83%.
NeMoscow sent a request to Zhukov at the regional Ministry of Health. They asked why the salaries of medical workers and drivers are below the regional average, why the number of teams in the regional capital is being reduced, how young staff are being retained, and what was the rationale behind the decision. change wages. A response had not been received at the time of publication of this text.
The situation in the Jewish Autonomous Region is not unique. Across Russia, medical workers are complaining about salary cuts or unpaid overtime, demanding the benefits for primary care workers introduced in 2024. The situation is particularly tense in emergency medical services.
In 2024, the project "Social and labor conflicts" recorded There have been 93 labor disputes in healthcare, 80% of which involved ambulances. Since the beginning of the year, ambulance workers have been trying to draw attention to their problems in 35 regions of Russia.
Project Strike committee, which has been analyzing data on labor conflicts and strikes since 2019, counted NeMoskva used data on the number of incidents in which employees in various industries defended their rights. According to their data, healthcare as a whole is one of the most problematic sectors. In 2023, the share of labor disputes in the healthcare sector was 23%.
Since 2021, the number of complaints from medical workers about labor rights violations has been growing: 71 in 2021, 104 in 2022, and 170 in 2023. And in 2024 alone, 94 reports have already been received. However, this is still a long way off from the peak of 202, when 234 problematic signals were reported. For now.
Doctors and medical staff most often complain about pay and working conditions. In 2024, salary dissatisfaction accounted for 56% of problematic reports; in 2023, this share reached 96%.
According to Zabastkom, public appeals are the most popular form of reporting violations of one's rights. Far less common are employees going to court, quitting en masse, or refusing overtime. No one has dared to strike in the past few years.
The effectiveness of such actions is not very high. In 2022, doctors' and nurses' requests were satisfied in 32,7% of cases, and in 2023, in 40%. In the incomplete 2024 year, 41,5% of decisions have so far favored medical professionals.
