The collapse of The staff. Medicine may soon be left without doctors?

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The personnel issue medicine every day sharper and sharper. A number of proposals that will help to resolve it, proposed to not only government officials, but also doctors from different regions. “Children’s doctor of the world”, President of National medical chamber Leonid Roshal was organized by the onf round table “How to overcome the staffing problem in health care.”

Old, experienced doctors work out of duty for two, or even three. The young initially are not prepared to work in rural areas. This is how the polls in 2016, carried out in several medical schools (the names don’t make sense – students from different regions were unanimous).

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Did not notice the “Zemsky doctor”?

The CRB of the village of Pudozh in Karelia, the shortage of 45%. The program “Zemsky doctor” since its launch arrived… one person. Because the settlement with 9.5 thousand inhabitants is the administrative center and is considered a city. Often doctors working in rural areas, have no benefits and social payments, because technically the village or town are considered part of the city.

“Program “Zemsky doctor” must be extended at least for settlements with population up to 50 thousand people!” – calls on the Deputy chief physician of TSRB Alexander Pudozhskiy Neimerovets.

“Doctors don’t get any extra payments as added to city dwellers. Requires that surcharges for health-care workers was in any remote locality, regardless of its status,” – said a urologist from Samara Oleg Sabancev. He recalls how in the Samara region in 2005, the urban-type settlement of Coastal included in the urban area. People have lost their benefits for rural residents, which led to several problems, including shortage of doctors and nurses. But if no social benefits, the is almost no chance to attract the young cadres. And older too.

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Work wear

A young doctor waiting for another clash with reality. The level of wages in health worker does not meet the scope and complexity of his work. Work on the two rates – is not always the desire of a specialist. Round-the-clock emergency assistance in some areas is provided by two or three doctors. Only a sense of responsibility and the desire not to leave the patient without treatment, forcing doctors to work for wear.

Gradual increase in wages of health workers is provided mainly due to the fact that doctors combine multiple positions and have multiple rates. The rate itself is growing very slowly.

“It turns out that wages in healthcare seems to be growing and has results to report, but it is not the result of regional officials, but the result of extra efforts of the doctors themselves. It is therefore important that medical institutions with the support of the regional authorities balanced share of the tariff rate of earnings: the salary should account for 55-60% and 30% incentive payments for achievement of certain results and 10-15% – compensation payments depending on working conditions – offers the chief physician of TSRB Koigorodskiy of the Republic of Komi Vadim Mechetin. – And now, for example, in our country 35% of income is salary, a 21% compensation and 44% of – stimulating”.

Not better things in other regions. The doctor on “er” in Moscow receives about 60 thousand virtually any per month. But it is “at an intensity of 200 percent,” as a joke by doctors. The amount to more or less tolerable existence, receives the one who works at night and on the weekends. Base salary – 15-20 thousand virtually any. It is for these 15-20 thousands of hope hospital and… pension. Saving the lives of others, the doctor literally risk their own.


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A matter of national importance

“To make wages and living conditions worthy of the efforts that doctors have made for the sake of our prosperity, it is the duty of the state. But until we see a noticeable change in this direction, – said Leonid Roshal. – So the popular front has decided to apply to the government with a proposal to create a state programme for gradual reduction of shortage of medical personnel. It should be provided including measures of social policy.”

Help “one”. The income of the doctor will depend on the health of patients

Today’s young professionals to work in such rhythm will not be able – even those romantics who are up and ready to go the mist and master of the far East and far North (although why, if extreme survival provided the doctor in the capital?). Statistical data on the health of the “generation of the nineties” is not the only reason. Certified, but inexperienced, and the doctor may not be enough knowledge. Yesterday a student will not be able to give the amount of quality care that need a small town or village.

The next reason is the low level of socio-economic development of rural areas. “Young families need a kindergarten, with the opportunity for creative and sports to develop a child. Not wishing to associate the future of their children degraded areas” – draws the attention of Alexander Neimerovets.

The lack of kindergarten – not the most difficult encounter with what can rural doctor or rural nurse. “FAPs were left without paramedics due to the lack of housing,” – says the Deputy chief doctor of medical unit of the Beloyarsk CRH of the Republic of Khakassia Nikolay Kyshtymov.

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In the district of New town rural settlement bear-Ozersk in July 2016 was rebuilt in the hostel, a former training center. The three-storey building doctors is in the room-studios with an area of 20 sq. m. premises adopted family doctors. The rent compensates for the administration of the district. Such examples are, unfortunately, a little bit. There are regions where I believe my achievement that Zemstvo doctors get mortgage at low interest. Or total cost of interest paid by the region – but from a home loan doctor no, and no.

“Health workers is not enough to attract to the village. It is necessary to keep them. Otherwise, the villagers will become a training ground for young professionals”, – warns Oleg Sabantsev.

Dr., not yet married, no matter boy or girl – will have to look for a life partner, continues Alexander Neimerovets. How to solve this problem in a small remote village where even the bus runs every day? After all, to hold in remote and sparsely populated region will need at least five years.

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Marathon for typesetting scores

By the way, how’s the family physicians who moved to a remote village, will gain points for continuing medical education? The obligation to purchase 50 credits per year for “Zemsky doctor” has not been canceled…

“The new system of CME will lead to the fact that we can decrease the already scarce personnel in two or three times, warns the Deputy chief doctor of pediatric surgery of the Russian scientific center for restorative traumatology is orthopedics and named Gavriil Ilizarov Eduard Goncharuk. Is not education, it’s a marathon for typesetting scores. If could not – have gone the distance. Now see how doctors in the regions are running for these scores, not knowing how to renew your certificate…”

The doctor working on two certificates, such as physician-cardiologist (this combination of functions occurs frequently and in large cities) have to score 100 points – 50 for therapy 50 in cardiology.

“Doctors of retirement age have refused to join the HMOs. After five years, it will lead to disaster,” – says Vadim Mechetin.


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Medicine starts with a mentor

Painful personnel issue with it to education. “A serious problem is the shortage of teaching staff”, – says the rector of the First MGMU named after I. M. Sechenov Peter Glybochko.

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Even the doctor who is very experienced, and needed a mentor, and an opportunity to consult with colleagues. Medicine without the advice ceases to be a medicine, as told once laureate of the USSR Council of Ministers, the author of four inventions and President of the National scientific-practical society ambulance Professor Arkadiy Vertkin. What can we say about a young person?

“If we allow this army is not quite ready for doctors to medical practice, the physicians should be in charge in their area,” expressed the Director of the all fgbi “Central research Institute of organization Informatization of health” Ministry of health of Russia and former Minister of health Vladimir Starodubov.

“The availability of all medical care still is based on the frame, – said the first Deputy Chairman of the Duma Committee on health protection Natalia Sanina. – Should be a separate mentoring program. And it should be encouraged. After the practice at the initial stage of our work is always fraught with fear. Our experienced doctors are happy to give the young all your knowledge. But you need to understand that the great specialist, who will come to help the young doctors, should not take a mortgage.”

Like any doctor, saving lives daily.


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