Don't treat a scientist: doctors may be required to work in state clinics
A new version of the draft law of the Ministry of Health on compulsory medical training for graduates has been published on the federal portal of draft regulatory legal acts. The Ministry did not abandon the idea itself, and the proposed fine for non-fulfillment of work obligations was increased to three times the amount relative to the budget expenditures for training such a specialist. Izvestia investigated how this will affect the personnel situation, how many graduates are currently not working in their specialty, and whether the number of applicants to medical schools will decrease.
What the Ministry of Health offers
It is proposed to supplement the Federal Law "On Education" with Article 71.2 "Special features of training in educational programs of medical education and pharmaceutical education and fulfillment of obligations to carry out work after training".
It provides for the obligation of persons who have completed training in basic professional educational programs of medical education at the expense of the federal, regional or local budget to find a job in medical organizations operating in the compulsory medical insurance system within a year and work there for at least three years. The specific list of medical specialties can be determined by the government of the Russian Federation, as well as the duration of mandatory training.
If the graduate fails to fulfill this obligation, he must pay "compensation amounting to three times the amount of expenses" of the budget for his studies.
The targeted training system, which implies employment not in any medical institution, but in a specific one, will also continue to work. But for "target students" the fines will increase to three times the total cost of education.
In the explanatory note, the establishment of a three—fold compensation amount is explained by the fact that the current model of fines — when tuition fees are simply reimbursed for non-fulfillment of the terms of the target agreement - "is not linked to indexed financial indicators (for example, the minimum wage) and does not depend on the inflation rate."
"Currently, there is a negative practice when applicants, entering the first year, apply for targeted training, knowing that they will not fulfill their employment obligations, planning to return the funds in the amount spent over six years on their studies, without interest. Thus, the current one—time fine is actually not a penalty, but an interest-free educational loan, an installment plan," the authors of the bill believe.
If the document is accepted, the new rules will take effect on January 1, 2026.
How many graduates do not work in their specialty
The explanatory note to the draft law states that there are currently 154 universities and research organizations in the country that train students and residents at the expense of the federal budget, and 16 more at the expense of regions and municipalities. At the same time, about 35% of medical university graduates and 40% of graduates who have received secondary professional medical education at the expense of budgets of different levels do not start working in their specialty in medical organizations that are part of the state or municipal healthcare system.
The Ministry of Health estimates the current staff shortage at 29 thousand doctors and 63 thousand average medical workers as of 2023.
Anton Kotyakov, the Russian Minister of Labor, recently stated that 17% of medical students in Russia do not complete their studies at all.
In 2024, more than 35 thousand applicants were enrolled in medical universities in Russia. If the trend described above continues, only about 19 thousand of them will reach work in the public health system. The adoption of the law on compulsory work would have a short-term effect in the form of saving about 10 thousand people in the compulsory health insurance system.
Meanwhile, a survey of the Doctor's Handbook application platform in February (1,000 current doctors and 737 students took part in it) showed that 32% of current medical workers and 42.6% of current medical students would refuse to enroll in a medical university if the rule on mandatory work was in effect. If we take into account the results of this survey and the number of students who will not graduate from the university, then instead of 35 thousand, from 20 to 24 thousand students would be enrolled in universities. After deducting another 17% of students who will not graduate at all, we will get about the same 17-19 thousand graduates who have joined the public health system.
However, these are very rough calculations, which can only partially illustrate the impact of the introduction of mandatory training on the total number of personnel entering the public health system annually, since a huge number of important factors are not taken into account.
The sample of doctors in this survey is not very large, says Vitalina Levashova, Chairman of the Committee on Medical Education of the National Association of Healthcare Managers (NAUZ).
— Will those people who voted against remain in the profession or leave it, regardless of the mandatory work time? — the interlocutor of Izvestia asked a question.
Andrey Konoval, co-chairman of the Action Healthcare workers' union, also emphasizes that this survey cannot be considered relevant, but it accurately "reflects the mood" in the professional environment.
Is triple compensation fair
The trade unions of healthcare workers — both the All—Russian and Action - independently opposed the proposal of the Ministry of Health on compulsory work for graduates of medical schools.
The All-Russian Trade union emphasized that the initiative on compulsory work could be regarded as forced labor, that is, performing work under threat of some kind of punishment. Moreover, the provisions of the draft law containing norms on penalties for students cannot be regulated by legislation in the field of education, since fines are part of institutions of civil, administrative and criminal responsibility, the trade union pointed out.
— Our trade union considers compulsory work not for "target students", but simply for students of a budgetary form of education to be a discriminatory practice, since the procedure for exercising the right to education should be equal for all citizens, — said the co-chairman of the Action trade union. — In this case, there will be a defeat in the rights of representatives of the medical professions.
Andrey Konoval confirms that sometimes "tseleviki" consider this form of education as a kind of interest-free loan, but he calls such a huge compensation excessive. In his opinion, 150% would be enough.
— In the current conditions, doctors are forced to enter into labor disputes with their employer in order to protect themselves, — said Andrey Konoval. — In response, the administration worsens the working and rest conditions, subjecting such an employee to disciplinary harassment, which is very easy to do in conditions of high workload for a health worker. After the third or fourth penalty, he can simply be fired. A young employee has to either endure and remain silent, or risk losing his job with the corresponding consequences associated with mandatory work.
Anna Mironova, a member of NAUZ, Director of Development and digital transformation of SMT clinics (St. Petersburg), also emphasizes that now a student applying for targeted training has no clear idea of the conditions under which he will work.
"I am familiar with several cases where work turned into voluntary slavery," she told Izvestia. — For therapists in city polyclinics, a work schedule was drawn up without approval, they were forced to shift for colleagues who went on sick leave or on vacation, while the financial conditions left much to be desired. A young doctor becomes a powerless hostage to the completion of targeted training, which is the reason for the high rate of termination of employment contracts.
Anna Mironova emphasizes that triple compensation for non-work should be "mirrored by guarantees for future employment conditions" so that a medical graduate understands how his rights will be protected.
Larisa Popovich, Director of the Institute of Health Economics at the National Research University Higher School of Economics, emphasizes that compensation, most likely, in any case, will not be an incentive for those who do not intend to remain in the public health system.
— Therefore, the issue here is monitoring and tracking. Some regional leaders believe that in this situation, a person who has not been a doctor for a year or a year and a half should be stripped of his diploma and disqualified," she notes.
At the same time, Larisa Popovich considers the compensation itself from a medical university graduate who refused to work in the public health system, but instead, for example, went abroad, to be fair.
Vitalina Levashova is also sure that a system of this kind is needed. She believes that there is nothing wrong if this eliminates applicants who initially do not want to work in healthcare.
"But it is important for us to understand that we must create conditions for young professionals in any case," emphasizes Vitalina Levashova. — If there are no conditions, then these three years will not save us: young specialists will simply leave the profession and will do something else, having a diploma of medical education in their hands. This is only the first step towards enabling government medical institutions to build a system of support and adaptation for young professionals.
The first deputy chairman of the State Duma Committee on Health Protection, Badma Bashankayev, noted that there are problems with targeted training: only 63% of graduates and 88% of residents are employed in organizations that trained them at public expense. The State Duma Committee believes that legislation should clearly regulate the responsibility of the parties to targeted education, but this is not a matter of tightening sanctions — it is a matter of fairness and balance of interests.
Izvestia sent a request to the Ministry of Health of the Russian Federation regarding the draft law.
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