Lack of care: why there are not enough doctors in hospices
In the Tyumen region, relatives of palliative care patients accused a local hospice of overusing strong sedatives that immobilize people and accelerate their death. The Department of Health stressed that the prescribing of drugs is strictly regulated, and no official complaint has been received by the hospice. Anyway, statistics show that palliative care in Russia remains one of the most problematic, at least from the point of view of personnel — the ratio of part-time workers in this area is one of the highest, while there is practically no financial incentive for hard work. Izvestia found out how the problem with the shortage of doctors in hospices is being solved.
Why did you complain about the Tyumen hospice
A Tyumen resident complained to the media about the hospice on condition of anonymity. He claimed that his father was allegedly "stabbed" with sedatives and narcotic drugs to such an extent that he stopped recognizing his loved ones. Another Tyumen resident, Vera, also stated that an "eternal quarantine" for acute respiratory viral infections and influenza has been allegedly established in the medical institution since November 2025, which is why they are not allowed to visit their relatives and it is not possible to check their condition. The media cites dozens of angry reviews online.
Indeed, many people write about problems in the 2GIS service. "Dad was injected with something that turned him into a vegetable literally overnight... They injected me so that I wouldn't interfere with the staff and other patients," one of the comments says. Others accuse the staff of violating doctor-approved treatment protocols. But, to be fair, there are a lot of positive reviews.
In a response to Izvestia, the regional health department stressed that all work at the hospice is strictly regulated, including prescribing any medications. The discharge of narcotic drugs and psychotropic substances is carried out only for medical reasons, taking into account the severity of the pain syndrome and the patient's condition, with mandatory documentation and strict supervision by doctors and nursing staff over their use.
"All therapy is aimed at maximizing the relief of symptoms and maintaining the patient's quality of life without using methods related to "palliative sedation," the Department of Health emphasized.
There are practically no complaints about this service (there have been no complaints over the past year, only thanks), and all negative comments are necessarily analyzed and dealt with when possible, the department added. Some of the reviews in the department were called questionable, since there were no patients with the described situations in the institution.
— We assume that negative responses may be related to feelings of pain due to the bereavement of a loved one. In such cases, we suggest visiting a hospice psychologist who is ready to provide professional support to both the patients themselves and their relatives," the Department of Health noted.
The Department of Health also confirmed that in the Tyumen region, since November, a ban has been imposed on visits to inpatient facilities with round-the-clock stays due to quarantine for acute respiratory viral infections and influenza, which has not yet ended. Nevertheless, the administration of the institution does not prevent the visits of the sisters of mercy and the priest to the hospice patients, in exceptional cases it is allowed to visit relatives, if there is no threat to the health of others.
The main problem is the personnel
Diana Nevzorova, chief freelance palliative care Specialist at the Russian Ministry of Health, told Izvestia that 900 palliative care units, 43 hospices, and 578 nursing units were operating in the regions at the beginning of 2026. At the same time, the number of palliative care doctors in the country has increased by 73.1% over the past five years.
In general, the number of hospices and palliative care units that have been established in Russia is now sufficient, said Anastasia Zhdanova, program director of the Region of Care project of the Popular Front, lawyer at the Vera Hospice Foundation.
— The problem is how this infrastructure is used. Beds are often used not to help patients who need round—the-clock monitoring and selection of therapy for painful symptoms, but for social purposes: for example, elderly people are hospitalized after a stroke who are not provided with home care, but are in stable condition, she noted.
At the same time, on-site palliative services often exist only on paper, as the monitoring of the "Region of Care" shows. They are in the reports, but not in reality. Experts emphasize that on—site palliative care is even more important than the availability of hospices - such people should live at home or, if this is not possible, in inpatient social care organizations, and not occupy a place in the palliative care system.
— Similar work on differentiation has been done in Moscow, but today the burden on the palliative care fund is still high. This means that there are a lot of people who really need palliative medicine. Having created the hospice infrastructure, we must ensure very carefully that it is used correctly and that it is truly accessible to those who need palliative care," said Anastasia Zhdanova.
The most difficult situation in hospices is with human resources. During visits to palliative care units, experts see that staffing levels are significantly lower than recommended standards. First of all, there are not enough nursing staff, for example, junior nurses.
Nursing care (and not just palliative care) is the most scarce specialty in the world, said Larisa Popovich, director of the Institute of Health Economics.
"And the need for these specialists is growing many times faster than in other segments due to the aging of the population," she told Izvestia.
At the same time, Ekaterina Shelepova, deputy head of the Department for Medical Statistics at the Central Research Institute of the Russian Ministry of Health, told Izvestia that the number of palliative care doctors increased 2.1 times over the period 2019-2025, 2.3 times in outpatient settings, and 1.94 times in inpatient settings.
"Thus, the main indicators characterizing the human resources potential of the palliative care service tend to increase both in terms of availability per 10,000 population, as well as in terms of staffing of individuals and positions of palliative care doctors," she said.
The first issue of the Healthcare Manager magazine for 2026 published an article "The current state of palliative care in the Russian Federation (2019-2024)", which was prepared by specialists from the Central Research Institute of the Ministry of Health. According to the study, palliative care staff have a very high part—time ratio, significantly higher than that of doctors of other specialties. According to data for 2024, in outpatient settings it is 2.3, while in general medicine it is 1.2. In hospitals it is 1.8 (in medicine it is 1.4). The average gap is 2.0 versus 1.3.
The authors of the article acknowledge the situation as alarming and note that this "affects the quality of palliative care" and "contributes to the professional burnout of specialists."
At the same time, from 2019 to 2024, the provision of palliative medicine doctors per 10,000 population almost doubled, from 0.45 to 0.89. Staffing levels are currently estimated at 75.9% (82.8% in outpatient and 72% in inpatient units).
Among the average medical staff, the part—time ratio is also quite high - 1.7.
— A part-time ratio of 2.0 for doctors and 2.3 for outpatient services means that one person covers two rates. That is, there are actually half as many people in hospices as expected," Yan Vlasov, co—chairman of the All-Russian Union of Patients, explained to Izvestia.
Taking into account the staffing index of 76%, about a quarter of the rates remain empty altogether. In palliative care, it is not uncommon for a doctor to work part-time, "casually," the expert says. At the same time, those who work in the hospice all the time take on more than they should, and sooner or later this leads to burnout.
In turn, Marina Protskaya, head of the Palliative Care Department at the Medscan Golden Care Center for Chronic Diseases, a member of the National Association of Healthcare Managers (NAUZ), attributes the high rate of part-time care in hospices to the multidisciplinary approach of the doctor.
— A specialist can be both an oncologist and a palliative doctor, closing two rates. This often shows a desire to help where staff hunger is felt more acutely. However, we agree that system overload leads to burnout," the source told Izvestia.
In a hospice in the Tyumen region, according to the Department of Health, the team has been working in the same line-up for many years. The staff is also almost 100% staffed by junior medical staff — the figure is 96.3%.
Do hospice doctors have enough skills
Another problem mentioned in the article by the specialists of the Central Research Institute of the Ministry of Health is staff training. Currently, there is no medical specialty "palliative care physician" in the list of higher education specialties and in the qualification requirements of the Ministry of Health, it will appear only from September 2026.
In the meantime, experts call the basic knowledge fragmentary — it is given in other disciplines: oncology, geriatrics, neurology, etc.
Information often turns out to be superficial, which affects the work of specialists. In the "Region of Care", a huge problem is being fixed in many regions with non-compliance by doctors with clinical recommendations for the treatment of pain syndrome.
"There are no regions in our country today that fully comply with these recommendations,— Anastasia Zhdanova said. — The training of specialists should be more in-depth. It is very important to conduct internships for doctors and share competencies. Such internships were previously conducted by the Moscow Palliative Care Center, and it was the most positive experience for all participants.
Currently, the main training for hospice specialists is postgraduate and additional professional education: 144—hour advanced training programs, professional retraining programs - more than 500 hours, as well as an additional module in residency in 26 clinical specialties.
Usually, 144-hour cycles are not enough — this is just an introduction to a specialty that provides a minimum of pain relief and care, said Vitalina Levashova, director of the Higher Medical School. And in residency, palliative care hours are often minimal.
Since September 1, with the advent of a separate medical specialty, the Ministry of Health has also fixed the requirements for doctors of palliative medicine: you need to graduate from a university in "Curative medicine" or "Pediatrics", complete a residency in one of 26 clinical specialties and specialized advanced training in palliative care.
Anastasia Zhdanova, however, admits that the effect of this decision may be reversed: now the position of palliative care physician can be occupied by doctors from completely different fields: oncologists, internists, surgeons, etc. The introduction of a specialty may lead to a decrease in the staff flow. At the same time, she recognizes the importance of increasing the competencies that a palliative care physician should have, because it is almost impossible to master it in 144 hours.
The emergence of a separate medical specialty creates a point of entry and development in it, Dmitry Voronin, a member of NAUZ, head of the health committee of the Moscow branch of the New People Party, is convinced. However, people will go there to work only if their work is adequately appreciated, he emphasizes.
— At the same time, in the regions, a palliative care doctor receives an average of 60-80 thousand rubles. Under such conditions, it is difficult to compete for specialists, both with private medicine and with other areas within the system," says Yan Vlasov, adding that burnout eventually affects from 30 to 90% of palliative care professionals. — Someone leaves completely, someone stays, but they work differently, without a resource.
Anastasia Zhdanova notes that in many small towns and rural areas, palliative care doctors do not even have the additional payments that doctors who provide specialized care in the ambulance and primary care services have.
— This situation needs to be changed, and it is gradually happening somewhere. For example, there were no such surcharges in the Yaroslavl Region, and they were introduced after we reported this problem to the governor. In the near future, we will be able to assess how effective these measures are," she says.
Diana Nevzorova stated that the specifics of work in hospices have already been taken into account in the Order of the Ministry of Labor No. 664n dated September 29, 2021, which allowed setting the amount of compensation payments to employees engaged in palliative care.
However, doctors in this field do not need symbolic surcharges, but tangible surcharges that really change income, Yan Vlasov is sure.
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