Variable rate: how can head doctors solve a personnel problem
Healthcare facilities in the Saratov region should be staffed by 70% doctors and 77% average medical staff by January 2026. Otherwise, the head doctors will be dismissed — this is the ultimatum given to the medical organizations of the region by Governor Roman Busargin. Experts note that, on the one hand, such planned staffing levels are, in principle, very low, and on the other, the chief medical officers have very few real opportunities to resolve the personnel issue. Izvestia figured out how to solve the main problem of Russian healthcare.
What is the shortage of doctors in the Saratov region?
Roman Busargin told about the hard deadline for the chief doctors in his Telegram channel.
"A task has been set for all hospital managers — by January 1, 2026, healthcare institutions should be staffed with 70% doctors and 77% average staff," he wrote.
The governor said that regional and municipal authorities have already "introduced various benefits and support measures for medical workers, including attracting young professionals." However, the situation has not been fixed in a number of hospitals so far. He did not name specific institutions.
"At the end of the year, we will analyze each case in detail. By the end of the year, we will compile a register of all institutions, evaluate actions to attract specialists to the medical organization of each chief physician. Decisions on leadership changes will be made for institutions with the lowest indicators," the head of the region writes.
Roman Busargin noted that at the same time he was instructed to form a personnel reserve for head doctors.
Sergey Egorov, Deputy Chairman of the government of the Saratov region, told Izvestia that currently the staffing rate of doctors is below 70% in 62 medical organizations, less than 77% for the average medical staff in 25 institutions.
Sergei Prokhorov, Chairman of the Saratov Regional Organization of the Trade Union of Healthcare Workers of the Russian Federation, added that as of July 30, 8,244 doctors and 19,485 nursing staff were working in the region.
— The need for doctors is 1,357 people, including 710 in primary care. There are 1,389 people needed in the average medical staff, including 510 in the primary care," he said.
Currently, according to him, the staffing of doctors in the region as a whole is 65.31% and 76.93% for the average medical staff, if we count individuals.: that is, if doctors worked only for one rate. If we count the staffing for vacant vacancies, it is 86.5% among doctors and 89.5% among medical staff.
— In fact, this corresponds to the indicators determined by the governor of the region at the meeting, — said Sergey Prokhorov. — The indicators have not been fulfilled only by individual heads of medical institutions in the region, but they are really feasible.
What should be the staffing of doctors?
Sergei Prokhorov emphasizes that "in the current reality" the figures of 70% and 77%, indicated by the governor, are sufficient indicators for "meeting the targets of the territorial program of state guarantees."
However, other experts emphasize that this is very little. Vitalina Levashova, director of the Higher Medical School and Chairman of the Education Committee of the National Association of Healthcare Managers, emphasizes that such figures mean that virtually every doctor must work at one and a half hours to cover 100% of the needs.
"In such conditions, fatigue, burnout, and sometimes poor-quality medical care are inevitable," she said. — Indicators above 90% are considered normal, it is necessary to strive for 95%.
Andrey Konoval, co-chairman of the independent medical workers' union Action, also notes that striving for such indicators means the failure of the national Healthcare project, which ended at the end of 2024.
"According to the federal draft, even the initial rate of availability of outpatient doctors was 79.7% as of December 31, 2017," the Izvestia interlocutor notes. — By 2024, it was supposed to reach 95%, as well as for the average medical staff. Provision of nurses and other staff with a part-time ratio in 2018 was 88.8%.
In the Saratov region, the baseline figures were lower — 58.5% for doctors and 75.7% for average medical staff by the beginning of 2018. But by the end of the national project, the values should also have reached 95%, Andrei Konoval notes.
It will be difficult to bridge the gap that has not been managed in a few years. Vitalina Levashova points out that if staffing levels are currently only 50%, then it is impossible to increase the figure to 70% in four months.
Andrei Konoval fears that in the current conditions such an ultimatum may lead to the fact that the chief physicians will take the path not of increasing the number of staff, but of reducing the rates and staffing.
"If the number of positions in the staffing table is reduced, then staffing increases automatically," he notes. — Moreover, such recommendations are given in plain text by specialists of the Scientific institute of the Research Institute under the Ministry of Health in business medical publications.
The co-chairman of Action notes that in the regions where the trade union is represented, there is already a tendency to increase the outflow of personnel, which is hidden, among other things, by optimizing rates.
"These are completely ill—considered statements from the leadership of the region," Guzel Ulumbekova, head of the Higher School of Healthcare Organization and Management (HSE), MD, told Izvestia. — Because the chief physician has only one way — to lure staff from another hospital in the same or another region, which will not contribute to solving the problem. Unfortunately, today the head doctors have no real tools to solve the personnel problem.
How can doctors be attracted to hospitals?
Guzel Ulumbekova emphasizes that the demands to the chief physicians should be supported by additional funds to increase the salaries of doctors from the same regional leaders.
"Meanwhile, in the Saratov Region, the average salary of medical workers is one of the lowest in the Volga Federal District," she notes. — Both doctors and nurses who work there often move to other regions.
The salary of doctors in the Saratov region, according to Sergei Prokhorov, is slightly more than 65.5 thousand rubles, the average staff is 37.3 thousand rubles, and the junior staff is 30.9 thousand rubles. Meanwhile, in the neighboring Samara region, says Guzel Ulumbekova, the salary of doctors is already 88 thousand rubles. The availability of doctors per 1,000 population is also higher there — if in the Saratov region this figure is 3.5, then in the Samara region there are four doctors per 1,000 people. In the country as a whole, the average salary of doctors in Russia last year reached 115 thousand rubles, and the provision was 4.2 doctors per 1,000 population.
Andrey Konoval also emphasizes that it is the executive authorities of the constituent entities of the Russian Federation that can really increase the staffing of the healthcare industry by increasing salaries: the regional budget can also be a source of financing for medical institutions.
Mikhail Androchnikov, Deputy Chairman of the Trade Union of Healthcare Workers of the Russian Federation, calls the low tariff for medical services, which are paid through the Compulsory Medical Insurance Fund, the main problem. And until this issue is resolved, the migration of doctors between regions will continue.
At the same time, he says, the available opportunities in the Saratov region are being maximized. Sergei Prokhorov says that starting in 2024, the region has increased one—time cash payments for the first, second and third years of work of young specialists to 50, 45 and 40 thousand rubles, respectively. An incentive payment for young doctors has also been established, which is designed to bring the salary to 39,250 rubles per month. The Zemsky Doctor and Zemsky Paramedic programs are in effect, and there are additional bonuses in the form of free driver's license training, free access to swimming pools and gyms, provision of office housing, and payment of lifting fees.
How can the head doctors influence the situation?
Sergey Egorov, Deputy Chairman of the Saratov government, is confident that the heads of medical institutions in the region have a "wide range of tools" to resolve the personnel issue. He listed the measures that are somehow related to the work of the Ministry of Health of the region, regional, federal authorities and educational institutions. These include increasing the prestige of the medical profession, targeted recruitment of specialists (1,349 people are currently being trained), measures to support young doctors, scholarships for students, and measures already listed by Sergei Prokhorov.
The deputy prime minister called all these tools "replicable and available for use by chief physicians in the field," separately emphasizing that success depends on "active and comprehensive work on their implementation in each specific institution."
— Currently, the staffing work continues. The largest number of young professionals is expected to be employed during September–October 2025," said Sergey Egorov.
Andrey Konoval notes that chief medical officers, in the face of the impossibility of increasing salaries, should first of all build a dialogue. In particular, the union has repeatedly documented cases of unfair distribution of incentive and bonus payments, which led to the dismissal of staff.
Vitalina Levashova points out that the main tool of the management of a medical institution to retain existing employees is to regulate workload and maintain an emotional mood among employees. It is important to create a favorable atmosphere so that the staff does not leave the hospital, even in difficult times.
"All possible tools of material and non—material motivation should be used," she stressed. — It is important to form what is called an HR brand in general. Medical workers, knowing the personnel shortage in almost all healthcare institutions, choose an employer very carefully.
Another tool for attracting new employees is a referral program, which uses the connections and contacts of its own employees.
And Guzel Ulumbekova recalls that recently a new order was issued by the Ministry of Health stating that medical positions can be held by paramedics and nurses. In this regard, she suggests thinking about how to improve the quality of medical care using artificial intelligence tools. The AI, located on a platform with verified knowledge, will help the average medical staff, who holds the position of a primary care physician, to provide assistance more effectively.
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