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- Painful request: trade unions demand to introduce a single payment system for doctors
Painful request: trade unions demand to introduce a single payment system for doctors
The lowest average salary of medical workers in Russia is in the North Caucasus. Such an analysis was carried out by the Trade Union of Healthcare Workers of the Russian Federation based on Rosstat data. In five regions of the North Caucasus Federal District, this figure does not exceed 50 thousand rubles. In another 14 regions of the Russian Federation, it does not reach 60 thousand. Salaries of employees in similar positions in different regions may differ significantly, and there is a difference between municipalities and even individual institutions, the trade union noted. What is the reason for the current situation and how the wage system may change — in the material of Izvestia.
Where doctors are paid the least
In six Russian regions, the average salaries of medical workers are below 50 thousand rubles per month, and all of them represent the North Caucasus Federal District. This follows from Rosstat data, which was analyzed by experts from the Trade Union of Healthcare Workers of the Russian Federation.
Thus, the average salary of a medical worker in Ingushetia is less than 42 thousand rubles, in Chechnya — about 44.6 thousand, in Dagestan — about 45.7 thousand. Average incomes in Karachay-Cherkessia, Kabardino-Balkaria and North Ossetia also fell short of 50 thousand.
In 2025, salaries were less than 60 thousand rubles in Bryansk, Ivanovo, Kostroma, Orel, Smolensk, Tambov, Astrakhan, Ulyanovsk regions, Adygea, Kalmykia, Sevastopol, Mari El, Mordovia, Altai Territory.
For comparison: in Moscow, this figure is 159.5 thousand, in St. Petersburg - 125.5 thousand, in the Moscow region — 103.7 thousand, in the Leningrad region — 88.5 thousand. The largest salary is paid to medical workers of the Yamalo—Nenets Autonomous District, taking into account payments for work in special climatic conditions.
As the press service of the trade union explained to Izvestia, the regions form the wage system independently, therefore, the wage level in them differs.
"The main reason is also financing — the compulsory health insurance system and the budget of the region itself. There are more "rich" subjects and subsidized ones," the organization noted. — The trade union seeks to reduce the difference by introducing additional additional payments and allowances, salary increases, and indexations on the ground."
What's wrong with the payment system
The issue of wage inequality for doctors was raised at the IX Congress of the Trade Union of Healthcare Workers of the Russian Federation, which took place on April 16 in Moscow.
Thus, Irina Lizenko, chairman of the Primorsky Regional Trade Union Organization, stated about the "unresolved problem of the depreciation of the labor of medical workers" and noted that they "are being held hostage by insufficient funding."
"There are significant inter—regional differences in pay conditions, including salaries for the same positions," she said. — It is necessary at the federal level to form a single understandable remuneration system, which will establish uniform requirements for the structure of wages and incentive payments, taking into account the specifics of a specialist's professional activity and the fundamental level of wage increases for all categories of employees.
Irina Lizenko noted that it is the salary level that determines personnel policy, "therefore, we need firm government boundaries to ensure that employees receive a decent assessment of their work at the same rate."
However, she added, even in cities, where the income situation is usually better than in rural areas, medical workers often have to work at one and a half to two rates.
— At the same time, even working for one rate, you have to exceed the norm of your work, — said the representative of the trade union.
And Anatoly Domnikov, chairman of the Trade Union of Healthcare Workers, speaking at the congress, stressed that the quality of medical care, the availability of treatment, and the continuity of patient care are based on human resources.
"Life expectancy cannot be increased only by building hospitals and purchasing equipment," he said. — To achieve this goal, a reputable, respected, strong and protected medical professional is needed.
What might be the common requirements?
The press service of the trade union also noted that the main hope is pinned "on the introduction of a unified wage system, which we expect by the end of this year as a developed project."
On April 16, it was reported that the government had developed draft recommendations for calculating salaries in the healthcare sector, according to which the salary should be half of the total salary, excluding compensation payments. At the same time, the requirement for a salary for health workers of at least 50% of the salary is also contained in the government decree of December 2025.
Izvestia sent a request to the Ministry of Health with a request to clarify how the new wage system will work.
As Anatoly Domnikov explained to Izvestia, the trade union had previously offered the government an option for a new calculation of medical income, but this was on the eve of the outbreak of the COVID-19 epidemic.
— We raised the issue that the responsibility for salaries in healthcare lies with the subjects of the federation, so it all depends on how much they collect tax revenue, — he said. — And since budgets are different, salaries vary quite significantly. And our main goal was to at least bring the approaches to payment closer so that the gap would not be so large.
He also added that some regional authorities have gone further — some of them have transferred the authority to set salaries to municipalities and even to chief doctors. Therefore, even within the same region, salaries of health workers can vary dramatically.
But they did not have time to implement the system developed by public organizations because of the epidemic, he complained. The trade union has not yet seen the current draft.
— We are ready to discuss. In our version, in addition to the mandatory salary of 50% of salary, we proposed to introduce regional increasing coefficients that would smooth out the difference in income between different entities," Anatoly Domnikov said.
According to him, such a system would not significantly affect the salaries of medical workers in Moscow — there would be an increase, but by several percent. But neighboring regions would have felt the changes, and salaries between regions would no longer differ by three or more times.
And the press service of the trade union added that they expect a developed draft of the new system by the end of this year and its introduction in 2027.
Rector of the Higher School of Healthcare Organization and Management, Doctor of Medical Sciences Guzel Ulumbekova noted that she supported the trade union option proposed in 2019, as it would really help eliminate interregional and intraregional differences.
"But this requires funds and financial resources from the state," she said.
Nikolai Prokhorenko, an expert in the field of public health, called the existing wage system "wildly confusing" and confirmed that medical workers now have to work for several rates, take additional shifts, and combine positions in order to earn "more or less decent money." He added that there is currently not enough "common money" to normalize the situation, that is, to increase the financing of the industry as a whole.
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