In Russia, health care, according to many, is in a deplorable state: free medicine is in a state close, in medical terms, to a coma. Paid is mainly represented by dentistry and diagnostics. The segment of private medicine cannot appear at once. Initial capital sufficient for the construction of buildings suitable for modern comfortable clinics and the purchase of appropriate equipment in most cases is not available.
And it is not always possible to adapt any building for medical purposes. According to statistics, only 8% of patients give unequivocal preference to paid medical services, and 60% of those who become ill go to ordinary polyclinics for a start. In the latter, they are faced with the following situation: in order to receive a free medical service, it is necessary to do a certain number of paid tests.
In many cases, patients' complaints about poor-quality service in free medical institutions are justified. But what can be demanded from a doctor, a pediatric surgeon in a polyclinic in Karelia, who received 9,553.47 rubles net of taxes after working 145 hours, or a general practitioner from Crimea with an after-tax salary of 10,418.35 rubles for 156 hours worked?
"Road map"
In December 2012, by order of the Government Russian Federation authorities executive power regions, it was recommended to develop an action plan for changes in industries social sphere aimed at improving the efficiency of healthcare - the "Roadmap". The measures envisaged by the Roadmap are aimed at developing a mechanism for the level of payment for medical workers based on the quantity and quality of free medical services provided to the population. The government believes that decent remuneration of employees of medical institutions is effective tool personnel management in order to improve the quality of services provided to the population.
The Roadmap is a double-edged sword. The provisions set out in this document are aimed at improving the financial situation of medical staff. On the other hand, an increase in wages should increase the efficiency of the healthcare system as a whole. The Roadmap assumes a change in the procedure for providing medical care and development of new professional standards.
By 2019, it is planned to change the payment of doctors up to 200%, middle and junior medical staff - up to 100% relative to the state of salaries in 2012. In addition to the item on financing healthcare facilities, including the payroll fund, the Road Map has items that plan the regulation of mortality, tuberculosis incidence and other indicators of the quality of the healthcare system.
Double-entry bookkeeping
- income of paramedical personnel - 28,000 rubles per month;
- junior - 19,000 rubles.
These data take into account the total income, and it turns out that nominally the requirements of the Roadmap are met. But in reality, often doctors and nurses work at several rates - this is the only way they can get enough money to live on.
For those who are interested in the actual level of salaries, on the “Real Salary of a Medical Worker” project, you can not only see how much, for example, an ophthalmologist from Penza or a driver from Yakutia earns per month, but also leave data on your own salary. The project was created to demonstrate the true picture that is emerging as part of the implementation of the Roadmap and to combat inaccurate reports from hospital managers.
Chained by one chain
Doctors and patients are in the same boat. To cover the increasing costs of wages, medical accounting is forced to write off the same payment for medical services from compulsory medical insurance funds twice. The official data of Rosstat are very different from the data of real surveys of physicians. Nowhere in the country is there a real increase in wages in accordance with the data described in the action plan drawn up after the “May decrees”.
In addition to using aggregate data for reporting, an increase in the salary of doctors will be obtained by reducing the number of beds in hospitals and reducing the staff of hospitals and clinics. These activities are most often carried out spontaneously, without preparation, for example, without strengthening the outpatient system for treating patients. This immediately results in an increase in the number of medical errors due to the additional burden on doctors and nurses.
Queues in polyclinics are increasing, some patients are forced to turn to paid medical services in order not to waste time in queues. But, unfortunately, not everyone has the opportunity to be treated for money: patients refuse treatment or try to save themselves with “folk remedies”. Instead of a decrease in mortality, which, according to officials, is a natural result of the plan to reform the healthcare system, statistics indicate that 27,000 more people died in the first half of 2019 than during the same time in 2018.
Reductions in staff and other measures to optimize costs are a measure that the head physicians of hospitals and polyclinics are forced to resort to: they do not have more sources to comply with the plans of the Road Map. And without reports on the implementation of the Roadmap, the region will not receive a federal budget transfer.
Forecasts
According to the latest news, the salary of medical workers in 2019 should be increased by:
- 159.6% - relative to the level of 2012 for doctors;
- 86.3% - for paramedical personnel;
- 70.5% - for junior medical personnel.
Whether this will actually happen is still impossible to say. In October, at a meeting of the Cabinet of Ministers, it is planned to discuss the program, according to which they will discuss the transfer of the main part of the costs of increasing the salary fund of state employees for 2019-2020. Although you can’t count on a strong increase: the Government confirmed its plans to increase wages for workers public sector, but stipulated this probability with the financial capabilities of the state.
unstable economic situation in the country does not contribute to the planned increase in salaries by 8%. Most likely, there will not be a direct increase in wages according to the Road Map, but indexation to take into account inflation. So, it is not worth expecting an increase of more than 2.7%, excluding indexation, compared to last year.
Another subtle point in the issue of increasing the financing of the salary fund in budgetary organizations is that indexation is planned not from the beginning of 2019, but only from the second half of it - from October 1. This will hit the wallets of workers even more hard: the increase was originally planned for January 2019, then, as it is believed, due to the events on the annexation of Crimea, it was postponed to October 2019. Now the date cherished by many is shifted by another year.
The situation in some regions is so complicated that it is time for doctors to go on strike. So, the doctors of Transbaikalia are trying to get information from the Minister of Labor of the Territory not even about the compliance of wages with the Road Map, but whether they will receive in September the money earned in August. Disruptions in the payment of wages to state employees in the region have been dragging on since November 2019.
Officially, the country's budget provides for reserves for annual subsidies for indexing the salaries of state employees and civil servants in the amount of 100 billion rubles. Proposed by the Minister of Labor new system remuneration implies a direct dependence on the qualifications and performance of employees.
48 comments
So already in 2014, they gave out statistics on the average salary of nurses for mo 40,000 rubles. If only someone would let me hold such an amount in my hands at once ... I have 30 years of experience + the highest category + 25,000 without getting out at work, it doesn’t work anymore ....
The Chelyabinsk region is a district nurse of the highest category, I have a salary of 14,000 rubles, a district doctor is 22,000, and the nurses have a ceiling of 6,000. doctor salary 6300.
Moscow region. uch. m / s experience 3 years. for 1.5 years, salary payments decreased: from 19,000, then 17,000, for January 16 - 15,000. for February - 12,200 !!! in the salary slip - 17000?! payment for an apartment, kindergarten, circles for a child per month - 14,500. Elderly parents feed and clothe and treat ... ..
The indicator of the average salary is not objective. Those who are familiar with statistics know this. It is necessary to calculate the modal value of wages, because it calculates based on the most frequently occurring salaries. Officials take advantage of the illiteracy of the population and rub in all the inhabitants of the Russian Federation a biased indicator of the average wage. The indicator of the average salary of an organization consisting of 5 people, if four receive 100 thousand, and one 600 thousand, will be 200 thousand. As you can see, the salary of workers is half the average salary. This is what officials use in their machinations, adjusting salaries in all conceivable and inconceivable ways to the average, while not depriving themselves. I strongly recommend that you, citizens, know at least elementary methods of mathematical statistics, so that gentlemen officials do not feed you from TV screens with a serious look of their fat muzzles a biased average wage. Remember that the salary in the organization can be objectively calculated only by the modal value. Only then will it be possible to see how much the most common salary differs from the average and demand justice (or understand how much you are being deceived).
I work in a hospital in the city of railway, Moscow region, salary nurse the highest category is 9.380 rubles, with nightly, a bonus, for long service, and my experience is 33 years in one place, I get 18 thousand rubles a month in my hands. And diagnostic medicine is all paid! It’s a pity that our officials and deputies don’t have such salaries, but you can forget about the Minister of Health! it’s not paid quarterly, but paid, as a rule, at the end of the year. It’s easier for the command to steal and distribute at its discretion, this is an extra loophole for the administration to steal. We never know how much is transferred for employees. Everything is covered in darkness! And when everything will be calculated and included in the official salary, there will be no theft.
since 2016, the payment system has become different. I get 38,000 per month with all the incentives and allowances. The polyclinic made standards for a month for treatment, ambulance, medical examination. If one of them is not fulfilled, then the incentive bonus and the total failure to fulfill the plan are cut. must be adjusted each time in electronic format. In Yakutia, the Internet does not work well, it constantly freezes, we have to do it after hours. constantly come from the territory of the fund undifferentiated. where the full name or date, policy number, etc. are incorrectly filled in, and all this is removed, in total from 600 applications minus 100 people. sad job
It turns out that medicine is a nightmare everywhere! Oh, you are on top! Ministers, what do you think? Because of this situation, honey. people have ceased to respect us for workers. They look at doctors as slaves. They can insult us to come to an appointment without an appointment 5 minutes before the end of working hours and try not to accept although they came for help ... The doctor is also a man. He has a lunch break. This doctor gotta eat and go to the call
Good day to all. I work as a midwife in a maternity hospital. I want to say about the payment of consultations to our doctors. The patient pays 2,000 rubles for a consultation at the cash desk. This is an examination, an anamnesis and treatment appointment. At the end of the month, the management sends the total amount for all. We divide by the number of consultations per month and multiply for each individually. In 2015, each obstetrician received 46 rubles. Expenses during the inspection: gloves, 10 grams of oil, light, a piece of paper, 5 ml of soap and tap water. Well, how much is it? Rubles 200? And where are the remaining 1754? The road map is not clear. They pay, they don't. The feeling that before the checks they throw a piece to shut their mouths. In 2014 they paid once, in 2015 - 2 times, in 2016 - we are still waiting, they promised in May. It's August now. And special thanks to Ms. Skvortsova for dozens of closed maternity hospitals in Moscow. Will give birth at home. Mortality will rise. And we will be guilty again. It is also very interesting, now a child is considered born from 500 gr. And our Veronica proudly informs the President that the birth rate has increased. What a joy! And does anyone think by how much the number of disabled children has increased in Russia? Which are born on terms of 25-28 weeks.
It's a lie all around! I work in St. Petersburg in the nose of an organization. I'm a laboratory assistant! Laugh at my salary: 5520. Moscow pays me so much! 40 thousand about which everyone writes????
I work as a dental nurse in Kirov. I work alone with three doctors. They don’t give us nurses, we have to wash the tools for 260 rubles a month, the salary is getting smaller and smaller every month. what not to put into. We are patient Russian people!
On the basis of "there is no money in the budget," we fired all the cleaners. They replaced it with a company (is it really so more budgetary) - however, they themselves have a fluidity. 2 pediatricians themselves quit, and I think this is not the end. AT next year we are promised that we will be allowed to work only for one rate. And there will be no less work!
I live in the Yamalo-Nenets Autonomous Okrug of the mountains of Noyabrsk, the salary for the rate in 2015 with all the markups and 30 percent medical experience is 13 thousand rubles And since January 2016, the volume of work has been increased by 2 times
Black accounting works everywhere to check some numbers are actually completely different, and the Kemerovo health department pretends to know nothing, they are all smeared with the same world. My salary at the ophthalmic hospital for 1.75 rates is 21,000 rubles with the highest category, here both stimulating and KTU, all inclusive, and processing in double the amount of ch. temp. Janets does not want to pay, they get out like snakes, forcing us to write applications for about 5, then for 0.75, although the contract clearly stipulates that processing in double the amount should be paid !!!
I received 18k for December, for other months and even less. everyone lies, starting with the head physician and ending with MAKS and the FOMSI because they are stealing the budget. doctor of the highest category with 28 years of experience. Marina 1 city hospital State Budgetary Institution of Makhachkala
According to statistics:
average salary a health worker in our country today is about 45,000 rubles;
income of paramedical personnel - 28,000 rubles per month;
junior - 19,000 rubles.
yeah, at a rate of 5599. it doesn’t work out like 28,000 in Tver, honey sister. don’t compare to Moscow
Changes in the healthcare industry, developed by the regional authorities in accordance with Government Decree No. 2599-rr, adopted on December 28, 2012, are designed to increase the salaries of medical personnel and at the same time significantly improve the efficiency of workers, primarily through financial incentives.
High salaries under the "road map" in medicine is not the only priority of the adopted Presidential Decree No. 597 and Government Decree No. 2599-rr. The goals of forming an action plan are also:
- Organization of the competitive environment.
- Establishing a direct dependence of wages on the volume of services provided to the population, as well as their quality.
- Conclusion effective contracts, according to which the salary of physicians is established according to the "road map". Employee contracts should contain criteria for evaluating work, as well as indicators, the achievement of which will allow the employee to receive incentive payments.
- Careful study and adoption of regional health programs that make changes to the existing system.
How will it affect wages and for whom?
Having answered the question, "road map" - what is it in salary, you should decide how the work of medical staff will be paid when implementing the developed action plan. During the implementation of the program, the salary according to the "road map" in healthcare should increase by 2 times for employees belonging to the category of middle and junior staff, and in 3 - from qualified doctors.
However, not all medical workers can qualify for wage increases through the appointment of incentive payments. The salary under the "road map" in healthcare will not increase:
- at the heads of medical institutions dealing exclusively with administrative work. The exception is employees who combine medical practice and a managerial position;
- for medical staff whose activities fall under the federal program "Health":
- doctors involved in childbirth, as well as caring for newborn babies;
- family doctors;
- district pediatricians and therapists, as well as junior medical staff working with them;
- doctors providing high-tech services.
The roadmap for the salaries of medical workers does not apply to persons who do not have a document on obtaining a specialized education. An obstacle to getting additional funds is the lack of health insurance for the employee.
What to do if wages are not increased
Even for medical workers who do not fall into categories that are not covered by Presidential Decree No. 597, and who know the “road map” - what it is in medicine, the salary does not always increase. The fact is that remuneration is increased mainly due to incentive payments, which are appointed by a special commission when assessing the following employee performance indicators:
- the number of diseases found in patients;
- the presence of complaints and positive feedback - the degree of satisfaction of patients served by the doctor;
- the desire of a specialist to constantly improve their skills, to study the latest methods of work, professional achievements;
- the presence of complications and untimely hospitalizations;
- accuracy when working with reports and other documentation.
If the employee’s salary has not changed after the work quality check, first of all, you need to familiarize yourself with the act peer review and find out the number of points accrued to the employee, on the basis of which the bonus to the monthly wage is formed. Next, you should refer to the regulatory documents of the healthcare institution that regulate the calculation process additional payments. If an employee is constantly and, in his opinion, unjustifiably deprived of the allowance, protection should be sought from the judicial authority.
Strict control over the level of salaries of medical personnel is a distinctive feature management activities in healthcare this year.
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And it's not just that all medical organizations provide statistical reporting on wages according to the established forms in several instances. According to the press service of the Ministry of Health of the UK, this ministry and the regional CHI fund are conducting inspections of institutions.
Strengthening control over the situation with the remuneration of medical workers is primarily due to the need to bring the salary of physicians to the level determined by decrees of the President of the Russian Federation by 2018. Namely: the salary of doctors and specialists with a higher non-medical education should be 72,032 rubles, of middle and junior medical personnel - 36,016 rubles. In other words, in comparison with 2012, the salary of doctors will increase three times, the average staff - 2.6 times.
It is important to note that the salaries of medical workers have also increased in previous years - within the framework of the national project "Health" and the modernization program, which can be called the first stages of the industry's renewal. In fact, since 2006, a kind of "resuscitation measures" have been carried out in healthcare at the expense of federal and regional funds. And it allowed to increase wages. In 2012, for example, the average salary of doctors was 23,698 rubles against 17,867 rubles in 2010, and for nurses, respectively, 13,751 rubles against 9,927 rubles. And for the industry, on average - 14,606 rubles against 11,643.
At the same time, the funds received earlier under the national project and the modernization program to provide additional incentive payments remained in the industry. They are included in the general payroll and in the structure of the tariff for medical services and since 2013 are distributed to all employees. That is why medical institutions need to pay not just wages, but wages, depending on the volume and quality of medical care provided. And it is no coincidence that this year, appropriate changes were made to the approximate regulation on the remuneration of employees of healthcare institutions.
Due to the fact that since 2013 a direct dependence of wages on the quantity and quality of work performed has been established, specialists from the Ministry of Health of the Territory and the Regional CHI Fund are making considerable efforts to provide methodological and practical assistance in this direction. Moreover, the government of the region approved the Program for the gradual improvement of wage systems for employees of state and municipal institutions for 2013-2018, and the Ministry of Health of the Territory developed an action plan ("road map") "Changes in social sectors aimed at improving the efficiency of healthcare in the Stavropol Territory for 2013-2018". The Road Map has been approved by the Ministry of Health of the Russian Federation and approved by the regional government.
It should be noted that the "road map" defines the priorities of structural reforms in the system of providing medical care to the population of Stavropol for 2013-2018 and a gradual increase in the wages of employees in the framework of decrees of the President of Russia dated May 7, 2012. Moreover, each institution has also developed and approved its own "road map", its own action plan for all structural reforms and increasing the wages of employees. "Road maps" of health care institutions have been agreed with the ministry. And this means that the heads of institutions have assumed obligations to carry out structural reforms and, accordingly, to increase the wages of target categories of workers. After all, the Decree of the President of the Russian Federation stipulates that at least 1/3 of own funds from the reduction of inefficient expenses should be attracted to raise wages.
As for the priorities identified by the road map, this includes the development of new forms of medical care, and the creation of units in existing institutions emergency care, and much more. The initiative for the implementation of the "road map" has already been made: since April 1, 2013, the salaries of medical workers have been increased by 24 percent. According to statistics for the four months of 2013, the average wage in the industry was 15,710 rubles, 7.6 percent higher than in 2012. The salary of doctors was 24,986 rubles, and that of nurses was 14,721 rubles.
And these are industry averages. And there are institutions where the salary of doctors is much higher. For example, in the Apanasenkovskaya Central District Hospital, the average salary of doctors for four months of the current year was 31,534 rubles, while for four months of 2012 it was 26,185 rubles. In the city polyclinic No. 2 of Nevinnomyssk, the same figures are 27,796 rubles against 23,982; at the Stavropol ambulance station, 26,260 rubles against 19,010 rubles. This once again confirms that a lot depends on the health workers themselves - and how much they earn, and how the earned funds are distributed in institutions. Including in terms of control by doctors and paramedical staff. After all, they know better who and how provides medical care, how much they receive. A kind of "people's control", which in Soviet times had considerable power. A plus teamwork Ministry of Health of the Territory, heads and personnel of medical organizations.