Compensation payments to doctors. Guarantees and compensations to medical workers for work in harmful and dangerous conditions. Why incentive payments to health workers can be canceled

Document's name:
Document Number:	204/13
Type of document:
Host body:
Status:	current
Published:
Acceptance date:	03 April 2018
Effective start date:	April 20, 2018
Revision date:	March 25, 2020

On the approval of the Procedure for the provision of lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities ...

GOVERNMENT OF THE MOSCOW REGION

RESOLUTION

On approval of the procedure for granting one-time compensation payments medical workers(doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

Document as amended by:
(Official website of the Government of the Moscow Region www.mosreg.ru, 06/26/2019);
(Official website of the Government of the Moscow Region www.mosreg.ru, 03/25/2020).
____________________________________________________________________

______________
* Name as amended, put into effect on July 7, 2019 by Decree of the Government of the Moscow Region of June 25, 2019 N 375/19 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7 ..

In accordance with Appendix No. 8 "Rules for the provision and distribution of subsidies from the federal budget to the budgets of subjects Russian Federation for one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people "to the state program of the Russian Federation" Health Development " , approved by Decree of the Government of the Russian Federation of December 26, 2017 N 1640 "On approval of the state program of the Russian Federation" Health Development ", Government of the Moscow Region
(Preamble as amended, entered into force on July 7, 2019 by Decree of the Government of the Moscow Region of June 25, 2019 N 375/19; as amended by Decree of the Government of the Moscow Region of March 25, 2020 N 140 / 7.

decides:

1. Approve the attached Procedure for the provision of one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people.

2. Establish an expenditure obligation for the Moscow Region related to the implementation of measures to financially secure lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population up to 50 thousand people.
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

3. Determine the Ministry of Health of the Moscow Region as the authorized central executive body of state power of the Moscow Region to provide lump-sum compensation payments to medical workers.

4. Financial provision of one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people, is carried out on the terms of co-financing at the expense of funds of the subsidy provided within the limits of budget appropriations, provided by law Moscow region for the next fiscal year and planning period.
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

5. The Main Directorate for Information Policy of the Moscow Region shall ensure the official publication of this resolution in the newspaper "Daily News. Podmoskovye", "Information Bulletin of the Government of the Moscow Region", placement (publication) on the website of the Government of the Moscow Region in the Internet portal of the Government of the Moscow Region and on " Official Internet portal legal information(www.pravo.gov.ru).

6. To impose control over the execution of this resolution on the First Vice-Governor of the Moscow Region Gabdrakhmanov I.N.
(Paragraph as amended, put into effect on July 7, 2019 by Decree of the Government of the Moscow Region of June 25, 2019 N 375/19.

Governor

Moscow region

A.Yu.Vorobiev

The procedure for providing lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to ...

APPROVED

Government Decree

Moscow region

April 3, 2018 N 204/13
(As amended by
from July 7, 2019 by resolution
Government of the Moscow Region
dated June 25, 2019 N 375/19. -
See previous edition)

The procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

______________
* Name as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7 ..

1. This Procedure regulates the provision of lump-sum compensation payments to medical workers (doctors, paramedics) who are citizens of the Russian Federation who do not have unfulfilled obligations under a targeted training agreement (with the exception of medical organizations with a staffing level of less than 60 percent), who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people and concluded labor contract with a medical organization subordinate to the Ministry of Health of the Moscow Region, on a full-time basis with the duration of working hours established in accordance with Article 350 of the Labor Code of the Russian Federation, with the performance of a labor function in positions included in the list vacancies medical workers in medical organizations and their structural divisions, upon replacement of which one-time compensation payments are made for the next financial year (hereinafter, respectively - a one-time compensation payment, medical workers), as well as medical workers who have fulfilled their obligations related to targeted training (targeted training), provided that they continue to work in the same medical an organization located in a rural settlement, or a working settlement, or an urban-type settlement, or a city with a population of up to 50 thousand people.
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

2. The amount of the one-time compensation payment is 1 million rubles. for doctors and 0.5 million rubles. for paramedics.

3. A one-time compensation payment is provided to a medical worker once.

4. The Ministry of Health of the Moscow Region (hereinafter - the Ministry) has the right to make a decision to provide a medical worker with a one-time compensation payment if he has obligations related to targeted training (targeted training), subject to the conclusion of an employment contract with a medical organization subordinate to the Ministry (hereinafter - medical organization), the staffing of which is less than 60 percent.

5. The Ministry annually, before November 1 of the year preceding the next financial year, approves the List of vacant positions of medical workers in medical organizations and their structural subdivisions, upon replacement of which one-time compensation payments are made for the next financial year (hereinafter - the program register of positions).

6. A one-time compensation payment is provided on the basis of an agreement on the provision of a one-time compensation payment (hereinafter referred to as the agreement) concluded between a medical worker, a medical organization and the Ministry.

7. The form of the contract is approved by the Ministry.

8. Copies of the following documents are attached to the contract:

passports of a citizen of the Russian Federation;

insurance certificate of state pension insurance;

certificates of registration of an individual with a tax authority;

completion document educational institution higher education (doctors) or professional educational organization(paramedics);
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

a document confirming the completion of an internship or residency (for doctors of specialties, training for which in an internship or residency is mandatory for working in accordance with the Order of the Ministry of Health of the Russian Federation dated October 08, 2015 N 707n "On approval of the Qualification requirements for medical and pharmaceutical workers with higher education in the direction of preparation "Health care and medical sciences");
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

document on professional retraining (if available);

certificate of a specialist (or certificate of accreditation of a specialist);

certificates of recognition of foreign education and (or) foreign qualifications;

specialist certificate issued Federal Service on supervision in the field of healthcare of Roszdravnadzor, or its territorial bodies (for persons who have received medical training in universities of foreign states who are citizens of the Russian Federation);

employment contract;

a work book or information about labor activity received in a multifunctional center for the provision of state and municipal services on paper;
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

order of appointment;

a document from a credit institution containing the name of the bank, BIC of the bank, TIN of the bank, KPP of the bank, personal account of the medical worker;

licenses to carry out medical activities by a health care institution.

9. The contract is concluded on the basis of an appeal from a medical worker to the head of a medical organization, received after the conclusion of an employment contract providing for work in a position included in the program register of positions, and the end probationary period if such a period is set for a medical worker upon employment.

10. The contract signed by the medical worker and the head of the medical organization is sent by the medical organization to the Ministry.

11. The Ministry, within a period of not more than 30 working days from the date of receipt of the agreement on the provision of a lump-sum compensation payment, signed by the medical worker and the head of the medical organization, signs the said agreement and sends two copies of the agreement on the provision of a lump-sum compensation payment to the medical organization.

12. If there are grounds for refusing to conclude an agreement, provided for in paragraph 13 of this Procedure, the Ministry, within the period specified in paragraph 11 of this Procedure, sends a reasoned refusal to conclude an agreement on the provision of a lump-sum compensation payment to a medical worker.

13. The grounds for refusal to conclude an agreement are:

non-compliance of the medical worker who signed the contract with the requirements provided for in paragraph 1 of this Procedure;

sending to the Ministry of an agreement that does not correspond to the form of the agreement approved by the Ministry;

the absence of copies of the documents provided for in paragraph 8 of this Procedure.

14. If the reasons that served as grounds for refusing to conclude an agreement are eliminated, the medical worker has the right to re-apply for a lump-sum compensation payment in accordance with paragraphs 9 and 10 of this Procedure.

15. Ministry:

maintains records of concluded and executed contracts;

transfers the lump-sum compensation payment to the account of the recipient of the lump-sum compensation payment.

16. A medical worker who has concluded an agreement with a medical organization and the Ministry assumes the obligation to:

1) perform labor obligations within 5 years from the date of conclusion of the contract for positions in accordance with the employment contract, subject to the extension of the contract for the period of non-fulfillment of the labor function in full (except for the rest time provided for and 107 of the Labor Code of the Russian Federation);

2) to return to the budget of the Moscow Region a part of the one-time compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract until the expiration of the 5-year period (except in cases of termination of the employment contract on the grounds provided for in paragraph 8 of part one of Article 77 and paragraphs 5-7 of part the first article 83 of the Labor Code of the Russian Federation), as well as in the case of transfer to another position or admission to training in additional professional programs;

3) return to the budget of the Moscow Region a part of the one-time compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract, in case of dismissal due to conscription for military service (in accordance with paragraph 1 of part one of Article 83 of the Labor Code of the Russian Federation) or extend the term the duration of the contract for the period of non-performance functional duties(at the choice of a medical worker).

Revision of the document, taking into account
changes and additions prepared
JSC "Kodeks"

On approval of the procedure for providing lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or work settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)

Document's name:	On approval of the procedure for providing lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or work settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)
Document Number:	204/13
Type of document:	Decree of the Government of the Moscow Region
Host body:	Government of the Moscow Region
Status:	current
Published:	Official website of the Government of the Moscow Region www.mosreg.ru, 04/09/2018
Acceptance date:	03 April 2018
Effective start date:	April 20, 2018
Revision date:	March 25, 2020

In recent years, the salaries of doctors and the entire system of remuneration of medical workers have changed significantly, which can be associated with the need to motivate employees to provide quality medical care. In turn, the level of salaries of healthcare workers should fully depend on how high-quality medical services they provide to the population.
Government Decree No. 2190-r dated November 26, 2012 provides for a phased change in the payroll system in public sector, which implies the improvement of the main components of wages - salary, tariff (hourly) rate, as well as additional incentive and compensation payments.

At the same time, the level of salaries of healthcare workers should fully depend on how high-quality medical services they provide to the population.

Salaries of doctors and medical workers in 2016*

According to Rosstat, for the first half of 2016, the average salary of doctors and medical workers amounted to 48,946 rubles.

Most high salaries doctors are predictably recorded in the Nenets, Chukotsky, Yamalo-Nenets, Khanty-Mansiysk - Yugra, autonomous regions; Kamchatka Territory; Magadan, Sakhalin, Tyumen regions; Moscow and the Republic of Sakha (Yakutia).

The lowest salaries of medical workers and doctors: Oryol region, Republic of Mari El, Ulyanovsk region, Republic of Ingushetia, Republic of Adygea, Republic of Dagestan, Kabardino-Balkarian Republic, Karachay-Cherkess Republic, Republic of North Ossetia-Alania, Republic of Kalmykia.

See the full tables of doctors' salaries in 2016 in Russia below.

Partial wages for medical workers

The salary of a doctor can be formed according to the principle of piecework wages, taking into account some features. In particular, it is necessary to take into account the recommendations of the Ministry of Health of the Russian Federation, as well as the Russian Tripartite Commission (RTC). Generally speaking, the current legislation contains provisions that allow organizations to establish piecework wages, while there are no exceptions for employees of medical institutions. When piecework wages for medical workers, the established price for the work performed is taken into account, while the tariff rate is set for the completed labor norm, and does not include incentive or compensation payments. The fact that these concepts are not equivalent follows from the conclusions of the courts on the basis of the consideration of civil cases. In addition, the order of the Ministry of Health of the Russian Federation No. 377, which contained a direct indication of the possibility of using piece rates to establish the salaries of medical workers, also became invalid. To date, the Ministry of Health of the Russian Federation adheres to the position that the salary of doctors should include: salary, incentive payments, compensatory payments and the tariff rate. However, if in the hospital there is still a need to establish a piecework form of remuneration for individual employees, then it is necessary to provide for such a form in the local act of the institution - in collective agreement or other local act. This will not be a violation of current labor laws.

Brigade forms of remuneration

Some hospitals are considering setting up facility-wide pay arrangements, ie where the salary of a particular doctor or other healthcare worker is dependent on the overall performance of a unit, department, or field team.

Today, the system of remuneration of medical workers in ordinary city and district hospitals provides for the calculation of the amount of incentive payments, depending on the specific collective results of the work of hospital employees.

The formula for calculating the optimal average daily load on the ambulance team:

According to the author's method V.M. Shipova and A.N. Plutnitsky, the optimal load on the ambulance team has not been determined, since the flow of calls is random and the frequency of calls is not regulated. But it is possible to calculate the optimal load on the ambulance team. Based on the planned and normative data on providing the population with ambulances and the number of calls, we derive the formula:

318 X 10: 365 = 8.7, where
318 - number of calls per 1000 population;
10.0 thousand - the number of the population;
365 - calendar days of the year;
The indicator 8.7 (9.0) calls is the average daily load on the ambulance team.

The remuneration system in such institutions is fixed in local acts (agreements, collective agreements, regulations, etc.), while taking into account:

approved classifiers of professions, positions;
developed medical professional standards;
opinions of trade unions of medical workers;
professional communities of employers;
the volume of state guarantees in the field of wages;
position of the Russian tripartite commission;
position of the Ministry of Health of the Russian Federation.

Thus, the joint recommendations of the Ministry of Health of the Russian Federation and the RTK do not provide for the use of a brigade form of remuneration. Previously, the use of the form of brigade wages for medical workers was provided for in the order of the USSR Ministry of Health No. 1180 dated November 10, 1986, but from 2009 it lost its legal force. However, the current legislation does not prohibit taking into account the results of the work of the team to calculate incentive payments to a particular medical worker. Also, the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012 states that specific incentives should be established for medical workers for achieving collective work results.

The ratio of parts of the salary

The Ministry of Health of the Russian Federation has set the maximum level of the ratio of the average salary of the chief doctors of hospitals and medical workers in the system of healthcare institutions. Thus, in accordance with Order No. 170 dated March 28, 2013, the level of the marginal salary of the head doctor of a hospital is a multiple of 8 salaries of employees of hospitals under the jurisdiction of the Ministry of Health of the Russian Federation. The regulation on the remuneration of employees of the Medical Organization was developed in accordance with the requirements of the Labor Code of the Russian Federation and other regulatory legal acts containing labor law norms.

Salary of medical workers

This section covers all legal features establishing salaries for medical workers, including the rules for applying professional qualification groups, accounting for seniority and the possibility of setting an individual salary for a medical worker.

Setting a personal salary

The salary is a certain amount of remuneration for the work of a health worker, which is established for him for the performance of his professional duties stipulated by a specific position. Salary does not include other additional payments. We believe that the establishment of health workers of state and municipal hospitals personal salaries labor law not expressly prohibited, although it is not recommended by other standards for the following reasons. In accordance with Art. 22 of the Labor Code of the Russian Federation, a medical institution, as an employer, must provide its employees with the same pay for performing similar work. At the same time, the establishment of different salaries for the same positions is not prohibited, but it seems unjustified. The RTC adopted unified recommendations on the establishment of remuneration for employees of institutions of the state and municipal system dated December 25, 2015, in which it is not recommended to establish different rates and salaries for employees who are included in the same qualification group. It is also not recommended to indicate the range of official salaries for health workers who are engaged in work of the same complexity. However, as it shows law enforcement practice, nevertheless, the decision to establish an individual salary is not recognized as labor discrimination in the event that employees occupy the same position, but perform different amounts of work of varying complexity.

How to take into account experience

By general rule the length of service of a medical worker does not affect the size of the official salary established for him in any way. As we have already said, the official salary is a fixed monthly payment of an employee who has fulfilled his labor duties in the proper amount. Since the remuneration of medical workers consists not only of the official salary, their continuous medical experience should be reflected in other payments, for example, in compensation payments. Such recommendations are established by order of the Ministry of Health and Social Development of the Russian Federation No. 818 dated December 29, 2007.

Application of occupational skill groups

Professional qualification groups (PCGs) can be used when establishing base rates and salaries by the Government of the Russian Federation, the salary of medical workers in state and municipal hospitals cannot be lower than the salaries established by the PCG. According to the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, the interested executive bodies, together with the Ministry of Labor of the Russian Federation, can develop and submit their specific proposals for the official salaries of the PCG employees. The basis for the formation of the PCG are certain requirements for the level of qualification of employees, which they need to carry out a specific professional activity, because in accordance with labor legislation, the salary of a doctor, like any other employee, depends on his qualifications. Therefore, before the establishment of basic salaries for specific positions by the Government of the Russian Federation, in healthcare institutions, PCGs can be used in the development of systems for remuneration of medical workers. This is also confirmed by the provisions of Decree of the Government of the Russian Federation No. 583 of 08/05/2008, which states that the salaries of employees are set by the management of the institution based on the requirements for qualifications and work experience in a particular position (PCG). This takes into account the volume of work performed by employees and its complexity.

The ratio of the salaries of managers and health workers

The official salaries of medical workers in no way affect the salary of the head doctor of the hospital and the salaries of his deputies. As stated in Art. 145 of the Labor Code of the Russian Federation, remuneration for the heads of state and municipal institutions is established in accordance with labor legislation, constituent documents of an official, regional and municipal acts. The specific terms of remuneration of senior officials are reflected in their employment contracts. At the same time, a number of normative acts adopted recommendations on setting the level of remuneration of heads of institutions: recommendations for 2016, approved by the RTC dated 12/25/2015, federal institutions- Decree of the Government of the Russian Federation No. 583 of 05.08.2008. In these documents, it is recommended to establish a salary for the heads of the institution, a multiple of 8 average salaries of all employees of the institution; The decision of the RTC dated December 25, 2015 also recommended that salaries for chief accountants and deputy chief physicians be set at the level of 70-90% of the salaries of hospital managers.

Salary: establishment control

Which authorities can check the correctness of the choice of official salary for employees of a medical institution:

labor inspection during inspections within the framework of state supervision over compliance by a medical institution with the labor legislation of the Russian Federation. In addition, the State Labor Inspectorate conducts inspections of the implementation of the program for improving the wage system in state and municipal institutions, which was approved by Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012;
Ministry of Health of the Russian Federation, as an agency that exercises the powers of the founder in relation to subordinate medical institutions; territorial MHI funds, which check the size of salaries as part of the audit of labor costs, which are included in the structure of the tariff for medical care in the MHI system;
other state bodies authorized to conduct audits of the financial and economic activity hospitals.
The reporting form on the wages of employees of medical organizations in the field of compulsory medical insurance was approved by Order of the Federal Compulsory Medical Insurance Fund dated March 26, 2013 No. 65.

Calculation of the amount of funds allocated for the remuneration of employees of the cabinet (office) of general medical practice (family doctor)

1. Headcount

2. Number of attached population, pers.

3. Per capita financing standard, rub.

4. Amount of financing, rub.

5. Report on the expenditure of funds

Chief Physician

Chief Accountant

Compensation payments to medical workers

Indication of compensation payments in the employment contract

Is it possible to prescribe in the employment contract of a health worker that the amount of his compensation payments is established by the legislation of the Russian Federation? If the legislator has established minimum dimensions compensation payments for health workers, the employer must indicate in the employment contract of the employee in a specific amount or as a percentage of the official salary. Compensatory payments to medical workers can be provided for various reasons: for medical experience, for irregular working hours, for work in rural areas, for the presence of a professional category, etc. Labor legislation, as a rule, establishes only the minimum amount of such payments. The employer must establish the specific amounts of compensatory allowances for medical workers by prescribing such sections in the regulation on the remuneration of the hospital. Additional guarantees for employees who work in conditions that deviate from normal must be specified in the employee's employment contract, in accordance with Art. 57 of the Labor Code of the Russian Federation. In addition, the recommendations approved by the order of the Ministry of Health of the Russian Federation No. 167-n dated April 26, 2013, indicate that specific factors and conditions for receiving all compensation payments should be prescribed in the salary regulation, as well as in the employee’s employment contract.

Reducing the amount of compensation payments based on the results of the SOUT

Let us consider the conditions under which the compensation payments provided to him can be reduced in connection with the special assessment of working conditions (SAUT). The amount of compensation for a health worker may change with the improvement of his working conditions, which is confirmed by the conclusion of a specialist in the SATS carried out in a hospital (Article 74 of the Labor Code of the Russian Federation); As you know, guarantees and compensations for health workers who are employed in working conditions that deviate from normal are provided in accordance with the provisions of labor legislation, the collective agreement of the hospital, the employee's employment contract, etc.

However, the employer must cancel the previously provided guarantees if the employee's workplace provides safe working conditions, which is confirmed by the conclusion of the state examination or SUT. In connection with the adoption of the new law No. 426 "On SOUT", there is a transitional period to the new system of job evaluation. So, if the hospital carried out certification of workplaces before 07/13/2015, then it will continue to be valid for 5 years. SOUT during this period is not necessary. The medical institution has the right, but is not obliged, to initiate the conduct of the SOUT before the expiration of the certification results.

If the preservation of the working conditions that gave the employer the right to establish compensation payments to its employees is confirmed, then the amount of these additional guarantees cannot be changed in comparison with those payments. which were valid at the beginning of 2014. In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 15, 2014 regarding the application of the new rules of the SOUT, the improvement of working conditions is the reduction of the final class or subclass of working conditions at a particular place of work of an employee. So, if the working conditions of the health worker have improved, which was confirmed in the conclusion of the SOUT, the hospital management may review the amount of compensation that is provided to the employee in harmful working conditions. At the same time, it is necessary to remember the rules for changing the terms of the employment contract between the hospital and the employee, which are detailed in Art. 74 of the Labor Code of the Russian Federation.

Replacing additional leave for harmfulness with monetary compensation

Many employees have a desire to replace part of the annual leave monetary compensation. Is it possible, from the point of view of the law, to replace the leave provided to an employee for working in harmful working conditions with monetary compensation?

Replacing vacation with compensation is possible, but it is important to observe a number of conditions:

it is possible to compensate only a part of the leave “for harmfulness” (2, 3, 4 degrees);
all employees of the Labor Code of the Russian Federation are guaranteed a minimum of 7 calendar days for work in harmful and dangerous working conditions;
if the collective agreement of the medical institution or industry acts guarantee such employees more than 7 days of additional leave, then at the request of the employee, the part exceeding the guaranteed one can be replaced by monetary compensation;
the possibility of replacing parts of vacation days with the provision of monetary compensation should be expressly stipulated in the local acts of the hospital or industry agreement;
the employee must express his desire to replace the additional vacation with money, his consent is drawn up additional agreement to an employment contract.

Accounting for compensation payments when on duty at home

The remuneration of medical workers consists of salaries, compensation and incentive payments. Taking into account all these payments, payment for the doctor's duty at home is also carried out.

Home duty refers to the stay of a hospital doctor at home waiting for a call to a medical facility or to a patient for urgent or emergency medical care. In relation to such employees, a special regime of work and accounting of working hours is usually established.

In accordance with the order of the Ministry of Health of the Russian Federation No. 148-n dated April 2, 2014, the time during which the health worker was on duty at home is working, and it is taken into account in the total accounting of working time.

At the same time, the legislation does not establish specific rules for calculating doctor's salary who was on duty at home. This means that all payments to the employee are taken into account in general order, including compensation payments, regardless of whether the doctor was on duty at home or not.

Compensation payments: control of establishment

The following government agencies and officials can check the correctness of the establishment of compensation payments to medical workers:

territorial bodies of the labor and employment service, in the course of the state examination of working conditions. It is during such an audit that the inspectors assess the correctness of providing medical workers with the necessary amount of compensation for working with harmful or dangerous working conditions;

state labor inspectorate, which evaluates the safety of working conditions, checks the provision and security labor rights health workers during special checks;

labor protection specialists and inspectors of trade union bodies of medical workers who carry out an independent examination of the working conditions and safety of employees at the workplace;

territorial bodies of compulsory medical insurance, during inspections, the purpose of which is to verify the cost of wages, which is part of the tariff for paying for medical care.

Stimulus payments to medical workers

Using the scoring

Medical institutions of the municipal or state health care system are not required to use a point assessment of labor activity to evaluate the performance of their employees. Incentive payment to medical workers must be established in local acts of the hospital, in a collective agreement, industry agreement or other regulations that contain labor standards.

By order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013, methodological recommendations were approved, which state that there are different mechanisms for distributing the incentive fund between employees of a particular institution. Including the introduction of a scoring system, bonuses is acceptable. This means that a particular medical institution can develop and implement its own mechanisms for accruing incentive payments to medical workers, including the right to introduce a points system for distributing payments. To do this, it is necessary to develop appropriate criteria and indicators.

PNP "Health" payments

Payments to medical workers within the framework of the national project "Health" are established in the regions in accordance with tariff agreements and the terms of the territorial program. Recall that one of the objectives of the program is the financial incentives for medical workers. Should the management of a medical institution keep payments to district doctors and paramedical staff that were previously provided to them under this program? Labor legislation in Art. 135 of the Labor Code of the Russian Federation identifies sources in which additional incentive payments to employees can be established, including the conditions for paying bonuses.

In accordance with the program of state guarantees for 2016, which was approved by Decree of the Government of the Russian Federation No. 1382 dated December 19, 2015, the structure of the tariff provided for paying for the assistance provided to the population in the compulsory medical insurance system includes incentive payments for district doctors, nurses, employees of feldsher and obstetric points, ambulance workers, etc.

In tariff agreements between the regional authority executive power, the territorial fund for compulsory medical insurance, trade unions of health workers, as well as medical non-profit organizations, specific tariffs are set for payment of medical care provided by hospitals.

To date, when setting these tariffs, the commission authorized by the participants takes into account the amount of incentive payments to health workers, which were previously established by the national program "Health".

In this regard, we believe that a medical institution should provide that all such payments should be made in the amount that is already included in the tariff for the provision of medical care under the territorial compulsory medical insurance program approved at the regional level.

Conditions under which incentive payments are not made

The medical institution must initially prescribe in the regulatory documentation special conditions, upon the occurrence of which incentive payments to specific health workers will not be made. The current system of remuneration of medical workers is established in the collective agreement of the hospital, in the regulation on remuneration, as well as in the employment contracts of specific employees. From the legal essence of incentive payments, it follows that their accrual to specific medical workers is not an obligation of a medical institution - it is its right. At the same time, in the order of the Government of the Russian Federation No. 2190-r dated November 26, 2012, it is directly stated that the remuneration system, as well as the conditions for receiving certain payments and remunerations, should not be interpreted by the parties ambiguously, they should be equally understandable as a health worker as well as the employer.

if during the inspections the fact of providing medical services to citizens for a fee is revealed, while the program of state guarantees provides for the provision of such services free of charge;
overlay disciplinary action to a medical worker.

At the same time, the remuneration system of a particular medical institution may provide for other conditions for depriving a medical worker of incentive payments in a particular period.

Reimbursement of medical workers

The issue of applying to medical workers such a sanction as deprecation of bonuses is controversial. It should be noted that according to departmental recommendations, as well as the provisions of the Labor Code of the Russian Federation, in medical institutions it is recommended to provide conditions for the use of incentive bonuses, but not conditions for depriving the employee of the bonus due. In accordance with Government Decree No. 2190-r, measures to improve the system of incentive payments to medical workers are carried out in order to correlate the salary of doctors with the specific results of their work. First of all, the quality of the medical services provided is taken into account, based on what certain incentive payments are applied. The bonus itself is one of the types of incentive payments for medical workers, therefore, the medical institution must establish specific conditions for receiving it. A specific list of disciplinary punishments is contained in Art. 192 of the Labor Code of the Russian Federation, however, such a measure as deprivation of bonuses (deprivation of bonuses) is not contained in the current version of the code. This is also said arbitrage practice. The courts unequivocally interpret the application of bonus deductions in relation to any employee of the employer as an unreasonable and unenforceable sanction, which is recognized as illegal by the current legislation. In this regard, we recommend that the chief physicians of hospitals avoid the application of such sanctions in relation to medical workers; the local acts of the hospital, all the more, should not contain any conditions for depriving them of bonuses.

Labor standards for incentive payments

When establishing incentive payments to health workers, certain labor standards are used, however, not all of them should be used as criteria for additional payments. In particular, labor standards are inapplicable, which are not directly provided for the purpose of assigning incentive payments and in no way reflect the results of the professional activity of a medical worker and the quality of the medical services provided to him. This is due to the provisions of the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, which states that all incentive bonuses for employees depend on the quality of their work and the achievements professional results, and specific indicators and criteria for their activities should be reflected in the employee's labor contract based on the developed remuneration system. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, the specific labor standards of the institution are established by the labor rationing system in the organization. At the same time, different norms and standards can be established in a medical institution: by the number of personnel, by time, by volume, output, etc.

It is inappropriate to use the following norms to determine incentive payments:

1. The norm of the number of health workers. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, this norm is needed, first of all, to determine the number of employees of certain positions that are necessary to perform a certain amount of work or production and other functions. For example, such a norm can be expressed in one medical position per site in accordance with the number of attached population.

2. Standards of time. In accordance with the order of the Ministry of Labor No. 504, they express the specific time spent by a health worker that is necessary for him to provide one service (performance of work). This indicator is primarily used to calculate the norms of the number of employees.

Service standards, in accordance with the order of the Ministry of Labor of the Russian Federation No. 504, are indicators of the number of jobs, equipment, production areas, etc., with which an employee works during a certain unit of working time. Such an indicator can be used to assess the performance of an employee when calculating incentive payments.

An approximate list of indicators for assigning incentive payments for the intensity and effectiveness of work, as well as bonus payments for certain categories of employees, was recommended by the expert group of the information center "ICFER-Medicine".

Medical workers' payroll

In medical institutions, there are several sources of formation of the fund for the remuneration of medical staff:

cash from budgets of different levels;
funds from extrabudgetary sources (from CHI funds);
cash received from income-generating activities.

In healthcare institutions that are under the jurisdiction of the region or municipality, the wage fund is formed in accordance with the relevant regulations of the subject of the Russian Federation or municipality. In accordance with the Decree of the Government of the Russian Federation No. 2190-r of November 26, 212, a system of differentiated remuneration of personnel is currently provided, the final salary of a doctor depends on the complexity of the work performed by him, its volume, as well as the qualifications of the employee. The procedure for determining the wage fund for medical workers of a particular unit should be approved in the local acts of the medical institution, which establish the system of remuneration of the organization. At the same time, the payroll fund is calculated in different ways. So, in some hospitals, the basis is taken staffing, in others - the amount of annual funding is taken into account.

The remuneration of medical workers in any case has a basis - official salary indicated in the employment contracts. It is in relation to the amount of salary that other mandatory payments are applied - compensatory. The procedure for their accrual should be prescribed in the local acts of the hospital.

The accrual incentive payments depends on the quality and volume of work established by the hospital, as well as on other conditions described in the regulation on remuneration. It is from these components that the modern differentiated system of remuneration is formed. Thus, the final salary of a doctor directly depends on the quality, complexity and volume of his work, i.e. on the quality of medical services provided to the population.

In order to calculate the incentive part of earnings according to such a system, it is necessary to follow the following order:

determine how many points each doctor earned for reporting period;
sum up all the points earned by the employees of the department;
determine the part of the wage fund that accounts for incentive payments to employees of the department;
calculate the cost of one point;
calculate the incentive part of the employee's salary based on the cost and the amount of points earned.

Based on this, the wage fund of a medical worker is the sum of all payments due to the employee for the month worked, including incentive payments, bonuses, and other regular payments. The salary of a doctor is calculated based on the tariff lists of the hospital, as well as its approved staffing table.

*) includes doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education providing medical services (ensuring the provision of medical services) in institutions of education, science, culture, healthcare, social services.

Launched in 2011, the Healthcare Modernization Program aimed, among other things, to increase the salaries of medical workers up to 200% of the average for the respective region. For this, the concept of “stimulating payments to health workers” was introduced.

Who is entitled to incentive payments in 2020

The above program fundamentally changed the payroll system for both doctors and nurses.

However, not all health care workers have been affected by it.

Stimulants are not allowed:
Enterprise administration. Managers may be an exception to the rule if they are in the practice of medicine.
Physicians who fall under the Health program, and more specifically:
involved in providing assistance during childbirth, while caring for babies;
pediatricians, district therapists, family doctors, junior staff working with them in tandem.
Professionals providing high-tech assistance.

The payment of incentives to physicians should contribute to the revitalization of their activities, to an increase in the level of services provided to the population. More money for those who help people better!

Incentive payments are accrued only to those employees who have a certificate of the established form in the main working specialty.

Documentary base of the Program

Federal legislation generally regulates the remuneration of state employees, including medical workers.

In Art. 129 of the Labor Code of the Russian Federation indicates the following types of charges:

basic, otherwise referred to as basic;
compensation depending on the specifics of the region;
stimulating;
social.

The first, the main part is necessarily paid to everyone without exception. The second paragraph indicates accruals that depend on specific working conditions. They vary by region. Incentive payments to doctors, which are of interest to us, are calculated based on an assessment of the effectiveness of the work of doctors and nurses.

The basic legal act on which the administration of a medical institution relies is the Regulation on the establishment of wage systems for employees of federal budgetary, autonomous and state-owned institutions, approved by Decree of the Government of the Russian Federation dated 05.08.2008 No. 583 (hereinafter referred to as the Regulation).

This paper says that all parts of the income, except for stimulating medicine workers, are strictly regulated by central and regional legislative acts. But stimulants are at the mercy of the medical institution.

The administration of the enterprise is obliged to issue a document regulating incentive payments to health care workers, then familiarize the workers with its content!

Where incentive criteria are developed

On the basis of clause 6 of the above resolution of the Ministry of Health and Social Development, recommendations were developed and sent to all institutions, which are mandatory for implementation when developing internal documents. Guided by this paper, each organization approves its own Regulation on incentive payments to medical workers. In addition, relevant acts are issued at the regional level.

Ask the administration of the medical institution the content of the above document in order to understand exactly how the accruals are made.

Union control

When developing and approving recommendations for medical institutions, the Government of the Russian Federation consults with trade unions.

This format is called a tripartite commission, in which employers also take part. It meets annually, therefore, it also provides recommendations to the administrations of medical institutions once a year.

And this means that the Regulation on the stimulation of labor with money should also be approved locally only for the specified period.

It reflects the following points:

sources of financing from which incentives will be paid (a special fund is created at the enterprise);
categories of specialists subject to the Regulations;
a specific accrual scheme with a division into financing from: a means of compulsory insurance and money received from entrepreneurial activity;
criteria for the effectiveness of the work of physicians.

Accrual nuances

Order of the Ministry of Health and Social Development dated December 29, 2007 No. 818 “On approval of the list of types of incentive payments ...” contains a number of specific factors to be encouraged, namely:

duration and continuity of experience;
results of work;
achievements associated with the intensity of activity;
the quality of labor.

The first two criteria are usually understood unambiguously, they are quantitative indicators. But in order to assess the level of efficiency, quality, intensity and effectiveness, we had to create a special methodology. The Ministry of Health, by order No. 421 of June 28, 2013, proposed to regional departments a list of performance indicators that should be taken into account when addressing incentive issues described in methodological recommendations.

According to specified document, the factors characterizing the efficiency of the work of physicians are:

how many ailments in his profile the doctor revealed at an early and advanced stage;
how many misdiagnosis he made;
whether there were cases of untimely hospitalization;
how many complications were revealed after operations (other manipulations with the body);
complaints and complaints from customers;
errors and inaccuracies in the maintenance of documents;
unsanitary conditions;
other.

The commission specially created in the organization carries out an assessment of efficiency. On a monthly basis, this body issues a special expert evaluation Act, which is the basis for an order on incentives.

The above criteria must be described in the Regulation on the remuneration of the enterprise. The Ministry of Health of the region is obliged to establish in its document the minimum value of each of the listed factors.

If at the end of the year it turns out that the hospital has unused funds under the Program, they can be paid to doctors (annual bonus).

How does combination and substitution affect the amount of stimulating

Health workers often have to work for an a priori absent or temporarily comrade. This does not always lead to higher wages.

Part-time workers will be credited with incentives only if their additional duties are properly executed, that is, by an employment contract. Doctors who replace their fellow vacationers can also be paid extra. But this type of combination should be formalized by an additional agreement.

The combination of positions under the main contract is not subject to additional incentives.

Deprivation of stimulants

To whom to pay, and when to refuse, the head of the organization decides. The law does not stipulate the obligation to accrue incentives to physicians, which implies a hypothetical probability of being deprived of this part of the salary.

This requires a good reason, for example, cons on all of the above criteria (the doctor did nothing), or gross violation labor discipline.

If you are faced with a refusal to accrue any part of the salary, demand an order from the management on the basis of which the accountant acted. Look for reasons in this paper. Only after studying them is it worth making a decision to file a complaint.

Last changes

In connection with the work on the implementation of the so-called May Decrees of the President of the Russian Federation (dated 2012), in 2017 there was a serious redistribution of funding for the parts that make up the salaries of doctors. There is a decrease in incentives for physicians throughout Russia.

Reduction of the size of incentive payments occurs in two ways.

In the first case, referring to the need to comply with federal legislation, they increased the base part of the salary. At the same time, some types of incentives were cut or completely canceled.

In the second case, they reduced payments that are not regulated by state regulations. This mainly affected rewards for the quality and intensity of work.

Since the end of 2018, the procedure for calculating and the amount of insurance premiums for compulsory medical insurance of the non-working population has changed, including in terms of the increase in the cost of medical services. An increase in such indicators should also entail a corresponding increase in the remuneration of medical workers, calculated based on the number of citizens served with this type of CHI. However, only practice will show whether the remuneration of medical workers will actually change or whether this is another castling within the framework of the FFOMS budget.

In 2020, the redistribution of funds will continue in order to equalize the wages of state employees. The remuneration of medical workers should be brought in accordance with the average salary in the region as a whole.

The increase planned for junior medical staff by 4.3% in 2019, by 3.8% in 2020 and by 3.4% in 2021 actually indexes wages to inflation.

Labor activity medical personnel specific - sometimes you have to work around the clock. However, not all healthcare workers work in safe conditions (when exposure to harmful and (or) hazardous production factors is excluded or their exposure levels do not exceed established standards). Many physicians are affected by harmful and dangerous production factors. The Labor Code and other regulatory legal acts provide for a number of guarantees and benefits for employees working in such working conditions. You will learn about this by reading the article.

General rules

Each employee has the right to a workplace that meets state regulatory safety requirements, as well as complete and reliable information about working conditions and labor protection requirements at the workplace.

Article 209 of the Labor Code of the Russian Federation defines working conditions as a combination of factors of the working environment and labor process affecting the performance and health of the worker. A production factor is considered harmful, the impact of which on an employee can lead to his illness. And dangerous - the impact of which on the worker can lead to his injury. However, the conditions themselves do not become harmful or dangerous - to identify such factors, certification of workplaces is carried out according to working conditions.

Note. If, according to the results of certification or on the basis of the conclusion of the state examination, working conditions at the workplace are recognized as safe, then compensation (including annual additional paid leave) is not provided to the employee (part 4 of article 219 of the Labor Code of the Russian Federation).

Article 219 of the Labor Code of the Russian Federation establishes that each employee, in addition to the basic rights established by Art. 21 of the Labor Code of the Russian Federation, is entitled to compensation established in accordance with the Labor Code of the Russian Federation, a collective agreement, an agreement, a local regulatory act, an employment contract, if he is employed hard work, work with harmful and (or) dangerous conditions. The amount of such compensations is established by Decree of the Government of the Russian Federation of November 20, 2008 N 870 "On the establishment of reduced working hours, annual additional paid leave, increased wages for workers engaged in heavy work, work with harmful and (or) dangerous and other special working conditions" (hereinafter - Resolution N 870).

Increased or additional compensation for hard work, work with harmful and (or) dangerous conditions may be established by a collective agreement, a local regulatory act, taking into account the financial and economic situation of the employer.

On February 13, 2013, Rostrud issued an explanation on the procedure for providing guarantees and compensations to persons employed in work with harmful and (or) dangerous conditions. In particular, this department, taking into account the Decision of the Armed Forces of the Russian Federation dated January 14, 2013 N AKPI12-1570, recommended that employers use the List of industries, workshops, professions and positions with harmful conditions labor, work in which gives the right to additional leave and a shorter working day (hereinafter referred to as the List), and Instructions for its application. Therefore, in harmful and dangerous conditions, for example, work is performed:

- in infectious, fungal and tuberculosis (anti-tuberculosis) hospitals;

- in anti-leprosy institutions and departments, offices and points;

- in psychiatric (psycho-neurological), neurosurgical, drug treatment facilities, departments, wards and offices, as well as nursing homes (departments) for the mentally ill;

- in physiotherapy rooms (departments);

– in dental clinics, departments and offices;

— in pathological departments and laboratories;

- in specialized MTEC for tuberculosis and mentally ill patients;

- at the stations (departments) of emergency and emergency medical care and departments of mobile emergency and advisory medical care of regional, regional and republican hospitals;

- in sanitary facilities.

Compensation for harmful and dangerous working conditions

Decree N 870 provides that the following compensations are established for persons employed in heavy work, work with harmful and (or) dangerous and other special working conditions, based on the results of attestation of workplaces:

- reduced working hours - no more than 36 hours per week in accordance with Art. 92 of the Labor Code of the Russian Federation;

- annual additional paid leave - at least seven calendar days;

- increase in wages - at least 4% of the tariff rate (salary) established for various types of work with normal working conditions.

Let's consider them in more detail.

Reduced hours of work

Working time is the time during which the employee, in accordance with the rules of internal work schedule and the terms of the employment contract must perform labor duties. Normal working hours cannot exceed 40 hours per week (Article 91 of the Labor Code of the Russian Federation). However, Art. 350 of the Labor Code of the Russian Federation for medical workers, a reduced working time is set - 39 hours a week. If the health worker also works in harmful or dangerous conditions, the duration of his work should not exceed 36 hours per week by virtue of Art. 92 of the Labor Code of the Russian Federation.

It should be noted that not only the Labor Code regulates the reduced working hours of medical workers: the employer must also take into account some federal laws and decrees of the Government of the Russian Federation. Thus, medical and other workers involved in the diagnosis and treatment of HIV-infected people, as well as persons whose work is related to materials containing the human immunodeficiency virus, should be given reduced working hours on the basis of Art. 22 of the Federal Law of March 30, 1995 N 38-F3 "On the Prevention of the Spread in the Russian Federation of a Disease Caused by the Human Immunodeficiency Virus (HIV)". At the same time, the working time for them is determined in accordance with Appendix 1 to Resolution N 101 and is 36 hours a week.

Health workers who are directly involved in the provision of anti-tuberculosis care are also supposed to work less (Article 15 of the Federal Law of June 18, 2001 N 77-FZ "On Preventing the Spread of Tuberculosis in the Russian Federation"). The list of positions of medical, veterinary and other workers directly involved in the provision of such assistance was approved by Order of the Ministry of Health of the Russian Federation N 225 dated May 30, 2003, the Ministry of Defense of the Russian Federation N 194, the Ministry of Internal Affairs of the Russian Federation N 363, the Ministry of Justice of the Russian Federation N 126, the Ministry of Education N 2330, the Ministry of Agriculture of the Russian Federation N 777 , Federal Border Guard Service of the Russian Federation N 292. Note that in accordance with Appendix 3 to Decree N 101, health workers of tuberculosis healthcare organizations and their structural divisions should be reduced to 30 hours a week.

Medical staff performing work in psychiatric (psycho-neurological) health care facilities, institutions, departments, wards and offices, social service institutions and their structural subdivisions intended to serve citizens suffering from mental illness, on the basis of Art. 22 of the Law of the Russian Federation of 02.07.1992 N 3185-1 "On psychiatric care and guarantees of the rights of citizens in its provision" are also entitled to reduced working hours, which, by virtue of Appendix 1 to Resolution N 101, is 36 hours a week for them.

In addition, Decree N 101 establishes:

– 33-hour working week for medical workers of health facilities (polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices), physiotherapy facilities and offices, dental departments, offices and health facilities;

— 24-hour week for medical workers who directly carry out gamma therapy and experimental gamma irradiation with gamma preparations in radiomanipulation rooms and laboratories.

Please note that doctors employed in jobs with harmful or dangerous working conditions, where a reduced working time is established, the maximum allowable duration daily work(shift) cannot exceed:

- with a 36-hour work week - eight hours;

- with a 30-hour work week or less - six hours.

For some categories of health workers, the duration of daily work is specified within the List. For example, for doctors, middle and junior medical personnel, as well as a cleaner for industrial premises of pathoanatomical departments and laboratories, the working day (shift) cannot be more than five hours.

A collective agreement may provide for an increase in the duration of daily work (shift) subject to compliance with the maximum weekly working hours and hygienic standards of working conditions (Article 94 of the Labor Code of the Russian Federation).

Annual additional paid leave

Based on Art. 350 of the Labor Code of the Russian Federation, certain categories of medical workers may be granted additional annual paid leave. Wherein minimum duration leave for work in harmful and dangerous working conditions is established by Decree N 870 and is seven calendar days.

Paragraph 2 of Decree N 870 determines that the minimum duration of additional annual paid leave, depending on the class of working conditions and the conditions for providing this compensation, should be established by the Ministry of Labor. However, to date, the relevant regulatory legal act has not been issued (which does not relieve employers from the obligation to provide additional annual paid leave). Prior to its adoption, the employer must provide leave of at least seven days. Of course, vacation can be more, but only if it is provided for by a collective agreement or local regulatory act.

If the profession or position of the employee who is entitled to compensation is included in the List and the duration of vacation indicated in it is greater than that provided for by Decree N 870, then when determining the amount of compensation, the List should be guided by (Decision of the Armed Forces of the Russian Federation dated 14.01. .

Note! By setting the duration of additional paid leave in the local normative act or a collective agreement, you need to focus on the List. For example, a medical statistician, paramedical employees of infectious and fungal health facilities, a cloakroom attendant employed in a dressing room for patients, are entitled to an additional vacation of 12 working days. The head doctor, his deputy doctor (with irregular working hours) of children's psychiatric hospitals have the right to 24 working days of rest. A psychiatrist, middle and junior medical staff involved in providing medical care to the mentally ill - for 30 working days, and doctors of anti-plague institutions - for 36 working days.

It should be noted that if, based on the results of certification of workplaces, the working conditions of a medical worker are found to be harmful or dangerous, the employer will have to provide additional paid leave, regardless of whether the name of the position occupied by the medical worker is included in the List or not (Determination of the Constitutional Court of the Russian Federation dated 07.02.2013 N 135-O).

Additional paid leave is also established by the Decree of the Ministry of Labor of the Russian Federation of 07/08/1993 N 133. In particular, an additional leave for work with harmful working conditions of 30 working days was established for psychologists and physiologists directly and full-time for those working with the mentally ill, for medical directors (with irregular working hours) of psychiatric (psychoneurological), neurosurgical, narcological treatment and prophylactic institutions, departments, wards and offices, nursing homes (departments) for the mentally ill and their deputies, as well as chief psychiatrists of health authorities directly involved in the provision of psychiatric care.

It may turn out that a health care worker is entitled to receive additional leave for work in harmful or dangerous conditions for several reasons. In this case, vacations are not summed up, but only one of them is provided - a longer one.

Labor legislation establishes that additional paid vacations are added to the annual basic paid vacation. But a question may arise here. As you can see, in general, additional leave should be provided in working days. But, according to Art. 120 of the Labor Code of the Russian Federation, the duration of annual basic and additional paid holidays is calculated in calendar days. How to convert working days of vacation into calendar days?

Rostrud explained in Letter N 625-BB dated February 1, 2002: a certain number of days of the main vacation in calendar days are counted from the start date of the vacation, and then a certain number of days of additional vacation in working days per six-day working week and find out the date of the last day of vacation. After that, the total vacation period is converted into calendar days. The resulting number of calendar days will be the total duration of the annual paid leave.

For example, on March 13, 2013, an employee goes on annual paid leave of 28 calendar days. For harmful working conditions, he is entitled to additional paid leave of 12 working days. In this case, the last day of vacation will be 04/23/2013. Now we translate the total vacation period from 03/13/2013 to 04/23/2013 into calendar days, we get a vacation lasting 42 calendar days.

Increased pay

In accordance with Art. 147 of the Labor Code of the Russian Federation, remuneration for labor of persons employed in hard work, work with harmful and (or) dangerous conditions is set at an increased rate compared to tariff rates, salaries ( official salaries), established for various types of work with normal working conditions, but not lower than the amounts established by labor legislation - 4% of the tariff rate (salary).

As with additional leave, the specific minimum amounts of such increases, depending on the class of working conditions, should be established by the Ministry of Labor, but this has not yet been done. Until the adoption of the relevant regulatory legal act, the legislation continues to be in force former USSR regulating these issues is the Decree of the Central Committee of the CPSU, the Council of Ministers of the USSR and the All-Union Central Council of Trade Unions of September 17, 1986 N 1115 and the Decree of the State Committee for Labor of the USSR and the Secretariat of the All-Union Central Council of Trade Unions of October 3, 1986 N 387 / 22-78 adopted in accordance with it. According to the said resolutions, surcharges are provided in the following amounts:

- at work with difficult and harmful working conditions - 4, 8, 12%;

- in jobs with especially difficult and especially harmful working conditions - 16, 20, 24%.

The specific amount of the increase in wages for work in harmful and dangerous conditions for medical employees is established by the employer, taking into account the opinion of the representative body of employees.

Guarantees for work in harmful and dangerous working conditions

In addition to the compensations established by Decree N 870, medical workers for work in harmful and dangerous conditions are entitled to other compensations and guarantees. Let's consider them.

Medical examinations

Medical employees engaged in heavy work and work with harmful and (or) dangerous working conditions (including underground), as well as in work related to traffic, undergo mandatory preliminary (upon employment) and periodic (for persons under the age of 21 - annual) medical examinations(examinations) to determine the suitability for the performance of the assigned work and the prevention of occupational diseases (Article 213 of the Labor Code of the Russian Federation).

Harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the procedure for their conduct are determined by Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 N 302n.

Note that for some categories of medical workers, it is mandatory to undergo a psychiatric examination. Thus, Decree of the Government of the Russian Federation of April 28, 1993 N 377 established a list of medical psychiatric contraindications for the implementation of certain types of professional activities and activities associated with a source of increased danger. This list includes the following dangerous and harmful substances:

— antibiotics (production and use in medical practice);

- infected material and material infected with helminths (work in contact with infectious and helminth-infected material, with infectious patients);

– laser radiation (all types of work with lasers, work with ultrasonic medical equipment).

In addition, for healthcare workers surgical hospitals, maternity hospitals (departments), children's hospitals (departments), departments of pathology of newborns, premature babies, psychiatric contraindications for work are also established, therefore, these workers are required to undergo a psychiatric examination.

Rules for passing a mandatory psychiatric examination by employees performing certain types activities, including those associated with sources of increased danger (with the influence of harmful substances and adverse production factors), as well as those performing their duties in conditions of increased danger, are approved by Decree of the Government of the Russian Federation of September 23, 2002 N 695. In accordance with these rules, an examination of a medical worker is carried out medical commission created by the health authority at least once every five years.

Remedies

Based on Art. 212 of the Labor Code of the Russian Federation, medical employees employed in work with harmful and (or) dangerous conditions, the employer is obliged to issue special clothes, special shoes and other means personal protection, flushing and neutralizing agents that have passed mandatory certification or declaration of conformity. Moreover, the employer must ensure the acquisition and issuance in accordance with standard norms. For example, standard industry norms for the issuance of personal protective equipment to employees of healthcare organizations and social protection population, medical research organizations and educational institutions, production of bacterial and biological preparations, materials, educational visual aids, for the preparation, cultivation and processing of medical leeches were approved by the Decree of the Ministry of Labor of the Russian Federation of December 29, 1997 N 68. In accordance with these standards, doctors and secondary medical staff of operating rooms, dressing rooms and plaster rooms, delivery and postpartum wards of healthcare facilities and institutions forensic medical examination a waterproof apron is required, rubber gloves, and when working in operating rooms with power tools, additionally dielectric galoshes.

Intersectoral rules for providing workers with special clothing, special footwear and other personal protective equipment were approved by Order of the Ministry of Health and Social Development of the Russian Federation dated 01.06.2009 N 290n. But the standard norms for providing employees of the disaster medicine service with special clothing and footwear were approved by Order of the Ministry of Health and Social Development of the Russian Federation dated November 18, 2004 N 201: medical workers of field hospitals, mobile medical teams, medical teams of healthcare institutions and formations of the disaster medicine service can count on them. In accordance with the rules approved by the same order, the issuance of special clothing and footwear is made to employees of the disaster medicine service, officials and professional duties which are related to ensuring the constant readiness of the forces and means of the disaster medicine service and which are involved in the performance of work in emergency zones.

Note. It is not allowed to replace milk with sour cream, butter, as well as the issuance of milk or other equivalent food products for one or several shifts in advance, as well as for past shifts.

Therapeutic nutrition and milk

At jobs with harmful working conditions, milk or other equivalent products are issued free of charge. food products(Article 222 of the Labor Code of the Russian Federation). The norms and conditions for the free distribution of milk are approved by the Order of the Ministry of Health and Social Development of the Russian Federation dated February 16, 2009 N 45n. Thus, medical workers working in hazardous conditions are entitled to 0.5 liters of milk per shift, regardless of its duration. If the time of work in hazardous working conditions is less than the established duration of the work shift, milk is issued when work is performed under the specified conditions for at least half of the work shift. Instead of milk, a health worker may be given equivalent food products, the list and norms for issuing which are given in Table 1 of the Norms and conditions for the free distribution of milk. The issuance of other products is not provided for by the legislation of the Russian Federation.

Instead of fresh milk, workers involved in the production or processing of antibiotics are given fermented milk products enriched with probiotics (bifidobacteria, lactic acid bacteria), or colibacterin prepared from whole milk.

Please note that the issuance of milk or other equivalent products to health workers according to the established norms, upon a written application of the employee, can be replaced compensation payment in an amount equivalent to the cost of milk and other equivalent products, if this is provided for by a collective or labor agreement (clause 10 of the Norms and conditions for the free distribution of milk, part 1 of article 222 of the Labor Code of the Russian Federation).

At work with especially harmful working conditions, therapeutic and preventive nutrition is provided free of charge. The list of industries, professions and positions, work in which gives the right to receive free medical and preventive nutrition in connection with especially harmful working conditions, the norms and rules for issuing nutrition are approved by Order of the Ministry of Health and Social Development of the Russian Federation of February 16, 2009 N 46n. In accordance with this order, therapeutic and preventive nutrition is due to doctors, nurses, managers and specialists directly working in medical pressure chambers, as well as doctors of all categories and specialties performing medical and sanitary support for work related to the destruction of chemical weapons.

Pension provision

As a general rule, men who have reached the age of 60 and women who have reached the age of 55 are entitled to an old-age labor pension. However, medical workers who work in harmful or dangerous conditions may be granted early retirement.

In particular, an old-age labor pension is granted earlier than the specified age (for men at 50 years old, for women at 45), if they have worked, respectively, for at least 10 years and 7 years and 6 months in jobs with harmful working conditions and have an insurance record of at least 20 and 15 years. Such a right, for example, can be used by doctors, paramedical and junior medical personnel, barmaids and other workers engaged in sanitary and consumer services underground parts of the organization.

In addition, the following are eligible for early retirement:

— middle medical personnel of X-ray departments (offices), as well as those employed in X-ray angiographic rooms;

- medical workers directly serving patients in tuberculosis and infectious diseases institutions;

- middle and junior medical personnel in leper colonies, psychiatric hospitals, boarding schools for mentally retarded children, underground hospitals (in spent salt mines);

— doctors, middle and junior medical personnel of burn and purulent departments, departments and chemotherapy rooms of oncological institutions;

- junior nurses(nurses) of pathoanatomical departments, prosector morgues;

- junior nurses for patient care, employed in x-ray departments;

- medical and pharmaceutical workers who contracted the human immunodeficiency virus while on duty.

Note. Direct patient care is work performed in conditions of contact between a medical worker and a patient: massage, injections, procedures, manipulations, food distribution and feeding of patients, their carrying, sanitization, washing, etc.

Not so long ago, the federal government introduced incentive payments to health workers in 2020. The purpose of such government assistance is to encourage health workers to be interested in their work. What are the conditions and procedure for obtaining financial support?

Regulations governing the provision of benefits

The regulation of incentive payments to health workers in 2020 is carried out on the basis of several regulations. The first of these is, namely article 129. It specifies the concept of wages and types of payments to employees of organizations.

Another regulatory legal act is Decree of the Government of the Russian Federation of August 5, 2008 N 583 (as amended on January 19, 2019) "On the introduction of new wage systems for employees of federal budgetary, autonomous and state institutions and federal state bodies, as well as civilian personnel military units institutions and subdivisions of federal executive bodies in which the law provides for military service and equivalent service, the remuneration of which is carried out on the basis of the Unified Tariff Scale for Remuneration of Employees of Federal public institutions"(together with the "Regulations on the establishment of wage systems for employees of federal budgetary, autonomous and state-owned institutions"), which establishes wage systems for people working in budgetary, autonomous and state-owned enterprises. There is also an Order of the Ministry of Health and social development RF dated December 29, 2007 N 818 "On approval of the List of types of incentive payments in federal budgetary, autonomous, state-owned institutions and clarifications on the procedure for establishing incentive payments in these institutions" (with amendments and additions), fixing the list of incentive incentives, factors , which determine the possibility of providing supplements to wages.

A list of performance indicators that are necessary to address the issue of stimulating workers is listed.

Local Incentive Payment Document

Each hospital should develop its own document that regulates employee benefits. It is called "Regulations on the payment of incentive bonuses to medical workers" and is considered an addition to the collective agreement, which is drawn up for one year.

This document must contain the following information:

the source from which funds are allocated to pay incentives to health workers;
a list of employees eligible to apply for additional payments;
payment procedure;
the amount of the monthly surcharge;
a list of criteria that are used to check the quality of work of the staff of a medical institution.

The sample Regulations on Incentive Payments for Medical Workers in each hospital are almost the same.

Who is eligible to apply for financial incentives?

In order to receive incentive payments to medical workers, a specialist must be certified in a specialty. The employee also needs to show Good work. After all, when deciding on incentives, the performance of each employee of a medical institution is taken into account.

The regional authorities themselves establish a list of positions that are entitled to receive cash benefits. The following healthcare workers do not qualify for the exemption:

administration of the institution. Managers can count on financial incentives, but only if they directly provide medical services;
health workers who take part in the Health program, namely, assist in the process of childbirth, care for babies, as well as other doctors working with them;
employees of medical institutions providing high-tech assistance.

Criteria by which the work of medical personnel is evaluated

Incentive payments to doctors are assigned after assessing the quality of their work. The following factors are taken into account during the audit:

The quality of the work performed per month.
The volume of provided honey. services.
Length of time in the institution.
The number of continuous work experience.
Skill level.
Collaboration work.
Individual increase factor.

In connection with the presence of these factors, it becomes clear that the implementation of financial incentives for hospital workers depends entirely on how the work will be done. This is the optimal motivation for healthcare workers.

Accrual procedure

The procedure for calculating incentive payments to health workers is regulated by a local document that sets out the rules for remuneration in a hospital. At the end of each month, the head prepares an order in accordance with which material incentives are paid to medical workers.

Also, management should create a list of employees at the end of the month indicating information about the work they have done. If the doctor has not coped with his official duties, then the allowance may not be issued. The decision to award the award is made by a special commission, which includes:

Trade union chairman.
Head nurse.
Head of department.

Medical staff are informed about what grades they received for their work. The Commission evaluates the activity on a point system. Strong grounds are needed to deny the provision of presidential payments to medical workers in 2020. For example, the doctor did not fulfill his duties or grossly violated labor discipline.

If the employee was not given a bonus in the accounting department, then you need to demand the provision of an order on the basis of which the accountant acts. It must indicate the reasons for the negative decision. If the employee does not agree with the decision of the management, then he has the right to appeal it.

In addition to incentive payments, doctors and all other workers in the medical field are entitled to a number of other state preferences. These include:

years and others;
preferential consumer .

Approximate calculation of the amount of the allowance

The calculation of incentive payments to health workers is made depending on the work done. For example, the salary of a doctor is 20 thousand rubles. The multiplying coefficient after evaluating the work according to the established criteria is 0.2. As a result, the material incentive will be equal to 4 thousand rubles. This calculation example is approximate, it depends on many factors.

Do they receive payments for combination and replacement?

Under the Regulation on Incentive Payments to Medical Workers, people replacing other employees are also provided with additional monetary compensation. But at the same time, the documentary procedure for registering a part-time job must be observed.

That is, an employment contract is concluded with the employee on the combination of positions. If it is stipulated within the main labor agreement, then no allowances are made.

There are no changes regarding incentive payments to health workers in 2020 yet. This program is really good motivation for doctors. The state is trying to do everything to make the salary of medical personnel worthy of this profession.