Юристы отмечают, что новая инициатива Минздрава нарушает 19-ю статью Конституции РФ. Впрочем, некоторые собеседники Бизнес ФМ не видят в документе ведомства ничего плохого.
The Russian Ministry of Health has introduced a new draft law that would require graduates of state-funded medical and pharmaceutical universities to work for three years in public healthcare institutions. Previously, students who completed state-funded programs had the option to either undertake mandatory service or financially compensate the government for the cost of their education. The provision for financial compensation has been removed from the new draft. Under this proposal, graduates who do not fulfill the three-year service requirement in state facilities would effectively face a ban on practicing their profession, as they would reportedly be denied accreditation.
Currently, this proposal is still an initiative by the Ministry of Health and is open for public discussion, meaning a final decision has not yet been made. The impetus for this measure stems from a significant staffing deficit in the state healthcare sector. According to the ministry, 35% of medical university graduates and 40% of medical college graduates who received state funding do not subsequently work in state clinics. As of 2023, the personnel shortage in public healthcare included 29,000 doctors and another 63,000 mid-level medical professionals. State institutions often struggle to compete with the private sector in terms of salaries. Furthermore, doctors interviewed by Business FM have previously highlighted the heavy administrative workload and difficult relationships with management and patients under the compulsory medical insurance system as key reasons for avoiding state clinics.
The previous version of the draft law proposed that graduates who studied on a state budget but did not complete three years of service in a state medical institution would be required to pay compensation equivalent to double the state`s expenditure on their education. Experts estimated this cost to be around 2.5 million rubles at current prices. However, the option to «buy one`s way out» has been removed from the current document. Instead, those unwilling to work for the state for three years would be denied accreditation, effectively prohibiting them from practicing medicine.
This potential ban on practicing the profession has caused concern among some experts. Medical lawyer Ivan Samarin argues:
Ivan Samarin, medical lawyer
This violates Article 19 of the Constitution, which declares equality before the law, including regardless of financial status. What happens now? A person whose parents have the means to pay for education spends eight years at a medical institution and can then go earn money, perhaps even working at their father`s private clinic. But a talented young person who got into a state-funded program through their own efforts must spend eight years of their life, and then another three years. Where is the observance of equality before the law here?
Nevertheless, this aspect of the bill could be amended to include mandatory service for those who studied on a fee-paying basis as well. Pulmonologist, Candidate of Medical Sciences, and former associate professor Alexander Palman does not see anything inherently wrong with this initiative from the Ministry of Health:
Alexander Palman, pulmonologist, Candidate of Medical Sciences, former associate professor
If a doctor immediately goes to a commercial structure after graduation, it means they were waiting for a comfortable position from the start. A normal commercial structure shouldn`t be very interested in a specialist who has just graduated. I studied very well; I graduated with honors. I remember the first year of my work, my residency — for the first six months, I couldn`t be left alone with patients. It was harmful to both me and the patients. And only after six months did I start feeling some readiness to make independent decisions, to take responsibility.
The Ministry of Health`s initiative has also evoked mixed reactions from current medical students and those planning to apply. Student Anastasia shares her perspective:
[In state clinics,] the money is incomparable to human dignity. People come to doctors, open the door rudely, immediately with complaints, demanding free and quality care. And we are deemed bad from the start: too rude, too young – anything. A million papers, only 12 minutes per patient. And if you give out your personal phone number for contact, people will text at any time of the day or night, genuinely believing it`s normal.
Medical student Maria is also not enthusiastic:
I understand there`s a wild shortage of medical staff in the country. When the same thing happened with IT specialists, everything was made very convenient for them: their salaries were raised, the market was saturated with finances, they have great conditions, it became prestigious. And now doctors are treated somehow like slaves.
However, Vita, a tenth-grader seriously preparing to enter a state-funded medical university, previously told Business FM that for her, mandatory service is not an obligation but guaranteed experience. She views it as a very good idea and an opportunity to gain work experience in a clinic, which will resolve future employment issues. She notes that while many want to work in private clinics due to higher salaries, it`s not always possible immediately after graduation. She considers it a good practice, provided it supports career growth.
It is important to note that even supporters of the Ministry of Health`s idea emphasize that the ultimate outcome will depend on how this initiative is implemented in practice. The current draft law from the Ministry of Health suggests that graduates would choose the region and specific institution for their mandatory service themselves. Furthermore, provisions are included for mentors to work directly with these young specialists at their placements.
