Parliament Approves Bill on Compulsory Targeted Training to Tackle Staff Shortages
A bill proposed by the Ministry of Health, introducing mandatory targeted training for students of medical universities and colleges, has successfully passed its first reading. This significant new regulation will apply to all students planning to pursue state-funded medical education starting in 2026. According to the Ministry of Health, these amendments are vital for addressing the persistent shortage of medical personnel, particularly in regional areas, and for enhancing the overall quality and accessibility of healthcare services for the population. However, opposition members within the Duma have voiced concerns, suggesting that instead of compelling students to complete their training in state clinics, a more effective approach would be to increase doctors` salaries and establish various forms of social guarantees within the legal framework.
During the bill`s presentation in the State Duma on Wednesday, October 8th, Deputy Head of the Ministry of Health Tatyana Semenova underscored that the proposed changes are primarily designed to rectify the scarcity of medical professionals across different regions and to improve both the quality and availability of medical care. She also highlighted that a substantial 70% of current medical students are already enrolled under targeted agreements, a figure that excludes those on paid programs.
Details of the Proposed Reform
The Ministry of Health had previously put forth the idea of mandatory `work-off` periods for medical students in early 2025. Under the draft law, students admitted to state-funded medical universities and colleges would be required to sign a targeted agreement with a prospective employer during their first year of study. Typically, regional health ministries and state medical organizations serve as the sponsors for such training. Failure to sign an agreement would result in the student`s expulsion and an obligation to compensate the state for their training costs. Similarly, if an agreement is signed but not fulfilled—for instance, if a graduate fails to report for duty—the medical professional would be mandated to repay the amount spent on their education, in addition to incurring a penalty equivalent to twice the cost of their training. Furthermore, all medical university graduates (including those who funded their own education), upon completing their studies and primary accreditation, would be obliged to work for three years (college graduates for two years) in an institution within the mandatory health insurance system, under the supervision of a mentor. Following this period, they would be eligible for periodic accreditation, which is essential for their continued professional practice.
Parliamentarians put forward several suggestions for refining the bill before its second reading. Deputy Igor Antropenko (United Russia) proposed that the duration of the mentorship period should vary depending on the doctor`s specialty. He argued, «While an oncologist genuinely needs three years, a therapist would likely require significantly less time.» Sergey Leonov (LDPR), who heads the Health Protection Committee, emphasized the importance of «cementing the factor of rootedness,» thereby ensuring that individuals admitted to targeted positions receive preferential treatment within their home regions. He also pointed out potential difficulties for dental graduates in completing mentorships in mandatory health insurance clinics, given the predominantly commercial nature of institutions in this field.
The Communist Party expressed strong indignation over the absence of social guarantees for future doctors within the proposed amendments. Deputy Nikolay Arefyev asserted that the «most straightforward» method to resolve the staffing crisis in state medical institutions would be to «raise salaries to match the level offered by private clinics.» He contended that the law, in its current form, primarily outlines «repressive measures» against students, failing to include any explicit «state guarantees.»
Evgeny Bessonov commented that under the proposed system, training sponsors would have no incentive to increase the salaries of young specialists or improve working conditions, as «graduates obligated to work off their training will arrive regardless.» Sergey Kazankov reminded the assembly that even now, training sponsors «offer working conditions that are unattractive to young people, which is why not all targeted quotas for medical specialties are being filled.» He speculated that after the law comes into effect in 2026, there would be «a noticeable decrease in applicants to medical universities, with many shifting en masse to other fields of study.»
Aleksey Kurinny, Deputy Chairman of the Duma Committee on Health Protection, stated that his analysis of the federal budget for the next three years revealed no «increase in allocations to the medical professionals` salary fund.» He further proposed, «To enhance the attractiveness of the profession, measures such as preferential mortgages should be considered, and minimum social guarantees—for example, a salary no less than 200% of the regional average—should be enshrined in law.» The parliamentarian also noted that deciding on a work-off location during the first year of study is «premature» and suggested extending this period at least until the third year.
Conversely, State Duma Speaker Vyacheslav Volodin (United Russia) advocated for stricter mentorship rules. He highlighted the presence of numerous private clinics within the mandatory health insurance system and suggested that by the second reading, it should be clarified that mentorship can only be undertaken in state clinics, «and not in private establishments within the Garden Ring.» Yaroslav Nilov, Head of the Duma Committee on Labor, went even further by proposing a ban on doctors working in the commercial sector without first accumulating three years of experience in state institutions.
«Chief physicians operating within such a system might begin to perceive themselves as slave owners,» cautioned Fedot Tumusov (A Just Russia – For Truth), First Deputy Chairman of the Duma Committee on Health Protection. He observed that the proposed amendments are viewed positively primarily by «adults, those who have already completed their education.» He emphasized, «However, for `Zoomers,` for Generation Alpha — the younger demographic whom these changes will directly affect — technological advancement at their workplace and the level of their salary are paramount.»
At the conclusion of the discussion, Deputy Minister Tatyana Semenova clarified that the issue of social guarantees is addressed at the regional level, implying that local authorities are responsible for attracting graduates with favorable conditions. She also noted that medical students would retain the flexibility to choose their preferred region for placement. Minister of Health Mikhail Murashko, present at the discussion, affirmed that «the primary objective of the bill is to resolve the personnel crisis in medicine,» and urged parliamentarians to «keep this overarching goal in mind while preparing amendments for the second reading.» These amendments are scheduled to be accepted until October 22nd.
