Russia`s State Duma has given initial approval to a legislative proposal that would mandate state-funded medical students to sign targeted agreements and fulfill a work obligation after graduation. This initiative has generated considerable debate within the medical community, with students largely opposing it, while practicing doctors see numerous advantages.
The bill, which passed its first reading, outlines a reform in medical education that compels all students receiving state scholarships to enter into work contracts post-graduation. Many perceive this as a return to the Soviet-era system of job allocation. Historically, such targeted contracts were typically signed by those who did not meet the competitive scores for general budget-funded places. Now, under the proposed law, even high-achachieving students who performed excellently on their Unified State Exams (USE) will be required to accept these placements, a prospect that has been met with strong disapproval.
«High-scoring students, who diligently prepared and achieved excellent results in chemistry, biology, and Russian language to secure a regular state-funded place, are reacting extremely negatively to this. Their common sentiment is: `I scored 292 points, and it was crucial for me not to take a targeted placement so I wouldn`t have to work in an unfamiliar medical facility. Now I`m still constrained by these rules, and the essence of state-funded education has been lost for me.`»
Conversely, the professor acknowledged that some regions face a severe shortage of medical personnel, with deficits reaching up to 50%. This directly impacts the quality of healthcare available to residents. In many rural areas, doctors are simply absent, forcing patients to travel to regional centers for basic medical attention. The government aims to resolve this critical issue within the next five to seven years.
Expert Opinions: Benefits and Drawbacks
Boris Churadze, Chief Physician of the Hadassah Clinic and Medscan clinic network, highlighted the benefits:
«The key factor is that it allows the state to purposefully and predictably address the staffing deficit, especially in regions where it is acute – particularly in remote and rural areas. Secondly, a social contract emerges: state-funded education is an investment in a specialist. This mechanism formalizes and defines mutual obligations. Society provides quality education to a medical student, and the graduate repays their debt by working where society needs their expertise. These are honest and fair terms. For many young people, finishing their studies is stressful due to the job search. Such a contract offers a clear path and guarantees employment.»
Regarding the downsides, Churadze added: «With this instrument, we are essentially not motivating, but ensuring the physical presence of specialists where they are urgently needed. In essence, we are reverting to the distribution system that existed in Soviet times. There were positive aspects then too, but often, and there is a similar risk now, doctors would simply `serve their time,` making it an obligatory program for sometimes unengaged professionals rather than a form of internal motivation.»
During the legislative discussions, the question arose whether students would have a choice of clinics for their mandatory service. A Health Ministry representative in the State Duma assured that applicants would retain the ability to choose a region. Vladimir Elishev, Chief Physician of the K+31 clinic network, believes that inexperienced doctors will gain invaluable practical experience in these regions that they might not immediately acquire in a large city after graduation:
«This approach to state assignments and guaranteed work placements is, in my opinion, an excellent support for young, aspiring specialists to immediately gain significant and successful medical practice after university. I don`t think we will have another alternative in the near future, because there aren`t enough large hospitals or complexes to provide a large number of jobs for all university graduates at once. The primary category of demand is still outpatient, primary medical care, district medicine, and rural medicine, which largely falls under the state healthcare structure.»
Penalties and Implementation
The bill stipulates that a penalty for non-compliance, applicable to both students and future employers, will be three times the cost of tuition. According to medical professionals interviewed by Business FM, previous penalties often did not cover the state`s investment in a doctor`s education, leading to instances where students who initially signed targeted contracts later paid their way out of the obligation. To obtain initial accreditation, a young specialist will be required to work for three years under the guidance of a mentor; however, these terms are subject to review for future consideration.
The law is expected to come into force on March 1, 2026, if formally adopted.
