The salary of doctors is one of the hot topics discussed in society today, because, despite the importance and demand of this profession, the salaries of health workers remain quite low, and even the government’s promise to raise the salary of doctors from January 1, 2019, as evidenced by the latest news, cannot stop the outflow of personnel.

Should we expect the situation to improve, and what will doctors’ salaries be next year? We offer to understand the problems of financing and the features of calculating the salary plans of a health worker.

Relevance of the problem

Of course, the problem of low wages is relevant for many areas dependent on government funding. But the salaries of doctors require special attention from the leadership of the Russian Federation in 2019, because the path from a medical university applicant to a highly qualified specialist in the field of medicine is very long and today there is an acute shortage of personnel in public medical institutions in the country. Experienced doctors are looking for more lucrative jobs in private clinics and abroad, while young people are in no hurry to apply to medical universities, clearly understanding that after difficult and lengthy training they will be faced with responsible and difficult work with low pay.

There is a way out, and it lies in reform, part of which is a new decent salary for doctors, designed to bring a tangible improvement in the well-being of doctors already in 2019, as well as other measures aimed at increasing the prestige of the profession.

Doctor's payroll

The salary of a health worker, as in many other areas, consists of the following components:

• salary;
• additional payment for labor intensity;
• allowances for length of service and category;
• regional allowances and compensatory surcharges, calculated taking into account correction factors adopted for a number of regions of the Russian Federation;
• bonuses, night shifts, overtime, etc.

In this case, only the first parameter is subject to indexation - the rate (basic salary), while the size of the variable component of a doctor’s real income in many government institutions drops sharply, as noted by the doctors themselves.

Of course, if we take the statistics of large medical centers in Moscow, St. Petersburg and other Russian megacities, the percentage of personnel outflow will not be large, but nationwide, over the last 5 years, more than 90,000 specialists have left medicine, which confirms that the problem exists and requires an immediate solution.

Previous attempts at reform

This is not the first time that talk about increasing the income of health workers has come up. According to the “May decrees” signed by the president 5 years ago, by 2017 doctors’ incomes should have reached a record 180% of the average income in the region, and by 2018 – all 200%. And, although most doctors did not feel a real increase in income, beautiful figures appeared in the reporting documents of the industry confirming the implementation of the reform.

In real life, doctors were faced with the so-called “optimization”, in which the following occurred:

• job cuts;
• unification of sections and entire departments;
• increasing overtime hours and the number of night shifts.

Thus, the workload on the doctor has significantly increased, which naturally does not contribute to improving the quality of the specialist’s work, and income, at best, has increased slightly or remained at the same level. At the same time, for doctors who remained working as before, their income remained approximately within the following range:

• 27,000 – 35,000 rubles for doctors;
• about 20,000 rubles for junior and mid-level medical staff.

Of course, there are also regions in which the salaries of doctors can truly be called decent. These include Moscow, St. Petersburg, Sakhalin and Khanty-Mansiysk Okrug. The highest incomes, reaching 117,000 rubles per month, were recorded in Chukotka.

What to expect in 2019?

Talk that the salaries of doctors should increase significantly in 2019 in accordance with the same “May decrees” gives hope, but the latest news in the economic sphere suggests that the chosen path will not be simple and easy. Negative events such as a drop in oil prices and the imposition of economic sanctions undermine the country’s economy, but the financing of the medical sector is fully borne by the budget. It must be remembered that the planned increase in payments to employees of state medical institutions will require an additional 95.5 billion rubles from the budget by 2019, and another 170 billion by 2020.

Naturally, no one canceled indexation and from January 1, 2019, doctors’ salaries will be increased by 5.5%, which will not even cover the projected increase in prices for various groups of goods.

It is difficult to say whether the promise of a significant salary increase will be realized. Most likely, this law will add to the list of projects that are destined to remain only on paper, and by the beginning of the new calendar year there will be a list of amendments that will push back the fulfillment of the promise to more distant dates. And how I would like this assumption to be wrong...

Rosstat published information according to which the average salary of doctors in 2018 in Russia is 72,000 rubles per month, and the salary of a nurse in 2018 is 36,000 rubles. But data from other studies and surveys indicate different results: real salaries of doctors, taking into account all allowances, are one and a half to two times lower. Where is the truth?

What's happened?

The requirements of Vladimir Putin’s May decrees in 2012 included, among other things, an increase in salaries for doctors in 2018. According to Rosstat, the president practically fulfilled his promise:

• in January 2018, the average salary of a Russian doctor was 72 thousand rubles;
• the salary of nursing staff in 2018 amounted to 36 thousand rubles in Russia as a whole;
• the salary of junior medical staff is 33.5 thousand rubles.

That is, the promised salary increase for doctors in 2018 took place. Of course, it is not yet everywhere 200% of the average salary in the region of the Russian Federation, but the given figures show a quite decent standard of living for doctors. But the All-Russian Popular Front (ONF) conducted its research and received figures that were 1.5-2% less than those officially announced. What is the reason for this difference?

Salary and salary are two different things

Rosstat reported at the end of 2017 that Order 597 on increasing wages for healthcare workers is practically not being implemented anywhere. The point is that at the end of 2017, only 16 regions of the Russian Federation, according to Rosstat, were able to pay doctors the required wages, that is, 180% in relation to the average wage for the regional economy. But in 2018, many constituent entities of the Russian Federation announced an increase in the salaries of medical workers almost doubling. And the whole secret is hidden in the word “salary”. After all, the earnings of doctors, nurses, paramedics and nurses consists of two parts:

1. fixed salary;
2. incentive payments.

And this same salary, as officials and Rosstat note, can even be an amount equal to the minimum wage (or even less), but in fact the wages are much higher. Precisely due to these same incentive payments, which depend on length of service, grade level, employment and other factors. But, most importantly, it depends on how the medical institution itself, where the doctor or nurse works, is financed. If this is a large hospital that serves many patients and performs a whole range of procedures, the amount will be the same, but if it is an ordinary rural outpatient clinic, it will be completely different.

In addition, these incentive payments are distributed by the heads of the medical institutions themselves. Therefore, it is quite difficult to control how fairly the distribution occurs. In particular, the ONF noted in its message that:

In the Ivanovo region, a paramedic with 39 years of experience receives 13,000 rubles. per month, general practitioner with 35 years of experience - 18,000 rubles.

In general, according to a survey conducted by the ONF together with the expert community, in the first quarter of 2018, health workers had the following earnings:

• 22% have less than 25 thousand rubles;
• 32% have less than 30 thousand rubles;
• 19% - from 40 thousand to 55 thousand rubles;
• in isolated cases - more than 80 thousand rubles.

In addition, as a result of the study, it turned out that doctors are often forced to earn extra money, so even after being on duty for a day, doctors go to work, and this is a violation of all standards, including international ones.

The amount of earnings depends on the region

The study also revealed that the salary increase for doctors in 2018 depends on which region of the Russian Federation they live and work in. In particular, in order to comply with the requirements of Decree of the President of the Russian Federation dated 05/07/2012 N 597, in some regions, in order to show the high income of doctors, officials use tricks, in particular, they register a part-time doctor, pay him a small salary, and in the reports The figure for this position is 2 times higher. At the same time, a doctor, of course, has to work full time.

Nurses are given the same salary as paramedics; it turns out that the difference in salaries between middle and junior medical staff is only 5 rubles. And in some hospitals, chief doctors have gone so far as to take out loans in order to pay their staff in accordance with the required figures. As a result, the requirement of the May 2012 decrees was actually fulfilled only in Moscow. The head of the Moscow Department of Health, Alexey Khripun, cites, in particular, the following data:

• the minimum salary for health workers in March 2018 in the capital was 68 thousand rubles;
• doctors have an average salary of 136 thousand rubles;
• for average medical staff - 73 thousand.

In addition, in Moscow, doctors receive real bonuses for the intensity of their work and level of qualifications.

The ONF held a meeting on this situation, following which it was decided to create a working group that will monitor the real level of remuneration for doctors and prevent data distortion.

Today, doctor is one of the most sought-after specialties in the capital of the Russian Federation. Experienced and qualified medical workers are required both in municipal medical institutions and in private clinics.

Moscow is distinguished not only by its multi-million population, but also by its size. It's no secret that doctors in the capital receive higher salaries than in provincial regions and cities.

The average salary of a doctor in Moscow is 60,000 RUB. But this does not mean that all doctors receive exactly this salary.

Salary directly depends on specialty, qualifications, work schedule and place of employment. Thus, doctors in private clinics earn more than in public medical institutions.

Average monthly salaries of doctors in Moscow:

• A chiropractor receives from 40,100 to 60,000 RUB.
• A local therapist in a clinic earns no more than 53,120 RUB.
• An occupational therapist is one of the highly paid professions. On average, a doctor in this field receives at least 70,000 RUB.

• • Pharmacist-analyst. The average salary is from 46,200 RUB.
  • Pharmacist-technologist. Average monthly salary - from 42,200 RUB.
  • Pharmacist. Salary - from 48,500 RUB.

• • 1. Pharmacist. The salary of a pharmacist ranges from 43,700 to 54,100 RUB.
    2. Vet. varies from 24,300 to 36,200 RUB.

Average salaries of doctors in other fields

Focus	Average salary (in RUB)
Psychotherapist	from 48 100
Reanimatologist	from 27 000
Rheumatologist	from 30 000
Sex therapist	from 45 000
Family doctor	from 43 000
Emergency doctor (paramedic)	from 30,300 to 45,200
Paramedic-laboratory assistant	35 000
Pre-trip inspection paramedic	15 000
Dental surgeon	67 800
Pediatric dentist	55 000
Dental assistant	40 000
Nurse	from 18,500 to 26,700
Masseur	from 21 000
Audiologist	from 40,000 to 45,000
Toxicologist	97 500
Traumatologist	from 40,900 to 60,600
Urologist	from 48,800 to 64,400
Endocrinologist	from 40,000 to 60,000
Dermatocosmetologist	75 000
Reproductologist	75 000
School psychologist	35 000
GP	81 250

Salary growth dynamics

According to the head of the capital's health department, the average salary of medical workers has increased by 54% in recent years.

Dynamics of changes in the average salary of doctors in the capital of the Russian Federation by year

Year, month	Monthly salary (in RUB)
2012
January	40 040
February	41 890
March	41 135
April	41 635
2013
January	49 460
September	53 375
October	51 225
November	54 100
December	51 900
2014
January
February	50 400
June	49 800
August	52 350
September	62 940
October	40 750
November	50 000
December	50 000
2015
January	60 000
March	60 000
April	60 000
May	50 000
June	50 000
July	60 000
August	60 000
September	55 000
October	50 000
November	50 000
December	50 000
2016
January	55 000
March	50 000
April	55 000
May	50 000
July	50 000
July	50 000
August	50 000
September	50 000
October	55 000
November	52 500
December	60 000
2017
January	60 000
March	60 000
April	57 500
June	60 000
July	60 000

Based on the table, we can conclude that the average monthly salary is gradually increasing. But the government assures that in subsequent years the average salary of a medical worker will be no less than 70,000 RUB.

A salary increase is a good incentive for successful work.

At the end of 2017, an order was issued that doctors’ salaries should be equal to twice the average salaries in the regions. So how are health care workers' incomes faring in 2019? Have the promises come true? How much do doctors in capital clinics earn today?

High-quality medicine is not the last stone in the foundation of a country’s well-being. Therefore, doctors themselves are forced to study a lot, constantly undergo advanced training and work a lot to ensure good health of citizens. That is why the government provides and develops all kinds of measures to support this category of specialists, both in the form of salary increases and in various non-material forms.

Regulatory framework

The May decrees of the head of the country, which were presented in 2012, contained clauses devoted to the salaries of doctors in the coming years. Rosstat testifies that the President more than fulfilled all his obligations to doctors and other medical personnel in Russia:

• the average salary of an average health worker is 72,000 rubles. (as of January 2018);
• for the annual period as a whole, the salary indicator is 36,000 rubles;
• Representatives of junior medical staff earn an average of 33,500 rubles.

Of course, the given salary levels for doctors do not apply in every region. However, in many regions of the Russian Federation, the salary of a medical specialist allows you to lead a decent life. The main regulation on this issue is Decree No. 597 of 05/07/2012 “On the implementation of social policy”. The standard refers to measures that will be taken to increase wages for medical professionals.

Wages and salaries - what will they increase?

Even at the end of 2017, Rosstat said that the order given in the previous paragraph is practically never implemented anywhere. Based on the data obtained during the study, we can conclude that only in 16 regions of the country doctors were provided with a decent standard of living according to data for 2017. However, already at the beginning of 2018, statements appeared from many entities about increasing the salaries of health workers by almost 200%.

As in any other area of ​​labor relations, wages are formed from salary and incentive amounts. The salary is usually a small amount, which is barely comparable to the subsistence minimum or. The increase occurred precisely through an increase in the size of incentive payments.
Traditionally, their size is influenced by several fundamental factors:

• length of service;
• class of work;
• nature of employment;
• region of residence;
• number of hours worked;
• type of medical facility.

The distribution of payments is primarily carried out by the heads of individual institutions. Part of the increase in total income occurs due to the fact that many doctors began to earn more through overtime and part-time work in the face of a shortage of personnel.

Dependence of earnings on region

The territorial subject of the Russian Federation in which the physician lives also plays an important role. In order to comply with Decree No. 597 and the document developed on its basis, many managers use tricks and indicate false data in official documents (for example, they mark part-time work, while a specialist works “full-time”, or equalize the income of nurses with paramedics and paramedics). even nurses).

As a result, we can conclude that the requirement to comply with a certain level of wages is met exclusively in the Russian capital - Moscow, where the minimum wage is 68,000 rubles, and the average is 136,000 rubles.

Current salaries for doctors

External pressure on the country and its economy could not remain without consequences in the form of a crisis, so the 200% increase in income in medicine was largely offset by the crisis. Real data look like this:

• based on the results of the first half of 2018, the average salary of doctors is 52,900 rubles;
• the income of average-level doctors is 29,400 rubles;
• junior specialists receive 19,400 rubles;
• the leaders in terms of salaries received by medical specialists are the following regions: Nenets Autonomous Okrug, Far Eastern Federal District, Chukotka;
• Doctors performing official duties in North Ossetia and Kalmykia have the “weakest” income levels.

Despite the lack of practical growth in wages up to 200% of the regional average, they still continue to increase. Further increases are planned for 2019. Especially the “lagging” regions expect such good news.

Doctor's salary at the end of 2018

Currently, the conditions for increasing income to 180% of the current average level have not been created. There is an assumption that at the end of 2018, the average monthly salary of a physician will be 66,000 rubles. However, the authorities promise to do everything possible to increase the earnings of medical staff in the coming months and to implement the norms of the “May” decrees of 2012 at the beginning of 2019.

Nurses' salary

Nurses' income growth is unlikely to reach 80%. Although, as evidenced by the requirements of the decrees, this indicator should be equal to 100%, i.e., become identical in all regions of Russia.

Junior medical staff salary

Salaries of junior staff are also projected to increase. However, as the practical side of the issue shows, not all regions have the opportunity and appropriate resources to implement these goals and objectives.

How are the salaries of health workers determined?

There are several components that are directly related to the statistical average:

• salary(this is the main part, although in practice it can be small and amount to only 20% of the total income);
• support payments(they are charged for processing, excessive loads, process intensity and difficult conditions);
• allowances(they are mainly based on length of service and working qualification category);
• compensation and regional amounts(paid to the constituent entities of the Russian Federation separately).

Indexation primarily affects salaries, but in practice it is auxiliary payments that play a significant role.

Prospects for salary growth

Indexation according to forecast standards will be 4% of the salary. The head of state also said that at the end of 2018, the average salary for doctors should be 200%, and for junior staff - 100%.

The President himself is convinced that the foundation for these changes has already been laid, and the first steps have definitely been taken. By the end of 2018, there is a gradual achievement of target indicators. As for the practical picture, salaries of specialists are uneven and variable across regions.

Putin's promises

In March 2018, the news reported that the goal of government at all levels is to raise the level of salaries for doctors to 200%, and for junior staff to 100% of the average values ​​for the region. The president also surveyed the heads of several medical institutions in different regions about their satisfaction with the standard of living, and they gave positive answers, saying that salaries had really increased. Along with this, plans and prospects for further work aimed at increasing the size were discussed.

Increasing the income level of doctors from the Federal Compulsory Compulsory Medical Insurance Fund

The chairman of the fund associated with compulsory health insurance made an unequivocal promise regarding a further increase in wages received by medical specialists. It was guaranteed that within the framework of 2018, all these conditions will be met, because the MHIF budget is formed and will provide many opportunities for improving the level of wages for doctors in the near future.

During the first reading, deputies working in the State Duma adopted a bill, according to which for the planning period (in the next 2 years) the fund’s income will be equal to 1.888 trillion. rub., and in 2018 it should amount to 1.993 trillion.

This is not the first time that such promises have been made by the MHIF. Along with this, an alternative opinion reigns in the Accounts Chamber. Auditors believe that the insurance service is simply overestimating its own capabilities.

The Government of the Russian Federation initially planned to increase the salaries of senior medical personnel by 7.5%, and after that - up to 180% (until October 1, 2018). Putin himself said that by the start of the 2019 annual period, doctors’ salaries should be equal to twice the regional average, while junior employees will receive 100%. But some regions have received requests related to acute budget deficits, as well as requests for help.

According to statements by experts working in the independent monitoring fund called “Health”, after analyzing information from Rosstat, it can be concluded that the achievement of target indicators did not occur either in 2016 or in 2017. Accordingly, the same dynamics should be expected in 2018. Despite the loud assurances of the authorities that the desired indicators are being achieved, in practice other, opposite conditions arise.

The Russian government promises that at the end of 2018 there will be a significant jump in the salaries of medical specialists.

However, real data shows the opposite picture. Despite this, the state is taking all kinds of measures aimed at increasing wages and improving the quality of life of medical and healthcare employees. This indicator depends on several factors. First of all, we are talking about the region of residence, qualification level, and the number of hours of work of the professional.

The following story is devoted to the issue of increasing salaries for health workers and the timing of when this should happen.

2018 is the last year in the long-term plan to improve the living standards of teachers and doctors, which was provided for by the so-called May 2012 decrees. In the new year, the income of medical workers should double the average salary in the region in which the doctor lives. For this purpose, in particular, a decisive increase in the salaries of doctors is planned in January. Salaries of doctors from January 1, 2018 - what the latest news from the government says about what percentage the income of medical workers will increase after indexation.

How are the May 2012 decrees implemented and can they be implemented?

Those who have at least half an eye been watching all these years what is happening around the so-called May decrees know that to achieve them, a variety of government tricks were used. In 2018, there can, of course, be no talk of real implementation and of the average doctor’s salary reaching twice the average salary in the region in which he lives.

One of the most striking examples that directly affects medicine. For paramedical personnel, that is, orderlies and nurses, as well as junior nurses, according to the May decrees, the goal was set to bring their incomes to the level of the average salary in the region. The goal is certainly correct. However, in some regions a simple step was invented - the nursing staff was reduced, but the workers were not fired, but transferred to technical staff positions. At the same time, their salaries turned out to be even lower than before.

For example, in the Sverdlovsk region, most hospitals did exactly this, and a nurse who received 17 thousand rubles a month began to receive 12 thousand, and her annual leave was reduced by more than half - from 60 working days to 29 calendar days. This situation is proven not only by the stories of the workers themselves, but also by documents - the duties of a nurse were included in the job descriptions of the cleaners.

In principle, even officials do not deny this situation. The Minister of Health of the same Sverdlovsk region directly said that by 2018 junior medical staff will be reduced fourfold. In large and seemingly wealthy St. Petersburg, there is a similar story - the authorities directly announced that they had laid off half of the junior medical workers, transferring some of them to the category of technical workers, for the same purpose - saving wages and distributing money in favor of the remaining medical workers to perform May decrees.

Thus, it was formally promised that medical workers would live better, but in fact many began to live even worse.

Although officials will most likely be able to bring the necessary indicators to the required level, and on the eve of the presidential elections, President Putin will report that his decrees of 2012 have been implemented, which means he has coped with his responsibilities perfectly and has the right to lead the country again.

The given example of how medical personnel were treated is just one of many examples of fraud with statistics. Journalists also wrote about more global work with numbers, when average salaries in the regions were artificially restrained, and the average salaries of doctors were artificially increased. Including, for example, by including in the calculation of the income of doctors of private clinics, who most often receive much more than their colleagues from public medical institutions.

What will happen to doctors’ salaries from January 1, 2018

Judging by the latest news coming from the government, the percentage of salary indexation for doctors in 2018 will indeed be quite good. Finance Minister Anton Siluanov called the indexation percentage for public sector employees included in the May decrees at 23%.

This is significantly higher than the indexation percentage of 4%, which most other public sector employees expected in 2018 - from the police and army to the officials themselves.

Back in the fall of 2017, Health Minister Veronika Skvortsova reported on how much medical workers in Russia receive. According to its data, in the first half of 2017, medical workers in Russia received on average per month:

• 52.9 thousand rubles - doctors,
• 29.4 thousand rubles - nursing staff,
• 19.3 thousand rubles - junior medical staff.

Such data were announced at the congress “Russian healthcare today: problems and solutions.”

According to the portal Trud.Com, the income of doctors in Russia is much more modest than in the minister’s report. According to portal analysts, the average doctor’s salary in 2017 was 30-35 thousand rubles per month.