«Olympic reserve» of doctors. Staff physicians will treat Russians due to a shortage of doctors

There is a catastrophic shortage of doctors and paramedical personnel in the country. According to the Ministry of Health, the shortage of doctors is almost 26.5 thousand people. And from the beginning of the year to mid-June 2023, according to the portal hh.ru, the number of vacancies for medical professionals increased by 22%. In total, 80 thousand vacancies are posted on the portal, of which 39% are offers for doctors. But there are few people willing: there are an average of 1.9 resumes per vacancy, worse only in the auto business — there are 1.8 resumes per vacancy, with a norm of 4-7.9 resumes per vacancy. Over the past year, 9.7 thousand doctors left the state medicine, and even more, 38.9 thousand — medical workers with secondary education. There is simply no one to treat people, so waiting times for an appointment up to 1 month have become the norm even in Moscow.

But 41605 residents are trained in the country — what is not the «Olympic reserve»? The Ministry of Health has prepared rules for admission of residents to work: they must successfully complete at least 1 year of residency, have a specialty from the group «clinical medicine», pass primary and intermediate certifications. Their work will be supervised by experienced medical mentors. Such changes should come into force as early as March 1, 2024. Will such interns cure or cripple people?

Legislators are not confused by such changes. Innovations, in particular, are supported by State Duma deputy and Honored Doctor of Russia Tatyana Kusayko.

— Patients should not be afraid. Students will be able to work only under the guidance of a mentor, after passing an intermediate certification, accreditation and on condition of studying in a residency for at least a year. This is a timely and important step — the independent application of the subject knowledge will help future specialists gain experience, make the right medical decisions and adapt faster in practical healthcare.

But not everyone agrees that young, newly graduated doctors are the solution to all problems. In the Altai Territory, for example, on the contrary, they are trying to retain experienced doctors of retirement age. They are paid allowances of 9 thousand rubles a month. 1.5 billion rubles have already been allocated for these purposes.

Larisa Popovich, Director of the HSE Institute of Health Economics, believes that under the supervision of experienced doctors, residents can do a lot of different work.

— There are a lot of different levels of tasks in medical activity that can be performed, including people without medical education in general, paramedics, for example, who exist all over the world, and residents have already completed a six-year training course, they know many things, they can perform many functions next to experienced doctors. For example, a prescription of medications prescribed by a doctor. They can help with routing, perform some auxiliary functions next to doctors, for example, in hospitals, they can monitor, monitor, take readings next to doctors — a huge number of such functions that go beyond nursing practice or correspond to it, because the experience of residents is somewhere at the level of experienced nurses. The only question is how the functions will be distributed and what tasks will be assigned to them in accordance with their professional competencies.

That is, in fact, we are talking about performing almost mechanical functions that do not require decision-making. This is already a matter of experienced specialists who, according to the idea, will control everything. But where to get them, when, again, there is a shortage of personnel? Who will supervise the youth? Experts express particular concerns about the operation of such a scheme in rural areas.

— If you look at the criterion where there is not enough anymore, it seems you need to send it to the village. But there is no way to single out people who will specifically babysit young people. And a young man in a remote rural area will practically be left to himself, the formation of a specialist's trajectory will go absolutely unpredictably. The number of errors and problems may be the maximum in this case. Therefore, the young people involved should be used under the patronage of older comrades, and this is possible in the situation of large cities and in polyclinics, and in consultative and diagnostic departments, and in hospitals, — says an expert in the field of public health, Candidate of economic Sciences Nikolay Prokhorenko.

However, in large medical centers, too, not everything is perfect — adds the expert

— If you use first—year residents in such routine areas as outpatient admission, as the management of patients after examination, this is basically the continuation of studies and work in one bottle. And it cannot have any catastrophic impact on the quality of medical services. It is another matter how this process will be organized in each specific medical organization where people undergo residency. In some places there are special mentors from among experienced doctors, in some places there are programs that allow graduates of medical schools to enter the practice of healthcare, and in some places they are extremely facade and formal, and in some places they are just on paper. And all this depends more not on the student himself, but on the clinical base where he got to.

It turns out a paradoxical situation: residents can work where experienced doctors are already present in sufficient numbers, and have the opportunity to monitor interns. And where the shortage of medical personnel is most acute, there is nothing for residents to do there.

The Ministry of Health under the leadership of Mikhail Murashko, patching up personnel holes with trainees, is trying to fight the investigation, leaving out the reasons for the shortage of qualified doctors. More about this — in the following material «NI».