"Saving lives. Inexpensive". Ambulance workers in Dorogobuzh decided to protest

Julia Suntsova

In early June, employees of the ambulance service of the Dorogobuzh Central District Hospital did not renew their employment contracts and were not confirmed in any other official way that they were willing to pay overtime. The personnel department at that time pretended to be in a tank and continued to draw up work schedules for paramedics, taking into account non-existent contracts, which in reality means unpaid shifts.

21 out of 27 paramedics of the department signed applications for waiving unpaid part-time jobs. This threatens the absence of the usual number of brigades in the coming months.

Salaries have long been inadequate for the severity of work and the responsibility that workers in the emergency service bear and whose main duty is to save people's lives, protesting medical workers explain.

Drivers of the service have not yet refused to travel, but they fully support the demands of paramedics with their signatures under collective appeals.

- Extremely low salaries. For example, an ambulance brigade paramedic with the highest category and sixteen years of continuous work experience in the Central District Hospital receives a little more than 24-25 thousand rubles for one rate (data for March), after deducting income tax, it turns out about 21-22 thousand rubles. For a paramedic without a category and experience, the salary is another 5.5 thousand less. It is not surprising that young people do not work in the ambulance at all, and indeed there is a constant outflow of personnel. The last time two graduates of the medical school were hired was already in 2008 and 2012, that is, they came to us 14 and 10 years ago. Over the same years, an experienced paramedic came only once, - paramedic Lyudmila Voitenko says.

For comparison, a paramedic of the highest category and similar experience in the Vyazemsky Central District Hospital (neighboring district) receives 44.6 thousand rubles for one rate. In the city of Safonovo, located 20 kilometers from Dorogobuzh, the medical assistant's salary is twice as high.

Such an inequality with a gap of almost 2 times with identical work in a state institution, in the same subject of the Russian Federation, with the same length of working time, defies logic and gives rise to questions, protesters say. Why do employees working according to the same standards and rules of the emergency service, in a unified healthcare system, have salaries that differ by one and a half to two times?

The remuneration system for ambulance workers is based on humiliatingly low salaries, which are half the officially established subsistence level in the Smolensk region (as of January 1, 2022 - 13,793 rubles). Thus, the salary of a paramedic on a mobile team is only 7,983 rubles, a paramedic for receiving calls is 7,725 rubles, and a driver is 6,860 rubles.

On May 1, indexation was carried out - 4%, that is, the salary of the paramedic was raised up to 8302 rubles, the driver - up to 7134 rubles. All this looks like a mockery - especially against the backdrop of inflation, adds Voitenko.

Recall, according to Rosstat, only for the period from the beginning of 2022 to May 13, 2022, consumer price inflation in Russia amounted to 11.84%, and according to the results of the entire 2022, the Central Bank of Russia predicts inflation of 18-23%.

In April of this year, ambulance workers of the Dorogobuzh Central District Hospital, among other things, received notices about a change in the criteria from July 16, 2022, according to which incentive payments are accrued for intensity and high performance.

The new rules, in fact, introduce a system of fines for the employee (they promise to deduct grades and points already earned according to other criteria). The innovation, of course, contradicts the principles of wages laid down in the Labor Code, which do not allow a system of penalty deductions from wages.

In addition, “planned volumes” are linked to the performance indicators of the employee’s work, which means the number of calls received by the emergency department. However, the number of calls cannot depend on the personal contribution of individual workers, especially in the conditions of an emergency medical service, and the decision on this criterion to charge (or not to charge) additional payments looks absurd.

- In order to somehow make ends meet, many of us are forced to work over the norm of working hours, for one and a half rates, sacrificing our health and personal time that could be devoted to loved ones and children. But even this does not change much - for work above the rate, even a stimulating allowance of 7 thousand, which is included in the structure of our salary, is not charged. That is, this additional labor is proportionally paid even worse - it costs almost 30% less! - explains the paramedic of the visiting brigade Irina Okhlupina.

Even more shameful is the situation with wages for ambulance drivers.

Their salary for 1 rate is only 15 - 16 thousand rubles a month!

These "norms" were confirmed in a recent response letter by acting. head of the Department of the Smolensk region Irina Veselova - 16 thousand 584 rubles was the average monthly salary of one of the drivers.

- How to feed yourself and even more so your family with this money, especially in the conditions of current inflation? The hospital administration forces drivers to work at a second job between shifts, neglecting rest. This most often leads to an accident involving an ambulance, says ambulance driver Anatoly Filippov.

Drivers always help the paramedic carry heavy patients, although this is not part of their job responsibilities. Hours in excess of the rate are paid to drivers not at an increased rate, as required by Art. 153 of the Labor Code of the Russian Federation, as for work on a day off, but on a part-time basis, which is contrary to the labor rules for drivers.

If the administration does not provide the monthly norm of hours in the driver's schedule, his salary simply decreases. In order to legitimize this practice, drivers are forced to sign statements agreeing to be paid in proportion to hours worked.

In addition, according to our observations, drivers are discriminated against when registering for the payment of federal “covid” payments. There were cases when the doctors of the visiting brigade were issued "covid" cases, but the drivers of the same brigade were not.

On top of that, on their weekends, drivers are forced to go out to repair cars in order to fix them on their own, and this is not paid properly. The technical condition of the fleet base needs attention, there are worn-out cars, and this directly affects the safety of medical staff, drivers and patients. The lives of patients also depend on the professionalism of the driver in the ambulance service - the time of arrival on a call and delivery of the patient to a medical institution, as well as the level of safety of medical evacuation on the road, sometimes cost lives, the collective appeal says.

Not only are the salaries in the ambulance of the Dorogobuzh Central District Hospital so meager, the hospital management has recently been making every effort to reduce the existing salary, the interlocutors note.

• Since January 2020, a personal multiplier of 3,100 rubles was removed, which compensated for the reduction in payment for the category in the amount from 70% to 30% of the salary and for the length of service from 80% to 40%.
• Since April 2022, a 20% surcharge to the salary has been removed for the increased amount of work arising due to the lack of orderlies and a disinfectant in the state of the ambulance department. The current and final disinfection of ambulances is carried out by paramedics and drivers themselves. Meanwhile, in the professional standards approved by the order of the Ministry of Labor and Social Protection of the Russian Federation in 2021, the sanitization of car interiors is not included in the labor functions of a paramedic.
• For several years now, there has been no payment for patients whose medical care is paid from the budget (outside the CHI program).
• Due to the unreasonable withdrawal of the third brigade from the line at night, the number of night shifts decreased, which also led to a decrease in wages.
• The compensation allowance for an increased (3.2) class of harmful working conditions is paid at a minimum of 4 percent of the salary (although, for example, this allowance is 15% for nurses in the admissions department of the Dorogobuzh Central District Hospital).
• No allowance is paid for work in rural areas, although about 20% of the residents of the Dorogobuzh region we serve live in rural areas.
• Contrary to the Resolution of the Constitutional Court of the Russian Federation of June 28, 2018 No. 26-P, the allowance for working on weekends and non-working holidays is paid only on the basis of salary - excluding incentive and compensation payments.

The protests were preceded by attempts to organize a negotiating table with the hospital administration. However, the employer responded to the written demands with a reply and even accused the ambulance workers of not working enough and not fulfilling the plan, and at a meeting with the staff, he said that the hospital had “no money” to increase wages.

Dorogobuzh ambulance workers also outlined the situation inside the hospital in their collective appeals to the President of Russia, the Federal Minister of Health, the governor and the head of the health department of the Smolensk region.

“On June 6, the administration of the Dorogobuzh Central District Hospital terminated part-time employment contracts contrary to the interests of the service. We are not involved in work on the terms of Article 153 of the Labor Code of the Russian Federation, although there is such an opportunity.

In this regard, there were problems with the scheduling of work shifts for June. The schedule for July has not yet been drawn up. For us, paramedics and drivers, this means a reduction in salaries, and for patients, a decrease in the number of teams on the lines every day, that is, an even longer wait for an ambulance and even less chance of a successful outcome in severe cases," the Dorogobuzh ambulance workers said in a statement. .

- With a long list of what and in what form the employees of this ambulance owe everyone, the station was not provided with the necessary number of brigades. Since 2021, the daily number of brigades at this station is 2.5 brigades (3 per day, 2 per night), while in accordance with federal standards approved by Order of the Ministry of Health of Russia dated April 20, 2018 No. 182, in areas with low population density with a radius of the territory equal to 50 km provides for 1 brigade per 7,000 people. Accordingly, 3.5 brigades are needed, that is, 1 more brigades. In his letter with ref. No. 0336, the employer, in response to our arguments, resorted to an arbitrary interpretation of the 182nd order of the Ministry of Health, dividing the territory of the served area into sections with different density and radius of service. This argument could still be taken into account if separate substations or posts were formed at these sites, but all brigades and personnel are deployed at one point - in the urban-type settlement of Verkhnedneprovsky, - Andrei Konoval , Secretary of the Interregional Trade Union of Medical Workers "Action" comments on the situation. .

Due to the three-level system of medical institutions introduced in recent years and the corresponding routing, often 1-2 teams are removed to transport patients to other cities of the Smolensk region: Vyazma (60 km), Smolensk (110 km), as well as in Yartsevo, Safonovo.

Patients are taken to neighboring settlements due to the absence of a number of on-duty specialists in the district hospital - a surgeon, a traumatologist, a gynecologist, a urologist ... The mileage of such calls is from 22 to 110 kilometers in one (!) Way, and the time spent on servicing one case, can be from 2 to 8 hours.

At the same time, the load from the entire territory falls on the remaining brigades on the lines in the Dorogobuzh region, and the time for patients to wait for ambulance crews increases. The risks of tragic outcomes for emergency patients are growing due to the fact that none of the teams is free at the right time. In these circumstances, even the not very large average daily number of calls per team cannot serve as an indicator of the low workload on ambulance teams.

An equally significant load factor is the duration of the calls, and not just their number. And, of course, in the interests of patients, the ambulance service must work on standby, otherwise there is a threat to the life of an emergency patient due to the fact that all teams are on call, Konoval emphasizes.

The employees of the ambulance station who signed the collective appeal separately talk about the conditions in which they have to work for many years.

Access roads on the territory of the Central District Hospital have not been repaired for many years, and in winter and summer they are in a terrible state.

The ambulance station itself has not been repaired for more than 15 years. During this time, the flooring was worn out, a fungus bred on the walls, which is not compatible with the sanitary and epidemiological regime of the medical institution.

- The ambulance room looks like a homeless den. Deputies, when they come to congratulate us on the Day of the Medic, each time suffer for a long time with the choice of a place for a group photo. The administration of the Central District Hospital tells us that it has no funds - neither to raise wages, nor to create decent and safe working conditions for ambulance workers. The management considers the reduction of the accumulated accounts payable of the hospital to be the most important success. But if this is so, then the question arises - what are the reasons for this state of affairs? It turns out that the regional government and the Smolensk Regional Duma have not been providing adequate funding for subordinate medical institutions, at least the Dorogobuzh Central District Hospital, for a long time, so that the hospital management is forced to save on the most necessary?! And what is the way out of this situation? We have to work even more - for two rates? Look for earnings on the side? Or leave the CRB altogether? But then who will stay and provide medical assistance to the population of the region?.. - paramedics ask a rhetorical question.

Ambulance workers in Dorogobuzh demand to increase their wages by 1 rate and further discuss the accumulated problems, taking as a basis the normal working hours - 1 rate, and not the average monthly salary, which includes all overtime, including part-time jobs and combinations, work on weekends and holidays.

To increase salaries, doctors propose to establish official salaries, work on weekends and holidays, as well as double pay for overtime work, return bonuses for classiness to ambulance drivers, withdraw notifications of changes from July 16, 2022, criteria for calculating incentive payments for intensity and high performance of work, etc.

The ambulance team also asks the supervisory authorities to verify the information provided about violations of legislation in the field of labor and health protection of citizens and take appropriate response measures.

"NI" sent a request to the Department of Health of the Smolensk Region with a request to indicate their position on the problems voiced by the employees of the ambulance station in the Dorogobuzh Central District Hospital. At the time of publication, no response had been received.