How Much Will The Doctor Get Paid

How much will the doctor get paid

The capital's authorities have made changes to the system of remuneration of medical workers: by slightly increasing the minimum wages, they sent under the knife allowances to them - for an academic degree, seniority, certain specializations, and harmful working conditions. Thus, in Moscow, following other regions, the recommendations of the Ministry of Health are bypassed to change the ratio between the basic and incentive part of the salary of doctors.

The capital's authorities have made changes to the system of remuneration of medical workers: by slightly increasing the minimum wages, they sent under the knife allowances to them - for an academic degree, seniority, certain specializations, and harmful working conditions. At the same time, the management of medical institutions received even more freedom in assigning incentive payments - for the results and quality of work. Thus, in Moscow, following other Russian regions, the recommendations of the Ministry of Health are bypassed to change the ratio between the basic and incentive part of the salary of doctors.

Ministry of Health: work on mistakes

The new rules were supposed to be a work on mistakes. In recent years, the Ministry of Health has recognized the imperfection of the existing system of remuneration for medical workers. State institutions have switched to this system since the beginning of 2013. The unified wage scale was replaced by individual labor contracts and supplementary agreements, and the notorious incentive part of the salary appeared, which could change depending on the results and quality of work. Thanks to the innovation, heads of departments and various institutions received unlimited control over budgetary and non-budgetary funds, the ability to independently draw up a staffing table and determine the amount of additional payments for employees. It was assumed that a special commission and a public council of the medical institution would evaluate the work of employees. In practice, this gave hospital and polyclinic management the ability to set salaries arbitrarily.

Here is what ordinary Moscow doctors told Mednovosti about their salaries:

Oleg S., neurologist

Taking into account the category and experience, my rate is about 25 thousand rubles. The rest is incentive payments. They are issued at the discretion of the administration. Before we were turned into a branch, having merged with another hospital, I received about 60 thousand rubles. The previous administration thought about employees, the new one - only about itself. They share the entire incentive fund among themselves. Even the trade union has no access to this “commission”. As a result, the deputy chief physician consistently receives a bonus of 250%. For me, 20% is a whole event, nurses and nurses generally have pittances.

Tatiana S., otolaryngologist

Today, the salaries of doctors with the same workload, skill level, length of service and position can differ several times. It all depends on the head physician, who distributes the "incentive" payments. My salary is 18.8 thousand rubles. At the previous place of work in the "stimulating" line there was never more than 6-8 thousand rubles. For the past few months I have been working for the same workload in the same position in a neighboring area. But the salary here is twice as much.

{# vrez.59478}

Checks of numerous complaints to the Ministry of Health confirmed what ordinary doctors were talking about from the very beginning: the salaries of employees with a similar level of qualifications, length of service and position can vary significantly, and depend not on the quality of work, but on proximity to their superiors. In some regional medical institutions, the salaries of doctors with the same workload differed nine times. As a result, Minister Veronika Skvortsova suggested that the governors change the current ratio, in which the basic salary of a doctor is only 40%, and the rest falls on incentive payments, to the opposite.

Moscow approach: an awl for soap

However, on the ground, they found a way to bypass the recommendations of the Ministry of Health. The incentive payments that did not depend on the arbitrariness of the authorities went under the knife, and the bonus to the salary guaranteed by the law - for seniority, certain specializations, harmful working conditions. That is, practically, the same basic salary.

The order of the Moscow Department of Healthcare No. 1033 of December 26, 2016 "On Amendments to the Order of the Moscow Health Department of 09.06.2012 No. 531" canceled, in particular, additional payments for an academic degree and honorary title. In addition, specialization allowances for doctors are being reduced. Thus, additional payments for psychiatrists, narcologists, as well as for doctors working with paralyzed patients, are reduced from 25 to 15%. Doctors working with HIV-infected patients will receive not 60%, but 30% of the official salary, and those who treat tuberculosis and cancer patients, children with central nervous system damage - not 15%, but 10%.

Supplements to employees of dermatovenerologic dispensaries, infectious diseases hospitals, surgical departments of all types of hospitals, hospice staff and even young specialists have been completely canceled. It is assumed that now medical institutions will independently, subject to the availability of financial resources, establish the conditions, procedure and amount of these payments. The length of service in public health is also depreciated - the recommended maximum payment for this is halved. As explained in the city health department, "this payment refers to the status and does not assess the qualitative and quantitative results of work."

At the same time, in the new edition of the order, the minimum salaries of medical workers have been increased. The salary for doctors increased from 18,600 to 30,000 rubles, for nurses - from 10,500 to 20,000 rubles, for junior medical staff - from 8,500 to 17,600 rubles. The "minimum wage" for heads of structural divisions has grown from 22,100 to 40,000 rubles.

As a result, virtually nothing has changed. For example, the basic salary of a dermatovenous dispensary doctor, Ph. D. under the new rules, it may amount to 34,500 rubles: the minimum salary is 30,000 rubles, the payment for seniority (15% of the salary) is 4,500 rubles. When calculating according to the old rules, this amount was 28,830 rubles: salary - 18,600 rubles, payment for seniority (30% of the salary) - 5580 rubles, for harmful working conditions (15% of the salary) - 2790 rubles, for an academic degree (10%) - 1860 rubles.

{# vrez.59477}

According to official data, the average salary of a metropolitan doctor is 70 thousand rubles. That is, even with the cut allowances, the base salary under the new system, although it becomes slightly higher, still does not even reach 50%, not to mention the 60% recommended by the Ministry of Health. And for ordinary doctors, incentive payments, which are independently appointed by the management of the medical institution, will continue to be of decisive importance. That is, a “bad” employee will receive 34,500 rubles, a “good” one - 105,500 rubles (an average of 70,000).

However, while this is all in theory. In practice, everything can be much more interesting, since financially hungry medical institutions will look for new ways to save the salary fund. As the organizing secretary of the independent Interregional Trade Union of Health Workers "Action" Andrei Konoval said, in one of the branches of the 180th Moscow polyclinic, instead of 24 district therapists, only eight work today, but doctors are paid extra for "expanding the service area" and super-intensive work "penny".

There are other ways to save money. For example, according to Anna Zemlyanukhina, therapist of the Diagnostic Center No. 5, the administration of the institution made changes to the collective agreement regarding the cancellation of additional vacations. The signature of the "pocket trade union" legitimized these changes. When it turned out that less than 50% of the employees of the institution were members of the official trade union, the administration, according to Zemlyanukhina, “tried to force employees into it” - threatening to deprive them of incentive payments and even dismiss them.

Regional experience: minus 30%

In addition, there is already the experience of the regions that began to "fulfill" the recommendations of the Ministry of Health before the capital. As Konoval said, active reform of the remuneration system in the regions in 2016 only worsened the situation. “Good goals were officially proclaimed: increasing the share of salaries in the structure of wages and reducing incentive payments, which are, in fact, a bonus,” said the activist. - But de facto, in a number of regions, the reform led to a decrease in salaries: having increased salaries by several thousand, the authorities simultaneously reduced compensation and incentive payments, including those that were guaranteed, and did not depend on the arbitrariness of the employer. So, in Udmurtia, guaranteed incentive payments were canceled for many categories of doctors at the regional level, and additional payments for harm, night shifts were reduced. It also canceled funding from the MHI fund for "piecework" incentive payments to polyclinic staff for each admitted patient. The preservation of these payments, as well as the previous level of compensation co-payments, were left to the management of individual medical institutions. And there they were immediately canceled. As a result, with the same amount of work, for example, many district therapists and narrow specialists of polyclinics began to receive 20-30% less."

In the decree of the government of the Udmurt Republic No. 501 of November 2, 2015, which approved a new system of remuneration for doctors, it is separately spelled out that while maintaining the volume and quality of work, the salary should not be less than the established on December 31, 2015. However, according to Natalia Strelkova, the local therapist of Izhevsk City Clinical Hospital No. 2, “there is no additional payment line for the period from January 1, 2016 to the present time, up to the level of 2015 provided for by this decree”. At the same time, the real volume of the doctor's work has increased. In particular, she is periodically involved in servicing patients in excess of the two areas assigned to her, the number of the attached population has grown from 1,700 to 2,000 people, the established plans for vaccination, clinical examination, and so on are overfulfilled monthly.

No longer hoping for the Ministry of Health, the hospital employees turned to the labor inspectorate and the prosecutor's office to protect their rights. As the doctors write in their statement, the salary of many of them has decreased by one and a half times: “district doctors receive about 24 thousand rubles, while in 2014-2015 their salary, under the same conditions, was 35-40 thousand rubles. Since April 2016, double pay for work on Saturday was canceled, since June - all additional payments to employees combining vacant positions, as well as for an increase in the volume of work. Abolished previously mandatory co-payments for district therapists and nurses. " And for all appeals to the management, doctors receive one answer: "The institution has no money."