The salary of a health worker is undergoing significant changes. Contractual wages for health workers were adopted. In accordance with the regulation on the new remuneration for medical workers, salaries are calculated based on three components.

Taking into account that physicians receive monetary rewards from public funds, the size of their salary is established by the norms of the law. How are health workers paid now? What changes are coming in 2018 regarding the size of the remuneration for doctors? These and other issues are discussed in this article.

Public sector employees were transferred to a fundamentally new system of remuneration for their labor. Previously, doctors were charged according to the approved tariffs. Now the salary of doctors is regulated by unified recommendations for the establishment at the federal, regional and local levels of salary systems for employees of state and municipal institutions.

The contractual remuneration of health workers consists of three components:

1. The salary itself, depending on the position and qualifications.

2. Compensation payments - payment for conditions other than normal. For example, for night duty, processing, work with a special contingent.

3. Incentive payments - clearly personalized monetary remuneration paid by order of the head to a specific employee.

At the legislative level, the recommended minimum salaries of employees for each position are established. Subjects have the right to increase the salaries of doctors in their region, if the budget allows. In this regard, in some cities, for example, in Moscow, the salary of medical workers is much higher than in other regions, for example, Yekaterinburg.

It's no secret that medical professionals receive small remuneration for their work. Due to the crisis, the salary of doctors from 2016 to the present has not been significantly indexed. However, in accordance with the Order of the Government of the Russian Federation N 2190-r, by 2018, the salary of medical workers in 2018 should increase significantly. The salaries of doctors should be doubled. However, there is still no normative act adopted in pursuance of this order. The law on the budget, in which the increase should be spelled out, exists so far only at the stage of the project. Therefore, it is too early to draw a conclusion about an unambiguous increase in wages.

The salaries of physicians are greatly influenced by such an innovation as formalizing labor relations in the public sector by concluding effective contracts.

Such contractual payment of medical workers is provided for by Order of the Ministry of Labor of Russia N 167n. An effective contract should be understood as the same labor contract, but in which, in addition to securing the duties of a medical worker, descriptions of working conditions, criteria for assessing the effectiveness of the work of doctors are also prescribed. This makes payments more transparent and predictable.

This regulatory act approved the approximate form of such a contract. However, when formalizing relations with doctors, you can also use the old form of contracts, but their text should include criteria for effectiveness in accordance with the law.

Specific conditions for payment to health workers are indicated in the local act of the medical institution in which the employee works.

However, when remunerating health workers in 2018 in terms of incentive payments, the following criteria should be followed:

1. for the intensity and high results of work. For example, you might find that the incentive allowance for a specialist doctor is based on the number of visits. Or surgeons are charged a fee, depending on the complexity of the operation;

2. for the quality of work. Incentive pay for this criterion may be charged in connection with a certain qualification. For example, a massage therapist of the highest category receives more payments than a physician who does not have this category in massage;

3. for the length of service and length of service. The longer a physician works in the public sector, the higher his salary. This allows you to retain experienced personnel;

4. based on the results of the work. By the decision of the head physician, medics can be paid bonuses based on the results of a month, quarter, year.

Also, when assessing the effectiveness of doctors' work, such circumstances can be taken as the absence of substantiated complaints from patients, participation in specialized seminars, the absence of cases of mortality due to a medical error, and competent execution of all medical documentation on time.

For the payment of incentive payments to nurses, performance criteria can be such circumstances as the absence of emergencies in the subordinate department, compliance with the rules for storing medicines, and quality provision of patient care in a hospital environment.

Due to the nature of the profession, doctors often have to provide assistance to the sick at night. For such work, additional cash as compensation payments. Labor law stipulates mandatory increases in pay for night work.

The minimum amount of the increase is established by a by-law and is 20% of the person's hourly rate. In this case, the night time is considered to be from 22 to 6 in the morning. Departmental acts apply to physicians.

For example, in Moscow it has been established that healthcare workers receive an additional payment of at least 20% of the hourly rate for each hour of work at night. The amount of payment to a physician can be even higher if this is fixed by a local act of the institution. It can also be envisaged that the employee will receive additional rest time.

An alternative to shifts for doctors is such a form of employment as duty at home. Such a mode of operation is not named in the Labor Code of the Russian Federation, however, it is provided for by a special departmental act - Order of the Ministry of Health of Russia N 148n.

In this case, the remuneration of medical workers is charged in the following volume:

The period of time during which the physician at home is waiting for a call is counted as 1/2 hour of working time for each hour of stay at home;

The time spent on providing medical care, and the time it takes a physician to travel from home to work and back as one to one.

Remuneration for medical workers is established by the norms of the federal and regional legislation.

In all budgetary institutions, there is a regulation on new remuneration for medical workers, according to which the salary of doctors consists of three components.

Also adopted are the minimum salaries, criteria for evaluating the effectiveness of the work of doctors, especially pay at night, while on duty at home.

Based on these norms, the budgetary institution sets the payment for each employee. Time will tell whether there will be a serious increase in salaries.

Many things in the state are interconnected, and everyone is well aware of how close the relationship is between the level of salaries of medical workers and the quality of the services they provide. Today information about what will be the salary increase for doctors in 2018, is considered especially relevant among the population, because any Russian is worried about his health and wants to receive actually high-quality medical services, and without their high payment by the state, it will not be possible to achieve this goal.

Olga Golodets, when discussing the effect of the "May" presidential decrees, made a sensational statement, saying that since 2018, doctors' income will increase by 200% compared to the 2012 level. According to her, the money for the implementation of this event was laid in state budget, and the decision has already been fixed by members of the government, therefore, no one plans to change it. Doctors must receive decent wages, because otherwise they will simply not be able to perform their duties efficiently and efficiently, and everyone, without exception, can suffer from this.

The salaries of people who are employed in the medical field today differ depending on the territorial location of the medical institution in which they are employed. The highest incomes today are for those doctors who work in St. Petersburg and Moscow, but soon the difference between them will decrease, because the increase in salaries in the healthcare system in 2018 in the Russian Federation will be uneven, so that all representatives of this profession receive approximately the same money.

Detailed calculations

Today, the salary of medical workers consists of a salary, additional payments (compensations) and allowances. The Ministry of Health increased the salary of medical workers (in accordance with the presidential decree), but practice shows that it is due to this that the overall level of wages decreases, because additional payments and compensations are becoming much smaller. Compensations are accrued by the head of the organization on a voluntary basis, respectively, you can lose them for almost any reason.

Ponder over the fact what will happen to the salaries of doctors today it is also due to the fact that the new methodology for assessing working conditions has shown itself in practice from an extremely negative side, because today compensation payments are paid specifically on the basis of an assessment of the workplace, and does not depend in any way on the position occupied by a person. Previously, the position was extremely important and surcharges were calculated on its basis, therefore, their size was larger.

Consequences of wage growth

The price of a rapid increase in wages may be too high, because there is a crisis in the country and there is sorely lack of money to restore the financial well-being of public sector employees. According to experts' forecasts, salaries of medical workers should rise from “average” 35,000 rubles to almost 50,000 rubles, however, according to medical professionals, they did not feel much of a difference between their past and present income. Moreover, more than 5,000 people from different regions of the country took part in the social issue on this issue, and the bulk of the respondents said that their salaries today do not exceed 20,000 rubles.

Only the growth of "black gold" can positively change the current situation, because only these funds can be spent on salary increase for doctors in Russia in 2018, latest news, however, they are still disappointing on this issue, because oil remains at a consistently low level. Taking into account all the above situation, one cannot but say that the real incomes of physicians simply cannot be increased (in any case, in reality, although growth is possible on paper, because such a practice has already taken place in past years).

With a 100% guarantee, one can only say that it will remain mandatory indexation of medical salaries, which in 2018 will correspond to the level of real inflation. The indicator coefficient was determined by the government at 4.5% (preliminary), which will enable the salaries of doctors to grow exactly by the percentage of inflation, and they will not feel the increase in the cost of food and services. There was no talk of additional indexing, which was practiced earlier.

Will there be a reduction?

It was already mentioned above that in the course of the optimization measures, almost 90,000 medical workers had already lost their jobs, as a result of which the workload on those who remained increased significantly. Today we can say for sure that reduction of doctors in 2018 in Russia, not planned, but the situation may change. And, of course, one should not take into account the fact that any person can lose their job in the event of poor performance of their duties, however, this will not be a layoff, but a dismissal (and severance pay is paid extremely reluctantly today).

Photo: Photo by Maxim Platonov

On October 1, doctors' salaries were raised - the base salary for doctors increased by almost 3 thousand rubles, for junior medical staff by 2 thousand, and for the average - by 600 rubles. The increase takes place within the framework of the execution of the May decrees, according to which, from January 1, 2018, doctors should receive 200% of the average salary in the region, and nurses and nurses - 100%. However, the experts of Realnoe Vremya advise doctors not to flatter themselves: the decree provides for the concept of “ average salary", Which is far from real.

"If the average salary in Tatarstan is 30 thousand per month, it does not mean that the doctor will receive 60"

Since October 1, salaries have been raised for doctors in Tatarstan - this is only the first part of the increase, the second is scheduled for January 1. According to the resolution of the Cabinet of Ministers of the Republic of Tajikistan No. 731 of September 29, 2017, the base salary of a specialist doctor will increase from 8748 to 11,722 rubles, nursing staff - from 7890 to 8560, and junior - from 6415 to 8498 rubles.

From October 1, the ratio of the average salary of doctors in the republic to the average salary in Tatarstan should be 180%, nurses - 90%, junior medical personnel - 80%. And from January 1, 2018 - 200% and 100%, respectively.

So, in the first quarter of 2017, according to the Federal State Statistics Service, the average salary in the Republic of Tatarstan was 29 358 rubles. 200% - the figure is almost fantastic, it would seem, finally, a holiday is coming on the street of doctors. "I have no doubt that this will be done," says Gulnar Khusnutdinova, chairwoman of the Tatarstan Health Workers' Union, "and the budget was drawn up with these increases in mind." But he immediately advises not to flatter yourself, because we are talking only about the average salary, and not the real one.

Gulnar Khusnutdinova advises not to flatter yourself, because we are talking only about the average salary, and not the real one. Photo: proftat.ru

If the average salary in Tatarstan is 30 thousand per month, this does not mean that the doctor will receive 60. This will not happen, because someone has a salary of 20 thousand, someone has 300 thousand, and this will be an average figure, - says Gulnar Khusnutdinova.

Which of the doctors receives 300 thousand? There are few such doctors, but they are, the leader of the trade union movement answers. And these are not necessarily chief doctors, but highly qualified specialists, "world-class doctors, these are the RCH and the ICDTs, they will be gladly accepted in Germany and the United States, and in order to keep them here, an appropriate salary is needed."

The majority of doctors have a salary of 27-30 thousand rubles a month, and only together with paid services and part-time jobs can it reach 40 thousand rubles. And practically everything is combined - on average, a doctor in Tatarstan works at 1.4 rates.

Optimization in Russian: the salaries of nurses will be distributed between doctors

In the interregional trade union of health workers "Action" fears that the figures set by Putin's May decrees will be achieved through optimization. We started with the junior medical staff - there was practically no one left in the hospitals, all the nurses were transferred to the position of cleaning women. Consequently, the decrees in relation to them do not need to be executed. At the time of publication, Realnoe Vremya failed to officially confirm these data, but experts cite figures for other regions of the Volga Federal District.

According to Rosstat, in the first quarter of 2016, the number of nursing staff decreased by 50 thousand people. In the Sverdlovsk region, junior staff were cut by 43 percent. In the Nizhny Novgorod region in the first half of 2017, 30 thousand people were made redundant, ”says Andrei Konoval, co-chairman of Action, an interregional trade union of health workers.

"Rosstat, perhaps, will record these data by region, but one must understand that these are average indicators, and the internal structure of the distribution of the wage fund is not in favor of the majority of medical workers," Konoval said. Photo by Maxim Platonov

According to Konoval, the government decree on the execution of the May decrees really spoke of the need for optimization measures and an increase in wages due to the vacated places, but now this is taking on caricatured forms.

A bright history in the Knyagininskaya Central Regional Hospital of the Nizhny Novgorod Region. They have two ambulance teams, each with one paramedic - there are no doctors. Earlier calls to these brigades were received by a nurse. This is a disgrace, of course, because she does not have sufficient qualifications to assess the severity of the patient's condition, but at the beginning of the year the nurse was also laid off, as throughout the country, and these functions were entrusted to paramedics. And what to do when the paramedics left for the call? Then the call is taken by the former nurse, and now the cleaning lady. And when her working day ends, she is received by a cleaning lady from a neighboring department, - Andrey Konoval talks about optimization in Russian.

Konoval believes that doctors of the mass category will not receive a salary of 200% of the regional average from January 1. “Rosstat, perhaps, will record these data by region, but one must understand that these are average indicators, and the internal structure of the distribution of the wage bill is not in favor of the majority of medical workers. In Udmurtia, a hospital doctor has a salary of 13 thousand, and the authorities report that in the first half of the year they had an average of 39 thousand. The same applies to Moscow: the average salary is declared to be 100-120 thousand, in reality the situation is different - the local therapist receives 40-50 thousand "

"Average salary plus 200 percent, but subject to full working hours"

Former Minister of Health of Tatarstan, now deputy of the State Duma Ayrat Farrakhov, believes that raising the salary of doctors to 200% of the regional average is a real task, there are sources of funding.

The sources of financial support for health care in our country are the compulsory medical insurance and the budgets of the constituent entities of the Russian Federation. In general, contributions to the compulsory medical insurance are 20 percent higher, and the budgets of the subjects have increased the volume of appropriations by more than 16 percent. The growth of appropriations in health care allows us to achieve the required level of salaries, and I am absolutely sure that this will be done, ”says Ayrat Farrakhov.

According to Farrakhov, increasing the minimum wage is not a one-time action, by 2019 it is planned to equalize the minimum wage and living wage... Photo by Maxim Platonov

How much doctors will receive, the deputy found it difficult to name, according to him, it all depends on the average salary in the economy, which will be in the region after January 1: “The average salary plus 200 percent, but subject to the full norm of working hours. Not part-time, not a quarter-rate, but at full working hours. "

As for the nurses who were transferred to cleaners, their salaries, according to Farrakhov, will also be increased. “In health care there are categories of workers who do not belong to the specified ones, but there are also additional allocations: it is planned to increase the minimum wage from January 1 to 80 percent of the subsistence minimum - this is almost 2 thousand rubles, and the second is a 4 percent salary indexation - this money will be enough to carry out decrees and raise salaries. "

According to Farrakhov, increasing the minimum wage is not a one-time action; by 2019, it is planned to equalize the minimum wage and the cost of living.

Therefore, there will be no low-paid budget jobs. Equating the minimum wage and the living wage, we are talking about the fact that there should not be poor people. There should be no working people who have an income below the subsistence level, says Farrakhov.

For the subjects, the deputy believes, the implementation of the May decrees is a financially intensive task, but 30% of the costs are covered by the federal budget. After the increase, efforts will need to be made to maintain the wages that have been achieved.

Daria Turtseva

The growth of incomes of public sector employees has been and remains one of the priorities social policy the state. Among them are medical workers. Will there be a salary increase for doctors in 2018? Should we expect a real increase in incomes or exclusively equalization in terms of the inflation rate? How are the May decrees of the President implemented in this part? All the answers are in our article.

Health care workers' salary growth program

5 years ago, Russian President Vladimir Putin in his May decrees set a strategic task:

Bring the level of doctors' salaries in 2018 to 200% of the regional average. For nurses, the bar is set at 100%.

According to the authorities, already in 2017, in a number of regions and regions of the country, the income of medical personnel approached 180% of the regional average. Olga Golodets, who is responsible for the social sector in the government, pleased with the announcement that the money for the implementation of this project has been programmed in the budget. Doctors can only improve the quality of services, receiving decent remuneration for their work.

An important component of this process is the equipping of medical institutions of the country with high-tech modern equipment. I am glad, as Vladimir Putin emphasizes, that about 60% of such high-precision equipment is produced in Russia, some of them at defense plants as part of conversion programs.

Moreover, it really is now reaching remote regions. For example, in the Arkhangelsk region, complex operations are performed on vessels, including stenting by the endovascular method, that is, a stent is placed on large vessels without incisions, through a puncture in one of the large arteries. And recently, in the same city hospital in Arkhangelsk, a donor kidney transplant was performed for the first time.

Difficulties in reforming the industry

The first problem lies on the surface - the country's economic difficulties lead to a deficit of finance, this is the first brake on the path to increasing the salaries of doctors in 2018.

Therefore, the issue is partially resolved through "optimization", but simply - through the reduction of staff and the consolidation, or even the closure of offices.

In the five and a half years that have passed since the announcement of the Decrees, 90 thousand medical workers have lost their jobs. And the process will certainly continue in the coming years.

The remaining employees have to take on an increased burden on themselves. It is no secret that many doctors and nurses, orderlies work at one and a half rates, plus - night shifts. But even these "super profits" are partly eaten away by inflation, growth in retail prices and tariffs for various services.

At the end of October, an obstetrician-gynecologist who worked at the Angarsk Perinatal Center died. She was on duty for at least 24 hours, many sources reported that her "working day" lasted 30 hours without interruption. The body could not withstand the load, especially since this was far from the first long-term duty of a responsible qualified employee of the maternity hospital.

Now the salary of medical workers consists of the following components:

• salary;
• surcharges for intensity and difficulty;
• allowances for category and length of service;
• regional coefficients.

If the salary grows from time to time, then it is quite possible to lose the bonus and other allowances: this is how the authorities will look.

It is important that, depending on the region, the level of remuneration can differ markedly. Both capitals have the ability to maintain the income level of doctors and other workers in the field at a decent level, but in other regions of the country, the situation is not always so good.

If the country's leadership sets the task of leveling these levels, then the capital's authorities are trying to preserve the privileges of the Moscow Aesculapians. Recently, Moscow Mayor Sergei Sobyanin announced that in 2017-2018, the salaries of employees of medical institutions in Moscow will be raised by 40% compared to 2016. In absolute terms, it will be 120 thousand rubles a month in 2018, the mayor promised. The mayor also called on health officials to monitor the workload of doctors.

What do we have in reality today?

Everything is clear with Muscovites. And on average in the country, if the task set by President Putin is fulfilled, by the end of 2018, doctors should have a salary of 90 thousand rubles. But there is one big trick here:

Since 2017, the incomes of not only state healthcare institutions, but also private sector owners have been added to the common “piggy bank”. Add regional scissors to this, and the picture becomes even more confusing.

Now officially, the average salary of doctors is already called 47 thousand rubles.... In private clinics today, the "average" cosmetologist or other specialist has 90 thousand. A municipal therapist in Ingushetia can count on only 23 thousand a month, while in the Yamalo-Nenets and Chukotka Autonomous Districts it reaches 110 thousand (including the northern allowances).

Nurses are content with a salary of 20 thousand, and also on average. In a number of regions of the country, a decrease in salaries of medical personnel was noted in the first half of 2017 - these are Ingushetia, Adygea, Dagestan, the Jewish Autonomy, the Arkhangelsk region and the Nenets district.

25 regions showed an increase, but by a very small amount, for example, in Altai it is plus 53 rubles a month. And somewhere even less. The disparities are especially visible against the background of the income of Western doctors. In terms of our money:

• an American therapist receives about 416,000 rubles;
• in France his salary is 200,000;
• in Germany - 225,000 rubles.

Increase of salaries of doctors in 2018: news from the government

In October 2017, the salaries of health workers were indexed by 5.5%. Deputy Prime Minister Olga Golodets hopes that in 2018 the implementation of the May decrees of the President will be fully implemented. They are otherwise called " Social guarantees development program».

Some experts express doubts that the May decrees can be implemented as early as next year.... But the Deputy Prime Minister is more optimistic. Golodets reminds that over 670 billion rubles have been allocated from the state treasury for the project. If we compare the financing of the medical industry in terms of salaries this year and next, the optimism looks reasonable. In 2018, funds will be sent to different regions of the country twice as much as a year earlier. In this regard, the prospects for a tangible increase in the salaries of doctors in 2018 look real.

A colleague echoes and Minister of Finance... Anton Siluanov foresees an improvement in the situation in the budgetary sphere as a whole in the near future:

Real wages are projected to rise 4.1 percent next year. This is also due to the fact that we are increasing wages and payments in the public sector.

In 2018, 80 billion rubles will come from the budget to the medical industry to raise salaries. This was announced by the head of the Ministry of Labor of the Russian Federation Maxim Topilin. In part, the growth of salaries in health care is possible due to such a factor as the per capita standard. In 2018, it will increase by 21.7%, which will total 333.2 billion rubles. This standard can be described as the amount of funds allocated per year for one person attached to a specific medical institution under the compulsory health insurance system.

2018 is the last year to improve the living standards of teachers and doctors in the so-called May 2012 decrees. Incomes of medical workers should exceed the average salaries in the region in which a doctor lives in the new year by half. For this, in particular, a decisive increase in the salaries of doctors is planned in January. The salary of doctors from January 1, 2018 - what is said in the latest news from the government about the percentage of growth in the income of medical workers after indexation.

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

Those who have at least half an eye watched all these years what is happening around the so-called May decrees know that to achieve them, a variety of tricks of the authorities were used. Of course, there can be no question of real performance and the achievement of the average salary of a doctor twice over the average salary in the region in which he lives in 2018.

One of the 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 income to the level of the average salary in the region. The goal is definitely correct. However, in some regions, a simple step was invented - the nursing staff was laid off, but the workers were not fired, but transferred to the positions of technical personnel. Moreover, their salaries turned out to be even lower than before.

For example, in the Sverdlovsk region, most hospitals did just that, and the nurse, who received 17 thousand rubles a month, began to receive 12 thousand, and her annual leave was more than halved - from 60 working days to 29 calendar days. This situation is proved not only by the stories of the workers themselves, but also by the documents - the duties of the orderly 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 said bluntly that by 2018 the junior medical staff will be cut fourfold. In large and seemingly wealthy St. Petersburg, a similar story - the authorities directly reported that they had cut half of the junior medical workers, some of them transferred to the category of technical workers, with the same purpose - to save the salary fund and distribute money in favor of the remaining medical workers to fulfill May decrees.

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

Although officials are likely to be able to pull the necessary indicators to the desired level, and on the eve of the presidential elections, President Putin will report that his 2012 decrees have been fulfilled, which means that he has done an excellent job of his duties and has the right to lead the country again.

This example of how the medical staff was treated is just one of many examples of statistical fraud. Journalists also wrote about more global work with numbers, when the average salaries in the regions were artificially constrained, and the average salaries of doctors were artificially increased. Including, for example, due to the inclusion in the calculation of income of doctors of private clinics, which often receive much more than their colleagues from public medical institutions.

What will happen to the salary of doctors from January 1, 2018

Judging by latest news that come from the government, the percentage of salary indexation for doctors will indeed turn out to be quite good in 2018. Finance Minister Anton Siluanov called the indexation percentage for state employees who fell into the May decrees at 23%.

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

The Minister of Health Veronika Skvortsova reported on how much medical workers in Russia receive in the fall of 2017. According to her, 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 Trud.Com portal, the income of doctors in Russia is much more modest than in the minister's report. According to the portal's analysts, the average salary of a doctor in 2017 was 30-35 thousand rubles a month.