Will nurses' salaries be raised this year? A gradual increase in salaries for medical workers in Russia. Specific government steps for the healthcare system
Responsibilities
Routine maintenance, repair and reconstruction of metro tunnel structures under the guidance of a more highly qualified tunnel worker. Wiping and washing with water tiled surfaces, metal gratings, decorations and other elements of structures. Keeping inventory and equipment clean. Delivery of materials, towers, cabinets, stepladders, scaffolding and tools to the work site and cleaning them up upon completion of work.
You need to know and be able to:
Responsibilities
Current maintenance, repair and reconstruction of metro tunnel structures. Removing salt stains from cladding and dust from architectural surfaces using vacuum cleaners. Polishing marble in places where salt stains are removed. Washing tile facings with hydrochloric acid solution. Cleaning tubes and bolted joints from corrosion and dirt with metal brushes and rags. Preparation of materials for solutions and adhesive insulation. Cutting down beads manually, punching, sealing nests and furrows with cement mortar. Cleaning and washing of injection devices.
You need to know and be able to:
types of materials and methods of preparing solutions for cleaning cladding; rules for plastering work; principles of operation of vacuum cleaners, blowers; rules for fencing the work area with signals.
Responsibilities
Installation and dismantling of a hose with an injector during injection work. Sealing wells after injection of solutions. Preparation of surfaces for insulating coatings. Preparation of lead, leaded cord and other compounds for coining. Embossing seams by hand. Warming up bitumen mastics, installing a cement screed under the insulation, applying bitumen mastics to the surface. Dosage and preparation of various mixtures. Changing drills and caulking, connecting the tool to the air duct network. Assembly and disassembly of inventory scaffolding and scaffolding.
You need to know and be able to:
installation of mortar mixers, tunnel linings and their waterproofing; compositions of solutions and their basic properties; basic requirements for the quality of injected materials and additives.
Responsibilities
Drilling holes with drill hammers in the lining of tunnels and mines. Marking places for drilling according to the leak elimination map. Chasing joints with expanding cement and lead. Replacement of plugs and bolted connections. Insulation of vault walls underground structures and trays with rolled materials on mastics. Leak drainage with the installation of hanging boxes, pipes and embedding into the structure. Elimination of solution leaks to the surface.
You need to know and be able to:
design of the mechanisms used, schemes for the rational location of blast holes; types of tunnel linings; basic designs of waterproofing covers, rules for applying mastics and stickers of rolled materials; methods of minting work.
Responsibilities
Carrying out control injections and injections of cement mortars with the addition of polymer materials to eliminate leaks in structures. Opening and repairing metal insulation of tunnel structures. Injection of waterproofing compounds based on epoxy resins onto the inner surface of the linings to stop the filtration of groundwater. Embossing joints between metal and concrete linings and non-standard seams, as well as using polymer mastics. Insulation sticker to eliminate leaks in linings and in places with variable cross-sections.
You need to know and be able to:
technology of cementation works and formulation of injection compositions; basic properties of rocks and chemical consolidation of soils; rules for repairing seams and sealing cracks; the order and methods of embossing non-standard and complex seams; procedures and rules for safe work in tunnels and with toxic polymer materials.
The level of salaries paid to doctors worries many Russians. Every employee medical field hopes for payment corresponding to the level of intensity and intensity of his work, but hopes are not always justified. The money received is barely enough to pay for travel to work and home, make utility bills, and buy necessary clothing, food, and household chemicals. Not to mention the fact that during the holidays I would like to get my health in order after a busy year of work...
Of course, medical workers deserve decent salaries, because their main mission is to protect health Russian citizens, and the professional path of a physician is far from the easiest. At the same time, the level of salaries of medical workers does not correspond to reality at all. Russian economy. The salaries paid by state medical institutions are far from the level of private clinics, not to mention the salaries of foreign doctors.
The authorities promise that soon the medical profession in Russia will become prestigious and salaries will be high. Will they keep their promise this time?
In 2019, the authorities promised to do everything to ensure that this problem ceases to be relevant, and Russian medicine returns to the number of financially prestigious professions. However, alarm bells regarding the financing of the medical sector have not stopped ringing. Let's talk about what real changes those who have dedicated their lives to protecting the health of Russians can count on.
How are doctors' salaries determined?
The total amount paid to doctors is summed up from the following components:
- direct salary amount;
- additional payments taking into account the complexity of work and intensity of workload;
- additional payment taking into account length of service and assigned category;
- compensatory surcharges and adjustment factors that are adopted in each individual region.
When revising wages for certain categories of employees, only their first component – salary – increases. It is he who is subject to mandatory indexing. However, basic salaries for doctors are usually low, and most of their monthly funding comes from bonus payments, part-time work and overtime. This is becoming a serious problem, because the indexation of salaries in 2019 will affect their size very little, and the accrual additional payments today is entirely entrusted not to the state, but to the management of medical institutions.
Analysis of the current situation
They promised to raise the salaries of doctors to 200% of the regional average! Let us recall that five years ago President Russian Federation issued the so-called May decrees. According to the orders set out in this document, already in 2018, the level of remuneration for doctors should increase to 200% in comparison with the average regional salary payments.
Regional authorities claim that this order is already being implemented - back in 2017, in most territorial subjects of the Russian Federation, doctors’ wages became equal to 180% of the regional average salary. Olga Golodets, who holds the post of head social sphere The Russian Federation assured Russians that the country’s budget has allocated funding for a further increase in the salaries of health workers, and October 2017 has already been marked by a salary indexation of 5.5%.
However, the increase in wages recorded by statistical agencies is explained by the so-called “optimization”. Many medical institutions today are simply laying off staff, which is causing the consolidation and consolidation of entire departments. According to some reports, in the last five years alone, about 90,000 people who previously worked in public medical institutions have been fired or transferred to other jobs. Those who still hold on to their jobs are forced to work under conditions of ever-increasing workload - working at one and a half times the rate and regularly taking night shifts.
Let's say even more - despite such labor feats, doctors complain about a drop in real income levels. This is because the total amounts are formed by adding the variable and salary parts. Many heads of medical institutions carried out the May decree very simply - they raised salaries and reduced additional payments. Now in most territorial subjects of the Russian Federation, doctors receive about 30 thousand rubles, and junior and mid-level medical staff - about 20 thousand rubles.
For now, with a salary increase real income doctors are only falling Health workers representing the Jewish Autonomy, the Nenets District, Ingushetia and the Arkhangelsk Region say that they are receiving less than before the “increase” in salaries. Doctors from 25 regions reported that about a thousand rubles were added to their salaries, and Voronezh and Altai doctors amazed the public by declaring that their increase amounted to 32-53 rubles! If you look at the situation from a regional perspective, you can come to the following conclusions:
- The minimum average salary received by doctors in Kalmykia is 27.3 thousand monthly. Ulyanovsk medical workers receive an average of 30 thousand rubles, Samara – 35 thousand rubles, Penza – 33.4 thousand, Ossetian – 28 thousand;
- The situation is slightly better for those who work in Sakhalin and Chukotka, in Moscow, St. Petersburg and the Khanty-Mansiysk Okrug - regional authorities increased the salaries of local doctors by about 6 thousand rubles, and now average income doctors are estimated at 117 thousand monthly;
- If we take individual categories of health workers (for example, analyze payments to general practitioners), then significant regional disproportions are visible to the naked eye. In the capital, such a doctor receives about 60 thousand rubles, but as soon as he starts working in the region, his salary immediately drops to 45 thousand.
Alas, these statistical calculations do not quite realistically reflect the current financial situation in Russia. Since 2017, employees of this department together believe average salary doctors who work in clinics of all forms of ownership. At the same time, salaries in a city hospital are significantly lower than in private medical institutions. Well, if we compare with payments accrued to foreign doctors, the situation looks completely deplorable - for example, American therapists earn on average 416 thousand rubles, French ones - 200 thousand, and German ones - 225 thousand rubles.
The government comments on the situation with regional imbalances, explaining it by high premiums in the northern regions. Well, the rest of the doctors need to deal with local authorities, because federal budget each year is formed taking into account salary increases. The maximum that can be done is to split the increase into two parts: first, salaries will be increased at the federal level, and then at the regional level, taking into account local coefficients.
We also note that the head of the Ministry of Labor, Maxim Topilin, assured the public: in 2018, the federal budget will allocate 80 billion rubles to finance the salaries of health workers. He mentioned the “capita standard” (the amount allocated per year for each person assigned to a medical institution under a health insurance policy), which is planned to increase by 21.7%. As a result, this will cost the treasury about 333.2 billion in national currency.
Given the problems with financing the Fund compulsory medical insurance, it is possible that the government will refuse to implement the May decrees In the last speech of Anton Siluanov, who heads the Ministry of Finance, it was said that on average the salaries of public sector employees will increase by 23%, and the planned growth by industry will reach 4.1%, that is, salaries will be adjusted to take into account inflation. Thus, by the beginning of 2019, all financial obligations, which are set out in the May presidential decrees. As a result, average medical staff are guaranteed payments identical to the national average, and highly qualified public sector employees (doctors) receive salaries twice as high as the average.
Let us remind you that the salaries of employees financed from the Russian budget will be increased in two stages - the first (by 4.1%) will take place in October 2018, and the second (by another 4%) in October 2019. The minister said that as a result, state employees will receive an increase that will be significantly higher than inflationary manifestations.
The capital's mayor reported that in 2017-2018, salaries of health workers increased by 40%. Already in 2018, the average salary will be 140 thousand rubles, which is 2 times higher than the average monthly Moscow salary! However, the health workers themselves deny such information - they say that the average salary for their work in the capital is 64.73 thousand rubles. However, the government has allocated 500 billion rubles for a three-year wage indexation, of which:
- 196.6 billion – in 2018;
- 219.5 billion – in 2019.
At the same time, it is necessary to note the rather alarming news that appeared in the media not so long ago. We are talking about problems with financing the Compulsory Medical Insurance Fund, which is replenished from contributions from wages. employees. According to plans, the Fund should be replenished by 1.89 trillion rubles in 2018, by 1.93 trillion in 2019 and by 2.1 trillion in 2020.
However, now the government believes that this is not enough. Already at the beginning of 2019, the Fund will reach a state of deficit. To cover it, you will need to select from budget funds 95.5 billion in national currency, and in another year - to finance 170.4 billion rubles. Auditors of the Accounts Chamber came to the conclusion that already in 2018 the Fund will not have enough money to pay salaries to health workers, and the amount of the shortfall will be 43.1 billion rubles.
Previously, doctors were informed that it was the Fund’s reserves that would ensure an increase in their salaries. Now there is not enough money for the May decrees, since this Fund must finance, first of all, the purchase of equipment to provide high-tech medical care. As a result, the former head of the Ministry of Finance, Alexei Kudrin, proposed suspending the implementation of the May decrees so that the increase in wages would not lead to a decrease in purchase costs medicines, ordering the latest equipment and repair work.
Some government members have proposed increasing insurance premiums levied on the wealthiest Russians. It is quite possible that this will help resolve the issue of increasing salaries for doctors. Statistical departments, having combined the salaries of public and “private” doctors when calculating the salaries, will ultimately receive average figure in the Federation in the amount of 47-50 thousand rubles monthly.
However, in reality, this can be achieved in a simpler way - through massive layoffs and an increase in the number of rates per health worker. Naturally, a doctor who works two hours will receive twice as much. Another question is how will this increased intensity of work ultimately affect patients and the quality of their treatment, or the health of the doctor himself?..