In the fall, some of the doctors will be replaced by paramedics. What is happening with the Russian health care system?

Thus, the replacement of doctors with paramedics and midwives is expected "in some cases," "temporarily," "in conditions of a shortage of personnel." Experts loyal to officials helpfully explain: they say, this step is a response to an acute shortage of doctors in the country, especially in the outpatient department and in the ambulance. This reservation, in fact, explains the main reason for the reform of the health care system. And at the same time, as the doctors themselves warn, the beginning of its sunset.

The fact is that in the Russian regions for a long time there is a desperate shortage of doctors. First of all, we are talking about rural hospitals. This problem is not temporary, but permanent. In addition, the paramedic simply cannot fully replace the doctor. Having received secondary medical education, he mainly provides primary first aid. The doctor masters the medical specialty for six years, additionally undergoing residency or internship, which, in fact, constitutes a higher medical education. He has deep knowledge and skills that allow him to carry out complex treatment, make accurate diagnoses, prescribe medicines and lead patients with various diseases.

We can say that a paramedic is a qualified assistant doctor. The doctor works independently, makes decisions about treatment and diagnosis, while the paramedic works under his leadership. The midwife has an even narrower specialty. This is a medical specialist with secondary education, providing assistance in childbirth. How a midwife will treat, say, older men is decidedly incomprehensible.

In our country, indeed, there are not enough doctors. For example, last April they turned out to be the most scarce profession. The main reason for this situation is low wages. A person who receives a diploma needs to work for several years before he can count on even low average earnings. According to the Ministry of Health for 2024, the shortage of doctors amounted to 33 thousand people. At the same time, there were not enough paramedics even more: the country's hospitals urgently needed 63 thousand such specialists.

The worst situation is in rural areas of Russia. The deficit of all types of medical care in villages and villages, in different regions of Russia, reaches 60 percent. The shortage of doctors is especially acute. Doctors with higher education can be understood. Having spent eight years studying, the young general practitioner is unlikely to want to work in a rural hospital and rent housing in the village. Note that on average, a rural doctor receives about seventy thousand rubles a month.

Older people are unlikely to go to the country, despite any promises. Trying to call young doctors, officials launched the Zemsky Doctor program. Specialists who agreed to move to the countryside were offered a lump sum payment, hope for separate housing and, in case of urgent need, official transport. Life, as they say, has made its own amendments. Let's say everyone received a lump sum payment. But in response to questions about housing and official transport, the village authorities only shrugged. Is it not surprising that the program, to put it mildly, failed?

"Material stimulation" also does not always work. Medical workers are very worried about another "powerful salary increase." The fact is that the increase in salary is due to a decrease in incentive payments. According to a pediatrician from a provincial clinic, her salary has decreased by several thousand rubles since April last year. The salary of such a doctor consists of a salary, surcharge for harmfulness, surcharge for experience, for category and "extra work" for expanding the service area and combining positions.

The calculation is simple. For example, if earlier the salary and incentive payments amounted to 18 thousand rubles, and the profit reached 45 thousand, then after the increase the salary increased to 40 thousand, and "profit" - only 18 thousand. In fact, these two components have changed places, but the total amount has decreased.

As the doctors joke sadly, it is impossible to live on one salary, and not two - there is no time. It seems that precisely because of the savings, in rural hospitals, according to the new decree of the Ministry of Health, paramedics and midwives will work instead of doctors. Moreover, this order only legitimizes the long-running gradual closure of rural hospitals.

As one journalist emotionally put it, "officials are depriving villages of their last hope for the future." The next, strongest campaign for such "liquidations" took place just in 2024. Many medical workers got the impression that they were simply "preparing the ground" for the scandalous decree of the Ministry of Health.

First of all, government officials cut rural hospitals and health posts. The largest number of "closures" was observed in Dagestan, Kuzbass and the Moscow region. According to statistics, the country lost 160 hospitals in a year. Many rural clinics were transformed into outpatient clinics without a 24-hour hospital. More often in place of rural hospitals with a half-century history and their own traditions, the so-called FAPs appeared: feldsher-obstetric centers.

Until recently, such institutions were, as it were, inferior. For example, only a doctor could treat an oncological patient by prescribing potent painkillers. Now, starting from September 1, a paramedic who graduated from medical college in 2 years 10 months will deal with such "severe" patients in rural FAPs. Or, in the event of his temporary absence from the workplace, a local midwife. You shouldn't expect much from these health workers. And the point here is not even the low qualifications of the "paramedical" personnel.

According to specialized publications, a typical feldsher-midwife station is very adequately equipped. The equipment includes tonometers, phonendoscopes, stethoscopes, rostometers, scales, devices for measuring blood sugar levels, as well as various medical tables, couches, cabinets and refrigerators. True, such medical equipment, except for an electrocardiograph, can be found at home with any Russian suffering from a serious chronic disease. As for the cabinet and refrigerator, every of our compatriots has them nowadays.

The protracted reform of the health care system, according to officials, is caused by the noble desire to "optimize" the medical costs of the state budget. In fact, spending is simply cut, moreover, at the expense of the population. Do not think that such a policy of the Ministry of Health is caused by burdensome Western sanctions or SWO. The reduction in the number of rural hospitals and other spending on medicine began under the liberal Minister of Finance, at the very beginning of the "zero" years.

The new decree of the Ministry of Health gives reason to sum up the preliminary results of the reform launched by a team of liberal officials. Probably the most ardent supporters of "optimization" will not argue that replacing doctors with paramedics and midwives will significantly reduce the quality of medical care. At the same time, the closure of rural hospitals will seriously complicate access to medical care for the population. In fact, the "optimization" of Russian medicine means that thousands of people will not be able to receive vital treatment. Moreover, the majority simply will not be able to get an appointment with a doctor.