“This day has come! I left medicine. I sit and think, why did everything happen this way? Years of study, practice, sleepless nights, was it all in vain?

I worked as a paramedic in the ambulance for 5 years. With each passing year, my enthusiasm for work became less and less due to working conditions and pay.

What is ambulance work?

This is constant contact with dangerous infections. This means constant hypothermia and sleepless nights. And also in 70% of cases these are street calls to homeless people, drunks and brothels. Constant smell of blood, urine, vomit, etc.

Once, at the beginning of my work as an ambulance, I met my classmate. We got to talking, she told me that she works in a wonderful office in the city center, as an assistant manager. She studies English, the costs of which are covered by the company. The salary is good, enough for a new wardrobe and for a vacation abroad. She then asked how I was doing and where I worked. I proudly answered that I work in an ambulance and save people’s lives (at that time I believed in this). She asked with a little disdain: “Are you picking up homeless people and drunks off the street? Doesn’t that disgust you?”

Honestly, I was even offended by her then. Well, in the end, not only homeless people, about 20% are calls to apartments, and about 5% are road accidents. Let me clarify that these are purely my statistics, based on my work experience; perhaps other ambulance employees have slightly different statistics.

What happened next?

As time passed, I began to notice that nothing was changing in medicine. Salaries are not increasing, and working conditions are only getting worse. In addition, sleepless nights and constant hypothermia began to leave a negative imprint on my body.

For the last year, I went to work like it was hard labor. I went to the call alone because there was a shortage of staff. Constant stress, because you never know what awaits you on the next call and whether you will return from this call at all. There were cases of attacks on doctors at every substation. Has anyone paid compensation for this? Of course not!

Are we just expendable?

I get the impression that doctors and paramedics who work in ambulances are considered by higher management to be consumables. Like, you knew where you were going, no one is forcing you to work.

I began to think more and more often about what if I was the next victim of the attack. How can I, a fragile and young girl, stand up for myself? What then? At best, my parents will receive words of condolences. Even if nothing happens, my future fate will be to live in poverty, acquire a bunch of diseases (my colleagues will understand me) and grow old before my peers.

If I had not met my good friend a few months ago and heard what he told me, I probably would have continued to work in the ambulance. I would still go to work, which brings no pleasure, but only disappointment.

“I would like to note that I like helping people, I want every patient to be healthy. But, unfortunately, our state is doing everything to discourage doctors from their last desire to work and help people.”

So my friend just told me a few phrases: “ Do you really not love and value yourself so much that you are plunging your life into this swamp with your own hands? You can change everything and live differently. Get out of here before it's too late! A couple more years will pass, and you will no longer be able to leave. The ambulance sucks you in, taking away all your vitality. Over time, the desire to change something disappears, because fear of something new and self-doubt appear. In any case, the emergency room is not the place where a woman should work, much less a sweet and pretty girl like you.”

Honestly, his words made me change my life dramatically. I left the ambulance the next morning, right after my shift ended. By the way, in the HR department I listened to a whole mountain of tricky instructions addressed to me like: “You will still come running and beg to be taken back. Do you think you can find something better? Well, well, let's look at your failure. Run“Run, you won’t find anything better anyway!”

You know, their mockery became a powerful incentive for me. Within 3 days I got a job at a pharmacy. The probationary period was only 2 weeks.

What now?

And now I work, it’s warm, clean, I sleep at home in a comfortable bed, and besides, I get 2 times more salary. I entered the correspondence department to become a pharmacist. Life is getting better. I go to work like it’s a holiday, because I know that I’m finally somewhere where my work is paid what it deserves and where my work brings me pleasure.

I wish all my former colleagues to have the courage to rethink their lives and decide to change it.

“I realized that an ambulance is not a place to work for a fragile young girl. And in general, women should not work in such conditions.”

In general, the time has come for me to choose a university. Well, I thought about it and decided on a doctor, a surgeon. Mom is swearing, which surgeon? They say, first chop the cucumbers for salad and don’t cut yourself, then chop up people. Dad, on the contrary, praises and smiles like that. He’s waiting to see how I’ll carry medical alcohol for him.
Well, I went to the doctor. A classmate takes the Hippocratic oath every weekend and Friday. He doesn't accept anything. I'm learning alone! Time passed, and they entrusted me with sewing up one belly. The doctor looked at my work and stated:
- Sychev, with such skills you can’t sew up wounds, but sew up socks! Me too, needlewoman.
The first damn thing is lumpy, who doesn’t? This means I don’t waste time and keep asking for the operation. Trusted, hurray! Operated. Well, how can I say it? The patient, I am glad, remained alive. It’s just that I got a nickname - Beef Stroganoff.
- Sychev, are you treating a person or are you preparing a kebab? Surgery is not your thing.
- OK. Let's go where the responsibility for the patient's life is minimal.
That's how I became a pathologist. Of course, it was scary at first, but then I got used to it. Even better. A dead person will not ask for a certificate, will not trample in the office, and will not go to the head doctor to complain. But this is where failure befell. My very first autopsy showed that the patient was paralyzed. Well, I didn’t keep track of who it doesn’t happen to?
- The first damn thing is lumpy, and the first dead man is alive, right, Sychev?
- Well, Faizulai Faizulaevich...
- You're not a good pathologist! Is your girlfriend also indistinguishable from a dead one when you arrive? If you become a student of Khryashchev, there is only one path for you!
Khryashchev Sergey Viktorovich. They say that after death he will open himself up and declare poisoning. In short, he is such a pathologist that next to him there are other pathologists - pediatricians. Or money at the register. The coolest corpse cutter, but also the harshest.
I come to him on the first day, and he does this with his eyes: morgue-morgue. Like, so that it’s immediately clear who you’re dealing with. He sews up his clothes only with surgical thread, picks his teeth with a scalpel instead of a toothpick, and drinks exclusively medical alcohol. In a word, a doctor to the core. And he is a good teacher. But with regards a little. The first time we went into the morgue with him, he barked like this:
- Company, get up! Why are we lying here, get up quickly! I later found out that he was a former military man, and the habit remained. And then it seemed strange. He also likes to talk to his “patients”.
- Oh, Marya Petrovna, she died half an hour ago. As they say, it's piping hot. So, what's in the belly? Yeah, the soup is still warm. Not like mine. Slavka, take the borscht to the microwave.
Or:
- Arthur Borisovich, what is our cause of death? I’ll open up the skull and let’s brainstorm together! However, my skills grew, he taught steadily and loved to say:
- You will learn, Slava, you will go to work as a surgeon, you will recruit a client base for me at the morgue! In short, a funny guy.
One day a black man is brought in to us.
- Sergei Viktorovich, he is black, like your humor!
- Shhh, Slavka. Can you hear this silence? Not because they are dead, but because you joke the same way you operate! Don't be offended, let's go cut the tanned guy...
And then the Negro will dig up! I almost turned gray. But at least that would help Khryashchev.
- Sychev, have you heard of post-mortem belching? It smells terrible. Okay, what do we have here?
Okay, to hell with the burping. I cautiously approach the African American, and my hands are shaking! Not from me, from the dead man. The second time I almost turned gray.
- Calm, Sychev. Post-mortem convulsions.
And then the black man slowly opens his eyes. He looks at me, then at Khryashchev. And the black man and I chorus:

Aaaaaaaaaaaaaaaaah!
- Sergey Viktorovich, what is this?!
Khryashchev stands puzzled:
- Oh my God. I remember they brought them in alive, but they turned out dead. But on the contrary... Hush, Snickers, don't yell.
- Do you speak Russian?
- Oh, Slavka, he understands us.
- I... I don’t remember anything... Rasel...
- Oh, your name is Russell? I'm Sergei Viktorovich, and this is Slavka. Hello, my black friend!
The poor black man mutters something and clutches his head with his hands.
- Oh, I can’t remember a damn thing! Oh, there is... I have one phrase to remember, the main thing!
- Well, what do you have?
- Morning... Morning is aground...
- Yeah, aground in the morning.
- Morning in the shallows... Vip, vip!
- Well, drink it. A bird like a heron.
- Morning is aground, bittern rasel!
- So. Is the bittern shallow this morning, Russell? Hm. Slavka, come here. While the black man is recovering, Khryashchev takes me aside.
- Sergey Viktorovich, what is this?
- Is the bittern shallow this morning, Russell? It seems like nonsense, but on the other hand... In our army they didn’t encrypt like that! This is a code phrase, apparently, and someone wanted to eliminate the black man. We need to figure this out. Where was the black one found?
- They picked it up near the trash can, he was, ahem. In Russian folk costume.
- Yeah, props. Well, definitely an agent. Also with amnesia.
So Khryashchev decided to go to that place and see if there was anything interesting. For lack of anything else, they dressed the black man in a doctor's uniform - a pure intern. We leave the hospital, everyone looks around.
- Sergey Viktorovich, is this on exchange with you?
- Nooo, you're fucking!
- Quiet, Russell! Don't attract attention!
We got into Khryashchev's Volga and drove off. It's not far from the place, and here are the trash cans. The homeless people are sitting there, nothing seems interesting.
- Oh, coal, howdy! Well, you rocked it yesterday!
- Nah, you're a pussy!
- Russell, leave the homeless alone. Sychev, look for evidence.
And then I see serious gentlemen coming. In suits. Worried, their eyes search everywhere. Suddenly they saw our black man and hurried.
- Sergei Viktorovich, is this not our honor? They wave their hands and shout something.
- Slavka, Russell, get into the car quickly!
Like in an action movie. They jumped in, Khryaschev put his foot down and forward. I looked around - they were all waving, then they also got into the car. And the car is serious, I need to operate on it for half the city. They're catching up. Russell sits, hums, and holds his head. And here it is:
- Recall! Recall! Stranded in the morning...
They overtake us and press us. They honk. Khryashchev turned pale:
- That's it, Slavka. We've finished the game.
- Stranded in the morning...
These suits opened the door of the Volga:
- Idiots, why the hell did you take our black man?!
- I remembered! There will be a hangover in the morning, drink the brine!
In short, they told everything. The Ambassador of Zimbabwe, first day in the city, decided to take him to a pub. Out of habit, he got drunk on vodka and ran off to roam around the city. Then he caught up with the homeless people and passed out. There he was mistaken for dead. Of course, we were thanked for saving the ambassador and given a monetary gift. Khryashchev took a leave of absence for this reason, and I decided to leave medicine. Well, his, not mine. He got a job as a cook in a restaurant. And guess what? No one cooks beef stroganoff better than me! By the way, my nickname here is Surgeon. I sew the stuffed chicken only with surgical thread. And I cut the meat with a scalpel. Out of old habit.

I wanted to write this post later. In the meantime, forget about it and enjoy your vacation. But circumstances are different. Rumors, speculation... I won’t be able to rest peacefully, watching from the sidelines as they married me without me.

So. Why did I decide to leave public medicine?

A short introduction. How I became a doctor.
I don't come from a family of doctors. I didn’t bandage dolls or give them injections when I was a child. But for as long as I can remember, namely from the age of 3, I wanted to be a doctor. And I was driven by the desire to help others.
Then I couldn’t even imagine myself as anyone other than a doctor. Only the specialties changed; sometimes I imagined myself as an ophthalmologist, sometimes a neurologist.

Many teachers and acquaintances said that it was difficult to enter medical school and suggested that I consider other professions. By the eleventh grade, my mother also joined them. But it didn’t stop me from realizing my dream. And she even paid for preparatory courses for me at two medical universities at once. For which I am still very grateful to my mother!

I didn’t expect to enroll right away, and decided that I would continue to enroll until I did, even if it took several years. And I have a lot of persistence.
I failed the first exam for the medical faculty of the Second Medical School - written chemistry. But I was lucky, that year the Moscow Faculty opened - the exams were oral, and I passed.

The Moscow faculty trained therapists for the clinic. And by the 5th year I realized that this was fate. This is exactly what I want to be as a local therapist. I was interested in everything; I didn’t want to study any one specialty. I wanted to guide the patient from start to finish, adjust the treatment, see the dynamics and results.

It has now been 13 years since I completed my internship. And there was not a single moment in my life when I regretted my choice of profession. I don’t regret it even now. Local doctor, family doctor (call it what you want) - that’s mine. And this is not just my opinion. This is also the opinion of colleagues and patients. At least most of them. No one will say that I manage outpatient records poorly or that I am inattentive to patients. And the recent award as one of the 10 best local therapists in Moscow in 2017 on Active Citizen is proof of this. For which I am very grateful to my patients. This means that my work as a local doctor was not in vain.

So why, despite all this, am I leaving government medicine? Am I going for a promotion? No. Will your new job have a higher salary? No. Less.

But I can't stay. It took me six months to reach this decision. And I can’t say that it was easy for me. I got used to my patients, my beloved district nurse, to my area, to my colleagues, even to the stupid EMIAS and my cards. Over the years, many of my patients and colleagues have become practically family to me.

However, everything has a certain limit. And there are objective reasons why I can no longer work in a public clinic. And this is by no means a low salary (the salary of general practitioners is now decent), or an inconvenient work schedule for me. But I simply don’t see myself as a hospital doctor. This is a completely different job that does not involve dynamic monitoring of the patient.

I will name the reasons as they are, in order of importance:

1. In conditions of a 15-minute appointment without a nurse (the Moscow polyclinic standard, introduced in 2015, took nurses beyond the reception area, now nurses essentially perform the functions of administrators), combining several specialists at once (as a result of the “optimization” of 2014-2015, many specialists were reduced), in most cases, filling out a ton of documentation alone, both electronic and paper, justifying it in the card, and having each sneeze (from blood biochemistry to ultrasound) signed by the manager - it is impossible to work efficiently without it being to the detriment of their own health and family. And family cannot come last for a woman.

I'm tired of working 10-11 hours a day and doing homework with my child at 5 in the morning.

Many health care managers will say that the general practitioner in many countries only has 10 minutes per patient, and nothing. But this is deceit. Nurses take on the lion's share of the work there. This includes partly an examination, ordering tests, and recommendations on lifestyle and nutrition. In many countries, calling and recording are carried out by a secretary. Now our doctor does everything himself, and examines, and fills out all the documentation, including test forms, and the doctor signs up for all tests, wasting precious minutes of time.

Also, doctors in other countries have time for documents. The lack of time for other work in the working day of our doctors provokes overtime. Many documents are completed outside of the appointment and in your own time. Because This is physically impossible to do during a 15-minute appointment. It takes about 40 minutes to fill out a disability certificate. MRI - 20 minutes. Referrals and discharges to other health care facilities - 15 minutes. But no one has yet canceled medical examinations, site passports, etc.

Patients often come with several problems and everything needs to be solved in one visit - again, it’s impossible to do it in 15 minutes.

In official letters, when asked about 15 minutes for an appointment, the DZM replies that the doctor can spend as much time on the appointment as the situation of a given patient requires. However, in practice, fines are imposed for patients waiting in the corridor for more than 20 minutes.

How can you spend more than 15 minutes on a patient, but not have others waiting in the hallway, with a full appointment for every 15 minutes? If the record is not complete, there is a fine for failure to fulfill the plan.

Considering the above, there are two options for the development of events:
— If you stay, you will worsen the quality of work (creating the appearance of medicine for the poor, and this is exactly what the current health care organizers need),
— Continue to work efficiently and work for 2-3 hours every day.

Neither of these options suits me.

As a result of constant overwork, emotional overload and lack of rest, I have already experienced mental devastation. Nothing makes me happy, I have neither the strength nor the desire to do anything at home, I went to work every day for the last few months with disgust and looked forward to the end of the working day. A little more and the point of no return will come. When the only option is to leave the profession.

But I don't want that. This is my profession. Favorite profession.

2. There is no opportunity to grow professionally in a 15-minute appointment:
- existing knowledge does not fit into existing conditions,
— overwork does not leave time for self-training.

Please do not confuse professional growth with career growth in this case. It's not the same thing. Career development in medicine is an administrative job. And I'm interested in medical.

3. It may not be nice to say this, but I'm tired of doing the work for some of my colleagues. Someone goes to smoke 20 times per session, but the cards are empty, and the result of the session is zero. And my appointment was filled 2 weeks in advance, and the entire 9-hour appointment proceeded without a single break. And then there’s filling out the documentation. Almost every patient from someone else's site is a blank slate. It is necessary to collect anamnesis, describe the underlying disease, background, concomitant ones, understand examinations, treatment, give recommendations on lifestyle and nutrition, and treatment. And this despite the fact that the patient has already visited his local physician or several doctors several times this year.

4. Patients also made some contribution to my decision to leave. For two years, appointments with general practitioners worked in the “all to all” mode - i.e. patients could choose who to go to and make an appointment with any doctor.

The result of this was the loss of the local principle and the uneven workload of doctors. Patients from my area could not get to me, because... Half of the admissions were patients from other areas. At some point, there were so many patients that I couldn’t even remember their faces, let alone their diagnoses and treatments. And I’m used to remembering all this. It was then that my examination protocols in the electronic card became the prosthesis of my memory. And that’s why I started filling out the cards as carefully as possible. Because only from them could I remember information about the patients.

When they came to congratulate me on March 8th this year, and I couldn’t remember who it was, I realized that that was it, this was the end.

Recently, the registration was returned according to the precinct principle. But patients from other sites continued to sign up, persuading or deceiving administrators, and wrote letters to the Health Department saying they didn’t want to be assigned to me. Yes, according to Federal Law 323, the patient has the right to choose a doctor. But with the consent of the doctor. I can understand patients. But they could not understand that one doctor cannot work for three. Thus adding fuel to the fire of my burnout.

5. I'm tired of hypocrisy. Guides. DZM. Some colleagues. Avoiding answers aside. Lack of answers in replies. Ignoring problems and replacing solutions to problems with a picture of fake stability and well-being.

I can understand. I can understand a lot. Because there is an explanation for this.

But no, sorry, I can’t accept it. And I don’t believe that it can’t be otherwise.

I think what has been said is enough to understand the decision I made.

Thanks to everyone who was with me and supported me! This is not the end. This is the beginning. The beginning of a new round of development. I believe that this is exactly what will happen!

Our status as a doctor now is worse than that of a waiter. Officials persistently convinced people that a white coat was a weakling, a loser, a subhuman. Patients come to us and begin to dictate their own rules: how and with what should I treat them...

“Being a concrete worker in Korea is better than being a surgeon in Russia” - an Irkutsk doctor about his experience working abroad

A surgeon of the highest category who went to a rural hospital in the Irkutsk region for a million under the program "Zemsky Doctor", is forced to work as a guest worker in Korea during his legal leave. The father of three children is suffocated by a mortgage and debts, but the hospital administration does not help the young doctor. The idea to give up everything and go to work as a laborer for Korean “sajans” came to him after an unfair complaint from patients.

Alexander Denisov (name changed) is 35 years old. In 2005, he graduated from the Faculty of Medicine of Irkutsk Medical University with honors.

“I dreamed of becoming a doctor in seventh grade,” he recalls. - My favorite TV series of that time were “ER” and “Doctor Queen”. During my school years and while studying at the institute, I simply idealized the profession of a doctor. The more painful it is to fall..."

The ambitious guy chose the profession of a surgeon. “The first disappointment came during residency,” says Alexander. - Nobody needed the residents and interns; no one was going to teach them anything. I found my way out: the whole second

I spent my residency course on business trips around the region, where I learned the art of surgery almost independently.”

To the area for a long ruble

After Ordine tours Alexander worked in Irkutsk, specializing in oncology.

Renting an apartment in Irkutsk near the center took 20 thousand rubles from the family budget. It was difficult to live on the remaining money. And Alexander decided to go to the region under a contract. In one of the small central district hospitals, 200 km from the city, he was offered 50 thousand - a quite decent amount for those times.

But what Alexander had to face in the village was not worth any money.

“In fact, I found myself the only surgeon for the entire region with a population of 14 thousand people,” the doctor recalls. - I was restricted from traveling, I couldn’t go on a visit or go to the city for the weekend. When I arrived, I was placed in a hospital, where I lived for two months. And all these two months I didn't pay wages. I am an intelligent person, at first I was silent. Then he threatened with the prosecutor's office, and they began to pay me, but in parts - so that I did not understand how much and for what they paid me. 50 thousand didn’t work out there.”

After Alexander had a row with the chief doctor over his salary, he was kicked out of the hospital and recommended to look for housing on his own. There are no problems with square meters in the villages, but all of them are without amenities, with stove heating. His new house had only one advantage - inexpensive rent, only two to three thousand rubles a month. Due to harsh conditions similar to northern ones, The doctor's family refused to go to him.

“My wife was from the city,” he explains. - I'm on duty all the time. How will she chop wood and carry water? Our child was small. Against this background, our personal drama happened: we got divorced».

“I thought that I would go to the region and raise some money,” continues Alexander, “but I lost my family. Everyday life, instability, lack of housing. Now II regret that I left the city then. This was my biggest mistake."

Medicine in the regions is similar in level of development to zemstvo medicine at the end of the 19th century, the doctor believes, at least in the Irkutsk region.

“At one time in the 2000s, the chief surgeon of the region had the wrong policy,” says the doctor. - He monopolized all surgery, especially planned ones, in a regional hospital. When I started working, elective surgery was generally prohibited in the districts. Now the regional hospital cannot cope with the flow of patients, but those young doctors who were once prohibited from performing planned operations have never learned how to do it.”

Now in the region, surgeons mainly deal with emergencies: appendicitis, hernias, knife wounds. Not every district hospital has traumatologists. If surgeons deal with traumatology, then only to the minimum: apply a plaster cast, a wire, make a reposition.

« In the regions, surgery as a science is dead. Complete degradation, no prospects. Regional medicine is in agony. Many of my classmates, who attended hospital circles and dreamed of operating and making a name for themselves, succumbed to this system. They sit in the central district hospital on meager salaries, they don’t know how to do anything and don’t want to. Others left medicine - or to become medical representatives, or altogether. 40 percent of my class are not working as doctors. They simply have nowhere to go: clinics are medical hell, and there are not enough places in hospitals for everyone. And even if you get a job at the Central District Hospital, like me, you will only degrade there,” the surgeon complains.

In addition, the hospital where he worked was not adapted to modern conditions: it was cold in winter and the water was imported.

Million-plus doctors are fleeing the village

Alexander worked under the contract for a little over a year and quit - he was tired of being the only one and being responsible for everything. The doctor never saw his 50 thousand monthly salary.

I decided to move closer to the city, to an area located 60 km from Irkutsk. There is a bigger hospital there, there are other surgeons, and planned operations are performed. There is a traumatology department. In addition, the “Zemsky Doctor” program beckoned, under which doctors who come to the village are given a million.

“There were no problems with payment,” says Alexander. - They gave me a million right away. I spent part of the money - 400 thousand rubles - on the down payment on the mortgage. I bought a car - it was my old dream. In fact, nowadays there is nowhere without a car, there is no mobility.”

Alexander bought an apartment in Irkutsk on the secondary market - a one-room apartment in a Khrushchev building, with an area of ​​33 square meters. m for 2 million rubles. And this despite the fact that he has a new family. My wife is also a doctor, currently on maternity leave, and has two small children.

For a million in the area you could buy a small house of 40-50 square meters. m with a plot of 10 acres, but without renovation. With repairs - for 1 million 200 thousand rubles. But Alexander doesn’t want to stay in the area with his family.

“First of all, a district is not a city,” he explains. - This is a village. Secondly, we need to think about the future of children. What can I give them in this village when they grow up? There is a school, but there are no development centers. In Irkutsk you can take your children to the swimming pool and gymnastics. First of all, you think about the children. It’s unlikely that any of the young people will stay in the village and be happy now.”

Nevertheless, Alexander wanted to build a house in the village and collected documents to join the “Young Specialist in the Village” program. I registered in the regional center, bought a plot for 100 thousand rubles with the remainder of the zemstvo million, registered it in my name, purchased building materials, ordered design and estimate documentation - all at my own expense, these are the terms of the program. I submitted the documents at the end of 2013, but didn’t have enough money for the house - a subsidy of 800 thousand rubles. I didn't wait.

“In May 2016, they called us and made us happy: we will receive money by the end of the year. Time passes, they tell us: “Sorry, there was a mistake. Agricultural workers got into the program ahead of you. They have already received the money." They are a priority; they submitted the documents later than me, some even in 2016. They told me: “Dear doctor, you will get into the program at the end of 2019. And if you receive the money, you will have to work in the village for another five years,” recalls Alexander.

Under the Zemsky Doctor program, he has already committed to work at the Central District Hospital for five years. For every unfinished year, if you suddenly have to leave, you need to return 200 thousand rubles to the state. And, unfortunately, many do not meet the deadline, fleeing the village.

“Over the past two years, seven or nine million-plus doctors have left our hospital. Nowadays, a million is not money. Since the spring of 2016, salaries have fallen sharply, doctors are working extremely hard, and the administration answers all questions: “Well, they gave you a million.” It’s as if the hospital allocated this from its budget,” shares Alexander.

The head of the therapeutic department, neurologist, anesthesiologist, and pediatrician resigned. Two of them found work in hospitals in St. Petersburg - in the big city both medicine and salaries are at a completely different level

“The pediatrician has only been out of work for a year. She traveled from Irkutsk every day, and she had a family in the city, three children. When she was on emergency duty, she I lived in the clinic in my office for two weeks. Is this normal? Our administration has an inappropriate attitude. A good manager should think about attracting and developing young people. And they sat in their chairs, and at least the grass didn’t grow,” the doctor is indignant.

Alexander works in the department five days a week. Takes 8 shifts per month. And for this he gets 24 thousand rubles. During the holiday period, he is on duty 24 hours a day, works part-time in a clinic and as an endoscopist, is on duty at night in a pharmacy, and teaches at a local college.

But still, the mathematics of the family budget does not add up. Mortgage payment - 30 thousand per month. Rent of a comfortable apartment in the village - another 12 thousand. True, the surgeon also rents out his mortgaged one-room apartment in Irkutsk - for the same 12 thousand.

His wife is on maternity leave, Alexander is the only breadwinner. Since 2016, the doctor has not been able to pay the mortgage payment. The bank reduced the payment amount to 24 thousand rubles, but the loan term increased from 10 to 15 years. Accordingly, overpayments on interest will increase.

“I contacted the chief physician and economist many times - to no avail. There is only one answer: “You got a million.” But what does a million have to do with my salary? The economist said that my arguments were unconvincing, the tariff commission decided not to raise my salary. I was also denied payment of compensation for rent, at least partially,” Alexander lists.

“I left for Korea after a patient’s complaint”

Alexander has a long vacation - 50 days. He used to use it to earn extra money in the areas. I went on business trips to remote hospitals and performed surgeries.

But last year he had an unpleasant incident while on duty. Relatives of a patient who refused to be hospitalized at a central district hospital due to mistrust of rural doctors caused a scandal in the emergency room and attacked nurses and an orderly. And then they themselves wrote a complaint against the doctor for failure to provide assistance - simultaneously to the Ministry of Health, the prosecutor's office and the investigative committee.

It’s fortunate that the doctor nevertheless conducted a minimal examination of the patient and took a written refusal from him. Doctors were able to prove their innocence only by medical history.

The hospital administration did not stand up for the doctor. It turned out that there were dummy video cameras hanging in the receiver that did not record anything. “I couldn’t prove that they attacked the nurse and orderly,” the surgeon complains. “I suggested that the head physician write a statement against them for slander, but he did not support me. He said: if you want, do it yourself. Why is our lawyer sitting in the hospital?”

And then Alexander decided for the first time in his life to spend his vacation not on medicine. He went to Korea - where, in two months of visa-free stay, a person who is not lazy and efficient can earn the annual salary of a Russian doctor.

“In two years in Korea you can earn enough to buy an apartment”

South Korea has a visa-free regime for Russians coming for tourism purposes - up to two months. But most of our compatriots use this time to earn extra money. Many, after two months, remain in the country illegally, risking ending up in a migration prison and being deported, followed by an entry ban for a period of three to five years.

Koreans call immigrants from Russia "rossya-saram". Moreover, they do not differentiate between the residents of the former Soviet republics: for them, Uzbeks and Tajiks are also Russians. Unfortunately, now this concept in Korea is associated with the word "guest worker".

People come to Korea to work from Primorsky, Khabarovsk territories, the Republic of Buryatia, Irkutsk region, and Kamchatka. Alexander never met anyone from the western regions of the Russian Federation. Ninety percent of those who fly by plane, for example, from Irkutsk, go to Korea to work. The migration police catch them and expel them to their homeland. Recently, its working methods have become more stringent.

“Migration control is humiliating, they shout at you and search you,” says Alexander. - They took away half of our plane and took us for interrogation. They don’t mess with them there, there are no conditions. They live in basements in a migration prison until they buy a return ticket at their own expense. It happens that families are separated: the wife is allowed in, but the husband is not. During my time, well-dressed people were taken into prison, even those who came for tourist purposes.”

But Russians go to Korea again and again - through China, Mongolia, Turkey. And they stay for a long time. “If you remain an illegal immigrant, young and unmarried, you can earn an apartment and a car in one and a half to two years,” explains Alexander.

He recalls meeting a woman from Buryatia. She has been living in Korea for two years with her owner, “sajang,” as a mistress. She has three children left at home, whom she, as a mother, misses very much. But she has no intention of returning to her homeland, where there is no work and where she cannot give anything to her children.

According to Alexander, Koreans are surprised: Why is Russia such a rich country, and its citizens work in other countries in the most difficult jobs?

“But where in Russia can you earn five thousand rubles a day? Nowhere! But here on average they pay one hundred thousand won (about 5.5 thousand rubles),” the surgeon answers the question.

"You can't trust anyone in Korea"

A ticket to Korea costs from 8 to 15 thousand rubles. The future migrant worker will need a few hundred dollars more for travel and payment for intermediaries.

“When I arrived for the first time, intermediaries charged $100 for their services,” recalls Alexander. - For this money, they send you an address via messenger where you must come on your own. They might meet you there and hire you. Intermediaries are not responsible for anything. If you have problems while working, they will not help. They simply won't answer your calls. Now the services of intermediaries cost 150-200 dollars.”

According to the doctor, only the Russians have intermediaries. Uzbeks, Tajiks, Thais, and Mongols work in Korea. And they all help their compatriots get jobs. But not the Russians - they take money for it. And most often they deceive their “clients” by promising easy work and high salaries.

“In Korea, you can make good money if you are literate: be hardworking, don’t trust anyone and know the language at least minimally. It is better to go alone or together - this is an ideal option. If you come with a large group, it will be more difficult to find a good job for everyone,” the doctor warns.

The majority of Russians who come to work have absolutely no knowledge of the Korean language. Even ethnic Koreans who live in Russia. The Koreans themselves speak very little English. Therefore, communication between employer and employees occurs at the level of gestures.

“Over the course of a month of work, you naturally learn some professional terms and certain words. “Amde” (impossible) and “pali-pali” (faster, faster) are the first things I learned,” shares Alexander.

Even the Uzbeks, compared to us, benefit. An agreement on the exchange of labor resources was signed between Uzbekistan and Korea so that citizens could freely come to work in the neighboring country. Uzbeks pass an exam for minimum knowledge of the Korean language and receive a work visa. If such an agreement existed between Korea and Russia, it would be easier for our guest workers.

For the first time, Alexander got a job “in the fields” - collecting nuts. This is the most difficult and lowest paid job. The whole day in the heat - from six in the morning to six in the evening. If the weather turns bad, you don’t work and, accordingly, you don’t get paid.

At six in the morning, the “sadjan” brings the workers to the foot of the mountain in his car. You need to climb to the very top - it will take seven sweats until you get there. Then the workers are divided into pairs. One climbs to the very top of a huge tree with a twenty-meter pole. Having secured himself on the top of a tree, he hits the tops of neighboring trees with this pole. Cones fall from them, the second one collects them.

During the day, two people need to collect 600 kg of nuts. These are ten bags of 60 kg each. But Alexander and his partner had a maximum of 8 bags weighing 55-58 kg each. After collection, these bags need to be taken down the mountain and loaded into the car. And they were not paid a penny for this work.

“It’s not just the intermediaries who deceive, the “sajans” are also different. It happens that people work in the fields for two or three weeks, and they are not paid at all. It’s not sweet here at all,” Alexander states with regret.

“They despise, but do not beat”

Then the doctor got a job at a reinforcement plant, making concrete blocks using German technology. There he mastered the professions of a concrete reinforcement worker, a crane operator, a slinger, and worked as a gas welder.

« At first I was ashamed, - Alexander admits. - But then I overcame myself, money has no smell. There are many people like me here. Two bank employees, three lawyers, and one university teacher worked with me.”

The surgeon admits that the plant was his best place to work in Korea. They were fed three times a day and provided with housing. For the apartment, they took 70 thousand won a month from the salary - less than a day's earnings.

Working day - from 5 am to 8 pm, 15 hours. It’s strict with late arrivals: you come to the checkpoint, put your fingerprint, if you enter at least five minutes late, you won’t be paid for the first hour of work. Day off - once a week, on Sunday.

Salaries at the plant are good by Russian standards. On average, it was 95 thousand won per day (100 thousand won is 5 thousand Russian rubles). In four to five days Alexander earned monthly salary of a surgeon at the central district hospital. The work itself is monotonous and does not require intellectual effort. But physically it is very difficult.

“Huge concrete baths - 50 by 10 meters,” the doctor describes the work process. - In the morning you spin these baths with a pneumatic gun. They are connected to each other by cables; you cut these cables with a gas cutter. You remove all this, remove it, use a crane to pull concrete blocks out of it and load it into a truck. This is the first stage of work."

Then during the day the baths need to be prepared for filling. “There are eight such baths on the line,” continues Alexander. - You wipe it, clean it, lay down the reinforcement frame, and pull 30 cables through each bathtub with your hands. By evening you pour concrete into them. The concrete hardens quickly - the blocks are ready overnight.” Small, monotonous, dreary work - day after day.

According to Alexander, he was treated well at the plant. “People are different,” he says. - Some people catch it on the fly, while others slow down. Thank God I belong to the first category. The first time I arrived, I was very afraid to switch to physical labor after mental labor. Our working day is eight hours, here it is twelve. The work, I heard, is very hard. I was worried whether I could do it. But I managed, and no one made any special claims against me.”

In general Koreans treat Russians with disdain, says Alexander, and you can feel it. They can yell at you and insult you, but they won’t beat you - fights are strictly prohibited in Korea. Fighting can result in a fine or even imprisonment.

There is also a gradation among migrant workers. Koreans are more willing to hire Thais or Mongolians. “They are more efficient,” suggests Alexander. - They learn the language before arriving. In addition, they drink less. Vodka in Korea is very cheap - about 1200 won, in our money about 50 rubles. What is that thousand to us? He went and drank several thousand, and in the morning he lays with a hangover. In this regard, we ourselves have ruined our reputation.”

“Arbeit is something like a panel”

There are more Russians in Korea than other migrant workers. Therefore, a certain excess supply has formed on the market for cheap labor. On his second visit, Alexander was no longer able to get a job at the plant. Every day he tries his luck at the “arbeit” - a special place, like a panel, where employers come and choose who they want to hire today.

“There are a lot of people,” says the doctor. - Local outsiders come to the Arbeit office - Koreans, plus Russians. There are plenty to choose from. Sometimes you come, but they don’t hire you. You never know where you’ll end up today.”

On the Arbeit they are recruited for the hardest and lowest paid jobs: in the fields, as laborers on construction sites. There is marine work - growing and drying seaweed, but there, according to Alexander, they often cheat. Work in a factory or in the construction of greenhouses, which are built here all year round, is considered good.

It is impossible to refuse the offered work on the Arbeit. “If you refuse once, they won’t take you anywhere else. If you don’t work on their terms, that’s it - you don’t have your say here. If you haven’t come to the arbeit for several days, then they won’t take you either. There are Russians who drink, they miss it, and then they just walk around and sit their pants down,” Alexander describes the conditions.

He lives with two other Russians in a motel, in a love room - a special room designed for sex. For such housing, the three of them pay 500 thousand won a month (about 25 thousand rubles).

“There are a lot of motels like this in Korea. For the sake of anonymity in their intimate life, Koreans do not do this at home, especially young people. Conditions in such motels are naturally not very good; there is no service: no toilet paper, soap, or towels. Plus, everyone knows that we are guest workers and they treat us badly,” says Alexander.

“Medicine in Korea is very expensive”

The surgeon tries to protect his hands as much as possible, but his hands hurt all the time from hard work. “There were force majeure circumstances a couple of times,” he says. “There was an electric shock, something flew in.”

If something happens, you will have to get treatment at your own expense, and medicine in Korea is very expensive. “I worked on nuts with a Russian guy from Khabarovsk,” says the doctor. - Suddenly he turned yellow. We ran wild, and on the Internet I found out that he was taken to the hospital and was diagnosed with hepatitis B and a period of jaundice. Treatment for 10 days cost him 2.5 million won - that's about 140 thousand rubles. Collected by the whole world."

Moreover, according to Alexander, even as a doctor, he will not be able to cure himself in Korea. You can't go to the pharmacy and buy what you need. All medications, even the simplest ones, require a prescription from a doctor, which costs 100 thousand won (about 5 thousand rubles).

The doctor admits that he would gladly take out insurance from a Russian insurance company when he went to Korea on a “tourist trip.” Only he didn’t have any extra money at the time of departure. So you work at your own peril and risk.

“I would still choose medicine”

We have been talking with Alexander for the second hour, and the conversation returns again and again to the realities of Russian medicine. When a doctor talks about his favorite profession, his tone changes and becomes more and more emotional.

« To go to our medicine, you need to have wealthy parents,” he says. “You can’t survive on a salary without outside help.” Unfortunately, I grew up without parents and was not used to waiting for help. You have to have a blat to get a job in a good clinic, stay there and move up the career ladder. I'm not complaining, I'm just talking about reality."

We couldn’t help but ask Alexander if he would like to change something in his life.

“I would still choose medicine,” he replied, “but a different specialty. Not a medical specialty, but a type of dentistry where money circulates. Or something like ultrasound or CT, so that there is an opportunity to earn extra money privately. But the surgeon will not open a private office, even if he really wants to.”

Alexander has three children. Maybe you shouldn’t have started a family so early? Maybe you should have gotten on your feet first, and then gotten married and had children?

“No,” the doctor answers confidently. - I would have acted differently about the family. I would have gotten married in my first year and had children so that by the time they graduated from university they would be big. I devoted all my time to my studies, my goal was to get a diploma with honors. He worked part-time as a nurse. But I didn’t get any return. Yes, it’s hard, but family is everything for me, my meaning in life, my drive.”

The doctor says it's not even about the salary, in relation to the doctor from the side of modern Russian society. “Medicine in our country seems to be free, the patient does not pay anything out of his own pocket. At the same time, there is no respect for doctors,” he regrets. - The media blames doctors for everything. Our status as a doctor now is worse than that of a waiter. Why did I go to Korea and not on a business trip to the region? Because there is an association: a white coat is a weakling, a loser, a subhuman. Patients come to us and begin to dictate their own rules: how and with what I should treat them.”

The surgeon believes that politicians and the Ministry of Health are deliberately pitting doctors and patients against each other. To earn a normal living, a doctor must work for 2-2.5 rates, on duty endlessly. Naturally, he is exhausted and does not spend the night at home. At the same time, he bears enormous responsibility for the life and health of patients.

The doctor is not engaged in his direct duties, but in the endless “licking” of medical histories. For every misplaced comma, the doctor is fined - remove 25%. For each fine, you have to write an explanatory note to the hospital administration. Naturally, doctors go wild, they don’t like all this.

Patients also go wild. To get to the doctor, they need to stand in huge queues, undergo examinations, each of which requires waiting. Who will people take out their anger on? On an ordinary doctor. And it’s not the doctor’s fault that the hospital doesn’t have the necessary medications, that you need to go to the region for examination, Alexander believes.

« It hurts me to look at all this. I will come from Korea and leave our medicine. I want to emigrate from Russia. Go to where you can still work in my profession. I won’t say anything specific for now, but as soon as I get settled, I’ll definitely write to you,” the “Medical Russia” surgeon promised.

Documentary film “Surgeon” (dir. Vasily Medvedev)

Graduates of medical universities in St. Petersburg have passed state exams and are preparing for three-stage primary accreditation. Those who successfully complete it will receive a certificate of accreditation - a document with which they can get a job as a local therapist or pediatrician in a clinic starting from August 1.

“Graduates have two options: someone will be able to enter residency, this is about 40-45% of the total number of 6th year students, the rest will go to work for us in primary care,” Chairman of the Health Care Committee Valery said at a meeting of the St. Petersburg government Colabutin. According to him, thanks to the innovation from the Ministry of Health, a double increase in young specialists is expected in clinics.

Let us remind you that in the midst of state exams, the Ministry of Health issued order No. 212n “On approval of the Procedure for admission to study in educational programs of higher education.” Graduates regarded it as an obstacle to entering residency. On the one hand, they heard that there will be changes this year, but they only found out what changes now. In accordance with the order, their fate will largely be determined by a single test within the framework of accreditation. But in addition to testing, achievements for all previous years of study will be taken into account, each of which is assessed in points. Yesterday's student receives the largest number of points for medical experience acquired during or after training. For those who do not achieve the required number of points, but receive accreditation, the direct path is to local therapists or pediatricians. Moreover, the number of “free” budget places in universities has been sharply reduced: it is assumed that mainly “target students” will study at state expense, since there is a shortage of doctors with “narrow” specialization in the regions. In large cities and in rural areas, on the contrary, there is a shortage of therapists.

“When the order came out, everyone was nervous and worried, it caused a resonance in the student community,” say graduates of First Honey. – Now everyone is calming down, looking for ways out of the situation. Of course, residency training is mostly done for commerce. But there are few places there either. The rest are forced to either change their chosen specialty, become therapists, or leave medicine. And many, probably 25-30%, are inclined to choose the last option.

Repay the debt

The system proposed by the Russian Ministry of Health will be tested for the first time this year. This is an attempt to fill the shortage of doctors in primary care. For a long time, to solve this problem, the ministry was asked to return the distribution of medical university graduates.

– We could not return to distribution from the Soviet system of medical higher education in its pure form - it would be illegal. Although there was logic in it - if you are studying at state expense, be so kind as to repay the debt to the state, and then do what you want. The same logic works in the current situation, when they decided to make therapists out of graduates, says Andrey Yaremenko, vice-rector for academic affairs at the First St. Petersburg Medical University.

Of course, the Ministry of Health does not force graduates into clinics. But against the backdrop of a reduction in budget places for residency and changes in the rules for admission to it, the choice for many becomes obvious. 6th year student of the Faculty of Medicine, PSPbSMU named after. Pavlova Elena Artemyeva wanted to continue her residency training and become an otolaryngologist. According to the new rules for admission to residency, she has all the advantages for admission - a diploma with honors, participation in scientific and social activities, experience in a medical organization. However, there are simply no budget places in her specialty based on the general competition at First Med. All of them are distributed between target audiences and “payers”. The girl was unable to receive the targeted referral, despite contacting medical institutions and authorities:

“The fate of those who are not ready to pay for residency has been determined - we will go to work in local therapy,” says Elena Artemyeva, she has already come to terms with future work in a clinic.

Andrei Yaremenko does not see anything unusual in the fact that the state is reducing opportunities for doctors to obtain a narrow specialization every year:

– Every person wants to be unique and get a lot of money. But the state needs doctors with minimal qualifications in the maximum number and with a minimum salary. This is an eternal conflict between man and state, and not only in Russia. For example, if you want to become a plastic surgeon in the USA, you need to go through a long and difficult journey and invest a lot of money in your education. If you are ready to be a general practitioner, then simply write an application and they will immediately send you to work somewhere in Oklahoma,” notes the vice-rector.

What scares future doctors most is patients

The trouble is that many schoolchildren, when choosing a profession, do not go to medicine, but to a prestigious university. They study well, as a rule, receive diplomas with high scores and go into the industry. Then there is a meeting with the patient and it turns out that the dad who can “resolve the issues” is not around, but there is a patient who is dissatisfied with the quality of treatment and has complaints. Confronting a patient head-on can be very dramatic. Unfortunately, not everyone is ready for it, just as they are not always ready for small initial salaries. These people leave healthcare almost immediately.

Therefore, the chief therapist of St. Petersburg Vadim Mazurov, the admission of graduates to work in clinics raises many questions.

“They will have to immediately plunge into real life and work. It is not yet clear how ready they are for this,” says Vadim Mazurov. – Is the graduate’s level of training sufficient to prescribe instrumental and laboratory examinations? Will he be able to maintain documentation, engage in prevention, medical examination? Will he be able to prescribe drug therapy to a patient, choose between an original drug and a generic, and evaluate possible side effects? Of course, we have clinical recommendations prepared by leading experts, which the therapist uses in his work. But when patients with ARVI, coronary heart disease, irritable bowel syndrome come to him within an hour... You immediately need to have a whole library on your desk in order to use the possibilities of clinical recommendations. This type of work is a huge burden that requires serious preparation. I worry about these children.

According to Vadim Mazurov, administrations of institutions have not yet encountered such young and inexperienced specialists, so this year they will also need special attention and patience. After all, even after residency training, only a few young specialists came to work in clinics, and the personnel shortage was solved mainly by doctors from other regions of the country who already had work experience. According to him, for a graduate to feel at least relatively comfortable in a new position, it will take at least two years of work. “These guys will need help, identify mentors and prepare all the conditions for work,” says Vadim Mazurov.

The graduates themselves also count on support:

– Of course, all students worry whether they will cope with the work. Perhaps at first we will be in the same office with a more experienced doctor,” says student Elena Artemyeva. – But we still have the skills - the last practice after the fifth year was held at the clinic, the new educational standard prepared us for the work of a local therapist. And for depth of knowledge there is always a reference manual - it is not prohibited to use it.

At PSPbSMU named after. Pavlova note that they are ready to help their students - for this there is a Center for Interaction with Alumni and the possibility of telemedicine consultations:

– They always have the opportunity to talk with a university representative if any problems arise. What's the worst thing? When a sick person comes to you, and you don’t understand what’s wrong with him, says Andrei Yaremenko and asks to treat the graduates with confidence. – Every year during the flu epidemic we send 6th year students to work in clinics. And we receive a lot of grateful feedback, they are attentive, intelligent, and will listen and help.

At the same time, Andrei Yaremenko admits that it is still difficult to call a graduate a full-fledged doctor who can carry out the entire scope of diagnostic and therapeutic measures.

– It seems to me that there should be some kind of intermediate position between the future doctor’s graduation from the university and the beginning of his broad professional activity. When a person obtains a driving license in Germany, he or she must drive for some time in the presence of a more experienced driver. Something similar should be here. At one time there was a wonderful position - a trainee doctor. It was created for doctors who had a break from work for more than 5 years. They received a salary, but worked with a mentor. Only after this did they go full-time. There is also some kind of internship abroad: a young specialist has a mentor, he works in a team, absorbs medical traditions, and this is how he develops as a doctor, says Andrey Yaremenko.

Forecast: Those who came to medicine “for love” will remain

To find a place in the district clinic, First Med graduates can use a specially created vacancy database. The number of proposals, according to Andrei Yaremenko, is sufficient for everyone. But the problem is that many of the graduates do not need these jobs - they simply do not want to go work as local therapists.

– Everyone has a dream. Let’s say a student dreamed of becoming the director of an aviation medicine clinic. The first goal on the way to his dream is to get into a clinical residency in extreme medicine. And now he has been given a serious barrier in the form of working in a clinic. And if he doesn’t want to work as a local therapist, he won’t do it,” notes Andrey Yaremenko.

According to Vadim Mazurov, even those students who go to work in clinics, “not out of love,” but out of despair, are unlikely to remain in primary care for a long time. This threatens clinics with staff turnover - young doctors will work for a certain period of time and again try to get into residency in their favorite specialty.

This is another possible problem for the heads of the institution - they prepared the young specialist and created comfortable conditions for his work. And after a couple of years the person thanks them and says goodbye. But, on the other hand, there is no other way out of the current situation with the shortage of doctors in clinics. Maybe not everyone will run away in the end. When I see a young therapist while conducting certification, I usually ask why he works in primary care. Many answer that they simply liked it here and wanted to stay,” says Vadim Mazurov.

At the same time, the chief therapist of St. Petersburg asks patients not to be afraid of young doctors:

I think this still will not affect the level of examination and treatment of patients. After all, it depends not only on the therapist. Subspecialty specialists will also take part in the treatment. But there is also a catch here - the main thing is that a medical school graduate does not become a dispatcher, redirecting his patients to other doctors for backup. With this approach, we will not prepare a good specialist.