Following from this, the incentives to become a GP are much lower in Russia than in the EU countries and it is no surprise that the average percentage of students that choose to become GPs in Russia is dwarfed by the equivalent figures in other European countries.
The question of how to address this acute shortage is paramount and attention naturally turns to the recruitment and training of Russian physicians. In Russia, training is relatively short and contained, taking 7-8 years, including medical school, a one-year internship or a two-year residency. Beyond qualification, the concept of continuous professional development is a relatively new one in Russia. The general requirement for physicians is to upgrade their qualification every 5 years through a course that lasts between 3 and 12 weeks. Until recently, this training has been provided by special postgraduate training institutions, and physicians were not able to select medical facilities in which to retrain. The drawbacks of inadequate medical education and postgraduate training along with a limited tradition of continuing professional development and low remuneration are demotivating for current, as well as future, physicians.
In tackling these problems, the government has sought to address the enduring perception of physicians and nurses as under-valued and over-worked resources in three ways:
- First, by increasing salaries of physicians and nurses
- Second, by acknowledging that the physician-population ratio should be lower while the number of nurses should increase
- Third, by implementing reform of medical education and training. Developing practical skills, re-equipping university clinics, embracing health technologies, strengthening the qualification and remuneration of trainers, increasing the residency term from 2 to 5 years and finally, allowing physicians to retrain within medical facilities.
While laudable and ambitious, this reform agenda could have a bigger chance of tackling the problems of skill shortages and a fragmented healthcare system, by addressing:
- The model of district physicians
- The shortage of GPs in primary care facilities
- The need to shift the emphasis of care from treatment (in hospitals) to prevention (through primary care and other means)
- The requirement to disperse key roles from physicians to nurses
- The integration of e-healthcare and digital technologies into the broader policy framework
- The regional inequalities that prevail across the vast Russian territory.
Twenty-five years after the end of the Soviet period, the desired shift towards an integrated framework of preventative primary healthcare remains a long way off and, in the current economic climate of low oil prices and economic sanctions, the healthcare financing gap which has persisted for decades will not be bridged any time soon.
More optimistically, these public-sector funding constraints will open multi-sector opportunities for e-healthcare to develop. As middle- and high-income earners increasingly turn to paid medical services and adopt care expectations prevailing in more advanced economies, providers will be forced to raise standards, improve efficiency and incorporate new global developments in prevention, diagnosis, and treatment. Innovations are already emerging to address these dynamics in Moscow and St. Petersburg. With the right policy environment, the potential efficiency gains, particularly in a country as large as Russia, are sizeable and the vision of ‘empowerment’ outlined by the Future Health Index may be less elusive than it at first appears.