Lavish conditions: trade unions argued for mandatory targeted medical training
The Ministry of Health of the Russian Federation is going to make all budget places in universities for medical and pharmaceutical education programs targeted, while increasing fines for refusing to work out to three times the tuition fee. Unlike the initiative to train medical students, this time there is no unanimous position in the Russian trade unions of healthcare workers: the all-Russian trade union cautiously supported the initiative, suggesting that universal targeted recruitment should be extended to other industries, and independent medical associations believe that this will only worsen personnel problems. How the industry reacted to the new initiative of the Ministry of Health is described in the Izvestia article.
What is the essence of the new initiative?
The new initiative of the Ministry of Health became known on August 26.
"It is assumed that all budget places in the main professional educational programs of higher medical education and higher pharmaceutical education will become targeted, students will be required to conclude a contract on targeted training," the Ministry of Health said in a quoted statement.
Students who violate the terms of the targeted education agreement will have to pay compensation to the budget: tuition fees and a fine of twice the cost. Simply put, you will have to pay three times more than the education cost. But the customer of targeted training will also have to pay a fine if he does not fulfill his employment obligations to the graduate.
It is also proposed to extend these conditions to graduates of secondary professional medical education programs.
The draft law has already been approved by the Commission on legislative activity of the Government of the Russian Federation. If adopted, it will enter into force on March 1, 2026.
Who supported the bill
The Trade Union of Healthcare Workers of the Russian Federation, the largest medical association in the country, conceptually supported the bill. Anatoly Domnikov, Chairman of the trade union, believes that this proposal will help to cope with the personnel shortage. He noted that this is also "not the best measure," but it will improve the situation by reducing the burden on already working medical workers.
"We discussed this initiative in detail and received answers to many of our questions from the Ministry of Health," Anatoly Domnikov told Izvestia. — Practice will show whether there will be any new pitfalls.
He recalled that the trade union opposed the initiative on mandatory work-out for all medical students. The situation is different now, he stressed: unlike working out, students' rights are not violated.
— We talked about the fact that it would be better to regulate the problem in a market way — with wages. But considering that it is quite difficult to do this now, the Government is going the other way. We believe that healthcare in this sense is the first step, and the measure with the introduction of targeted education will affect both the education sector and other sectors," Anatoly Domnikov said.
He mentioned that there are still concerns about the declining interest of applicants in medical education, but referred to the estimates of the Ministry of Health, according to which there will be no shortage of medical students.
Sergei Remizov, chairman of the Moscow Healthcare Workers' Union, believes that the issue is "long overdue." According to him, budget places in educational medical institutions should mostly be targeted, since "the state pays for education and should determine the need for specialists in certain medical organizations." Nevertheless, he emphasizes that the focus should be on the scarce specialties: general practitioner, primary care physician, intensive care physician, anesthesiologist, radiologist.
Independent associations are against
Andrey Konoval, co-chairman of the Action Healthcare Workers' union, believes that universal targeted education for medical students discriminates against an entire category of workers based on their profession.
"In the long term, this measure may have a negative impact," the source told Izvestia. — This will reduce the attractiveness of the profession for young people and reduce the competition for medical universities. Combined with triple penalties, this measure becomes absolutely prohibitive.
According to Andrey Konoval, the risks for those young doctors who want to protect their labor rights or the rights of patients are significantly increasing: attempts to reach higher authorities and correct the situation in a medical institution can lead to a conflict with management, and possible dismissal because of this can lead to a fine for not fulfilling the terms of the contract on targeted education.
Anna Okulova, editor-in-chief of the website Doctors of the Russian Federation (an independent community of medical workers), also strongly opposed the initiative of the Ministry of Health. According to her, practicing doctors are perplexed as to why medical personnel are treated in this way, although there are problems in different industries.
— We think that the shortage of personnel from such measures will only increase. You can't force a doctor to work as a doctor where he doesn't want to, without adequate financial compensation," Anna Okulova told Izvestia.
She emphasizes that doctors have been studying longer than anyone else, experiencing constant and increasing control from the heads of medical institutions, as well as pressure from supervisory authorities — and all this with not the highest salaries. Targeted training, when a doctor is told under what conditions he must work for three years, and otherwise threatened with a fine, will only make the situation worse.
— The new rules will stop many applicants. Even distribution in the Soviet version could be legally refused — if, for example, the receiving party did not provide housing. Now there is no choice," says Anna Okulova.
Opportunities for self-realization are also limited: if a hospital needs a therapist, the head physician is unlikely to take into account the desire of a medical graduate to be a hematologist. As a result, Anna Okulova believes, the country will receive a lot of unmotivated doctors. And the lack of an internship will force young doctors to learn from their own mistakes, which can turn into a criminal case. In the current conditions, says Anna Okulova, even in the dynasties of doctors, children were no longer recommended to go into medicine.
Another problem she points out is the difficulty of predicting staff shortages: it is impossible to know in advance how many doctors the clinic will need in six years.
The initiative has also been treated with caution in the pharmaceutical industry, where they hope to see more detailed information about the new format of student education.
"Pharmacies are mostly privately owned, and this business has absolutely no security, as well as guarantees that it will develop over the course of 5, 6, 10 years under the same legal entity and on the same premises," Maria Litvinova, executive director of Soyuzpharma, told Izvestia. — It is unclear whether pharmacies, having invested money in these students, will be able to hire them in a few years.
She calls for reasonable combined approaches in this matter. At the same time, Maria Litvinova understands the position of the state: the invested money should be returned in the form of real personnel who will work in the public health system. But the forms of these guarantees may be different.
How did the State Duma react to the initiative?
Sergei Leonov, Chairman of the Health Protection Committee of the lower house of Parliament, supported the initiative.
— The mechanism proposed by the Ministry of Health will be a mutually beneficial deal. A graduate of the school will be able to receive a targeted referral and independently choose which hospital to go to work in, and the medical institution will provide a job guarantee for the young graduate," he told Izvestia.
The MP stressed that the proposed training system is also linked to mentoring from experienced colleagues, and this is what he calls the main purpose of the bill.
— In three years, you can gain good practical experience and then determine for yourself in which direction to move, where and how to implement, — Sergey Leonov added. — This is a much softer option than the Soviet distribution model.
He suggests that at first there may be a negative reaction from applicants, but this "is unlikely to radically affect interest in the profession."
Alexey Kurinny, Deputy Chairman of the Health Protection Committee, agrees that the new fines and total targeted training on the budget will increase the number of graduates who will work for three years in the public medicine system.
— But in the long run, this will not help much, because after working for three years, young professionals will leave the public sector. Plus, the motivation of young people to receive medical education will decrease somewhat," the Izvestia interlocutor believes.
The State Duma deputy believes that strategically it is necessary to solve the main problems that create a shortage of personnel.: These are low wages and the associated overloads. At the same time, he calls for equalizing the differentiation in medical salaries between regions.
The deputy chairman of the Duma committee, Badma Bashankaev, did not comment on Izvestia's request.
What are the numbers for the target set now?
The Ministry of Education and Science told Izvestia that healthcare is a leader in using targeted tools. This industry accounts for 28% of employer offers and every second applicant application in 2024. In total, more than 23 thousand contracts were concluded. This is 53% of the total targeted enrollment and more than 65% of all students enrolled in the Health and Medical Sciences degree programs.
— In 2024, 3 thousand graduates of the specialty did not fulfill their contractual obligations. Of these, 41% had no financial obligations to the customer, as they did not receive social support measures from the customer during the training period, the Ministry of Education and Science added.
The Ministry of Health did not respond to a request from Izvestia about the shortage of students in the target areas. However, in April 2025, the Ministry of Health provided this data in response to a deputy request from Alexei Kurinny. Then it turned out that according to the results of the 2024/25 academic year campaign for the Health and Medical Sciences programs, only 60.5% of the total plan was accepted for target places.
Izvestia's own analysis of the target recruitment situation showed that the scores of such applicants were very different: for example, at the Far Eastern State Medical University, there were 537 applications for 75 total places and the admission threshold was 217 points, while there was a shortage in the target area, and the lowest score for admission was only 125! Even in those universities where the total enrollment was higher than the target, it was the general who scored higher in the competition.
Irina Abankina, a professor at the HSE Institute of Education, notes that it is in medical specialties that the highest proportion of deductions is made. Up to 30% of students are forced to graduate after their first or second year.
— This is due to the fact that the programs are really very complex, and to the fact that the guys do not go through a competition, but because they have signed targeted contracts and their level of motivation and training is probably inferior to the level of those who have qualified for budget places through the competition, — she told Izvestia.
Irina Abankina considers it more effective to work with medical university students in their final years, when universities will have people interested in the profession who can be offered internships, attractive jobs, and a clear professional trajectory. The expert says that the initiative of the Ministry of Health has a rational grain, but it carries risks for students, for the employer, and for the industry as a whole.
Vladimir Blinov, Director of the Scientific and Educational Center for the Development of Education at the Higher School of Public Administration of the Presidential Academy, corresponding member of the Russian Academy of Education, notes that the educational success of target students, as a rule, has always been lower than that of students enrolled on a "free" trajectory. But now the procedure has also changed: the stage of concluding targeted contracts has been postponed to the period after the competitive procedures have been completed.
— First the selection, then the contract. The conclusion of the contract is a condition for admission to the university. The formula is a bit harsh, but we are talking about state higher education, which is obliged to solve the personnel problems of the economy," he told Izvestia.
He believes that the commitment of targeted training should have a positive impact on the personnel situation. And the main difficulty of the target recruitment, he calls the difficulty of fulfilling obligations by both sides: in 4-6 years, the working conditions of the employer may change significantly, and a graduate or graduate may start a family, go on maternity leave, go to her husband's military service, etc.
— The order of the Ministry of Health of the Russian Federation is a very radical attempt to solve the really acute personnel problems of public medicine. Objective results will become clear only in 6-7 years," the expert said.
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