Low State Salaries at Heart of Russian Doctor Deficit

All across Russia, hospitals need doctors. Health and Social Development Minister Tatyana Golikova told a conference last month that the nation lacks almost a million medical professionals. The government is frantically developing programs to boost the numbers.

Why is there such a deficit of medical staff? According to doctors and recruitment service providers, there is one big reason: money. Much more lucrative and professionally appealing opportunities are available abroad or at pharmaceutical companies.

The federal government is pumping money into state-run hospitals to lure doctors, especially in rural localities where the shortage is most apparent. For instance, doctors under the age of 35 who agree to work for five years at a rural Perm hospital get a million ruble ($33,000) grant. Prime Minister Vladimir Putin promised in March that doctors' salaries will double regional averages by 2018.

But such monetary incentives often pale in comparison to what can be made at a drugmaker in Moscow or a clinic in Europe.

"In France, a doctor working at a hospital earns 7,500 to 10,000 euros [$10,000 to $13,000] a month," Caroline Galliaerde, CEO of recruitment and executive search company Brainpower in Russia and the CIS, said by e-mail. "Highly professional specialists earn even more."

A marketing director at a pharmaceutical firm in Moscow gets a starting salary of 150,000 rubles ($5,000) a month, according to Brainpower. A marketing manager or product manager gets 100,000.

Doctors in Moscow often get 20,000 ($700) a month as a starting salary; a raise takes several years to obtain, a doctor told The Moscow Times.

Luc Jones, head of pharmaceutical recruitment at Antal Russia, regularly sees highly qualified doctors quitting their profession to join the pharmaceutical industry to make a better living.

"Basically fewer people are choosing medicine as a subject at university because it requires many years' study followed by a low paying job at the end of it," Jones said by e-mail. "Additionally those already in the profession often realize that they can earn considerably more money by joining a pharmaceutical company — and these firms like people with a medical background."

"The tricky part is that these firms need commercially minded people," Jones added, "and this isn't always something that you'll find in graduates from a medical institute."

In Russia, medical school usually lasts about eight years, a doctor told The Moscow Times. Candidates begin taking care of patients after two years. In Europe, would-be doctors must tackle a longer and more challenging degree program, Brainpower's Galliaerde said.

"In the first year of medical school alone, 42 to 45 percent of the students drop out," she said. "In general, the medical education lasts 10 to 12 years, and only then can you begin to treat patients."

"Experienced doctors are over 35 years old," Galliaerde added.

Ksenia, a doctor at a downtown Moscow hospital who, in order to speak frankly, asked that her last name not be disclosed, has seen conditions at her workplace improve drastically in the last couple of years, but many colleagues have left for more lucrative jobs elsewhere, she said.

Ksenia said her hospital has become better equipped. Doctors choose exactly what machinery they want, and eventually the state provides it. For the most part, people choose to work elsewhere because of salaries, she said.

"Many graduates want to work in research where they can make more money, but in Russia it's difficult to get such jobs," Ksenia said. "A lot of graduates go abroad for work."

Marina Bogoslavskaya, head of the medical and pharmaceutical practice at Brainpower, agreed that salaries are a major factor in the lack of doctors for hospital positions in Russia.

"We often see situations where highly qualified doctors who speak fluent English and other languages, as well as have degrees in science, and are choosing between work at multinational pharmaceutical firms in Russia and a job as a doctor in Europe — they move to Europe," Bogoslavskaya said by e-mail.

"This attests to the fact that medical centers in Europe and other countries offer jobs with more precise prospects and comfortable conditions for professional development in comparison with Russian health care facilities," she said.

Highly qualified doctors are drawn to international projects not only because of better salaries and compensation packages, but also because of more interesting career opportunities, Bogoslavskaya added. Often doctors move to the business sphere for the opportunity to be involved in international scientific projects, which allow them to obtain new knowledge in their field together with highly qualified colleagues in Russia and at global offices, she said.

Galliaerde, CEO of Brainpower, added that "the medical profession has always been prestigious, despite the fact that it is not very profitable."

"The reasons for the current unpopularity of this profession in Russia are that doctors have low social status, poor working conditions, a lack of prospects for development and, most importantly, the very low salaries and poor funding of health care in general," she said.