Russian doctors and ‘forced labour’

The training reform approved by the Duma requires medical graduates to complete three years of service to repay the funds spent by the state on their studies. Behind this measure lie increasing budgetary difficulties, but also the intention to create increasingly submissive social and professional classes in a context where protests are now impossible.

Moscow (AsiaNews) - The Moscow Duma has approved medical training reforms, which require medical graduates to complete a three-year period of service in order to obtain professional accreditation, and state funding for studies will also be gradually recovered over the years. Until now, the rules provided for an agreement as an optional means of obtaining subsidies from future employers and guarantees of employment, or students could complete their studies without any problems using state budget funds.

Now, those who do not repay the funding under the new rules will be punished with fines of up to three times the entire cost of the study programme. Duma President Vjačeslav Volodin said that if graduates start working in municipal and state hospitals, this will allow for the significant development of the entire federal healthcare system, but the main healthcare workers' unions have declared their opposition to the approved bill. The All-Russian Trade Union has stated that “compulsory payment for studies is characterised as forced labour”, and the other major trade union, Dejstvie, speaks of “discrimination” against the medical profession.

Surgeon and social activist Andrej Volna commented on this issue in the programme “Facing Events”, stating that “this initiative resembles a return to Soviet practices, when there was a system of compulsory mentoring, but today there are no more mentors, and young people are not being trained by experienced doctors with extensive knowledge, due to the severe shortage of medical staff”. What they want to impose instead is ‘serfdom for medical students’. The result will be that no one will want to enrol in medical school anymore, further exacerbating the shortage of healthcare professionals.

According to Volna and many other commentators, this and other reforms indicate that the current Russian authorities ‘are exploiting the total absence of a real civil society’, knowing that protests are now almost impossible even in the professional sphere, without touching on political or war-related issues. In medical training, where knowledge is assimilated in various stages through experience as well as specific studies, coercion is particularly ineffective and even harmful, extinguishing young specialists' desire to grow in their profession and in their relationship with patients. Volna recalls a quote from Hemingway, who said that ‘young doctors and young priests start work with the same enthusiasm,’ but if that enthusiasm is extinguished in the early years, ‘you will not get good doctors.’

Russia's increasing budgetary difficulties are the main cause of the shortage of personnel, as there are no financial means available to attract young doctors to a satisfying and well-paid profession. All this opens up ever greater scope for corruption and the pursuit of illegal profits, not to mention the effects of war, which divert the best forces away from social needs. The tightening of the conditions imposed by the Duma also depends on the many laws on the restriction of freedom of expression, foreign agents, fake news and the discrediting of the armed forces, seeking to obtain increasingly submissive and manipulable social and professional classes, especially in sensitive sectors such as healthcare and public education.

As Volna explains, this effectively creates a new category, that of the tseleviki, the “targeted”, made up of students recruited under certain conditions and without entrance exams, who are willing to work even longer than the 2-3 years of “state compensation”, but also for 7-8 years without actually receiving salaries, thus reducing state losses. As the surgeon states, the state “expects citizens to pay the ransom for their profession, for their very existence”.