Compensation payments to medical workers. On a one-time compensation payment to medical workers when moving to work in the countryside. Incentive payments to health workers

Document's name:
Document Number:	204/13
Document type:
Host body:
Status:	Acting
Published:
Date of adoption:	03 April 2018
Effective date:	20 april 2018
Revision date:	25 march 2020

On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities ...

MOSCOW REGION GOVERNMENT

RESOLUTION

On approval of the Procedure for providing lump-sum compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

Document with changes made:
(Official website of the Government of the Moscow Region www.mosreg.ru, 26.06.2019);
(Official website of the Government of the Moscow Region www.mosreg.ru, 03/25/2020).
____________________________________________________________________

______________
* Name as amended by the Decree of the Government of the Moscow Region dated 25 June 2019 N 375/19 by the Decree of the Government of the Moscow Region dated 25 March 2020 N 140/7.

In accordance with Appendix No. 8 "Rules for the provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation for one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements , or a city with a population of up to 50 thousand people "to the state program of the Russian Federation" Development of health care "approved by the Government of the Russian Federation dated December 26, 2017 N 1640" On approval of the state program of the Russian Federation "Development of health care", the Government of the Moscow region
(Preamble as amended by Decree of the Moscow Region Government dated June 25, 2019 N 375/19; as amended on March 26, 2020 by Decree of the Moscow Region Government dated March 25, 2020 N 140 / 7.

decides:

1. To approve the attached Procedure for the provision of one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people.

2. Establish an expenditure obligation for the Moscow Region related to the implementation of measures to provide financial support for one-time compensation payments to medical workers (doctors, paramedics) who have arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with population up to 50 thousand people.
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

3. Determine the Ministry of Health of the Moscow Region as an authorized central executive body of state power of the Moscow Region to provide lump-sum compensation payments to medical workers.

4. Financial provision of one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people, is carried out on the basis of co-financing at the expense of subsidies provided within the budgetary allocations provided for by the Law of the Moscow Region for the next financial year and planning period.
(Clause as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

5. The Main Directorate for Information Policy of the Moscow Region shall ensure the official publication of this resolution in the newspaper "Daily News. Moscow Region", "Information Bulletin of the Government of the Moscow Region", placement (publication) on the website of the Government of the Moscow Region in the Internet portal of the Government of the Moscow Region and on " The official Internet portal of legal information "(www.pravo.gov.ru).

6. Control over the implementation of this resolution shall be entrusted to the first Vice-Governor of the Moscow Region, IN Gabdrakhmanov.
(Clause as amended, entered into force on July 7, 2019 by the Decree of the Moscow Region Government dated June 25, 2019 N 375/19.

The governor

Moscow region

A.Yu. Vorobiev

The procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to ...

APPROVED

government decree

Moscow region

dated April 3, 2018 N 204/13
(As amended by
from July 7, 2019 by the resolution
Moscow Region Government
dated June 25, 2019 N 375/19. -
See previous edition)

The procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

______________
* The name as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7 ..

1. This Procedure regulates the provision of one-time compensation payments to medical workers (doctors, paramedics) who are citizens of the Russian Federation who have no unfulfilled obligations under the contract on targeted training (with the exception of medical organizations with a staffing of less than 60 percent) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people and who have concluded an employment contract with a medical organization subordinate to the Ministry of Health of the Moscow Region, on a full-time basis with a working time established in accordance with with article 350 of the Labor Code of the Russian Federation, with the performance of a labor function in a position included in the list of vacant positions of medical workers in medical organizations and their structural subdivisions, upon replacement of which one-time jobs are carried out Compensation payments for the next financial year (hereinafter, respectively - a lump sum compensation payment, medical workers), as well as medical workers who have fulfilled the obligations related to targeted training (targeted training), provided that they continue to work in the same medical organization located in a rural population point, or a workers' settlement, or an urban-type settlement, or a city with a population of up to 50 thousand people.
(Clause as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

2. The amount of a one-time compensation payment is 1 million rubles. for doctors and 0.5 million rubles. for paramedics.

3. A one-time compensation payment is provided to a medical worker once.

4. The Ministry of Health of the Moscow Region (hereinafter referred to as the Ministry) has the right to make a decision to provide a medical worker with a lump sum compensation payment if he has obligations related to targeted training (targeted training), subject to the conclusion of an employment contract with a medical organization subordinate to the Ministry (hereinafter - a medical organization), the staffing of which is less than 60 percent.

5. The Ministry annually, before November 1 of the year preceding the next financial year, approves the List of vacant positions of medical workers in medical organizations and their structural units, upon replacement of which, one-time compensation payments are made for the next financial year (hereinafter - the program register of positions).

6. A lump-sum compensation payment is provided on the basis of an agreement on the provision of a lump-sum compensation payment (hereinafter referred to as an agreement) concluded between a medical worker, a medical organization and the Ministry.

7. The form of the contract is approved by the Ministry.

8. Copies of the following documents are attached to the agreement:

passports of a citizen of the Russian Federation;

insurance certificate of state pension insurance;

certificates of registration of an individual with a tax authority;

a document confirming graduation from an educational institution of higher education (for doctors) or a professional educational organization (for paramedics);
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

document on the end of an internship or residency (for doctors of specialties, training for which in an internship or residency is mandatory for the implementation of labor activities in accordance with the Order of the Ministry of Health of the Russian Federation of 08.10.2015 N 707n "On approval of qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health and Medical Sciences");
(The paragraph as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

professional retraining document (if any);

specialist certificate (or specialist accreditation certificate);

certificates of recognition of foreign education and (or) foreign qualifications;

a certificate of a specialist issued by the Federal Service for Surveillance in Healthcare of Roszdravnadzor, or its territorial bodies (for persons who have received medical training in universities of foreign countries who are citizens of the Russian Federation);

labor contract;

work record book or information about work activity received in a multifunctional center for the provision of state and municipal services in hard copy;
(The paragraph as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

order of appointment to the position;

a document from a credit institution containing the name of the bank, BIK of the bank, TIN of the bank, KPP of the bank, personal account of a medical worker;

licenses for the implementation of medical activities by a healthcare institution.

9. The contract is concluded on the basis of an appeal of a medical worker to the head of a medical organization, received after the conclusion of an employment contract providing for work in a position included in the program register of positions, and the end of the probationary period, if such a period is set for a medical worker when hiring.

10. The contract signed by the medical worker and the head of the medical organization is sent by the medical organization to the Ministry.

11. The Ministry, within a period of not more than 30 working days from the date of receipt of the agreement on the provision of a one-time compensation payment, signed by a medical worker and the head of a medical organization, signs the specified agreement and sends two copies of the agreement on the provision of a one-time compensation payment to the medical organization.

12. If there are grounds for refusal to conclude an agreement provided for in paragraph 13 of this Procedure, the Ministry, within the time period specified in paragraph 11 of this Procedure, sends a reasoned refusal to conclude an agreement on the provision of a lump-sum compensation payment to the medical worker.

13. Grounds for refusal to conclude an agreement are:

non-compliance of the medical worker who signed the contract with the requirements provided for in paragraph 1 of this Procedure;

sending to the Ministry of the agreement that does not correspond to the form of the agreement approved by the Ministry;

lack of copies of the documents provided for in paragraph 8 of this Procedure.

14. When eliminating the reasons that served as the grounds for refusing to conclude an agreement, the medical worker has the right to reapply for a one-time compensation payment in accordance with paragraphs 9 and 10 of this Procedure.

15. Ministry:

keeps records of concluded and executed contracts;

transfers the lump-sum compensation payment to the account of the recipient of the lump-sum compensation payment.

16. A medical worker who has concluded an agreement with a medical organization and the Ministry undertakes the following obligations:

1) perform labor duties for 5 years from the date of the conclusion of the contract for positions in accordance with the labor contract, subject to the extension of the contract for the period of non-fulfillment of the labor function in full (except for the rest time provided for in 107 of the Labor Code of the Russian Federation);

2) return to the budget of the Moscow Region part of the lump-sum compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract to the expiration of the 5-year period (except for cases of termination of the employment contract on the grounds provided for in paragraph 8 of part one of Article 77 and paragraphs 5-7 of part the first article 83 of the Labor Code of the Russian Federation), as well as in the case of transfer to another position or admission to training in additional professional programs;

3) return to the budget of the Moscow Region a part of the lump-sum compensation payment, calculated in proportion to the unworked period from the date of termination of the employment contract, in case of dismissal in connection with conscription (in accordance with paragraph 1 of part one of Article 83 of the Labor Code of the Russian Federation) or extend the period validity of the contract for the period of non-performance of functional duties (at the choice of a medical worker).

Document revision taking into account
changes and additions prepared
JSC "Codex"

On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who have arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)

Document's name:	On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who have arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)
Document Number:	204/13
Document type:	Decree of the Government of the Moscow Region
Host body:	Government of the Moscow region
Status:	Acting
Published:	Official website of the Government of the Moscow Region www.mosreg.ru, 09.04.2018
Date of adoption:	03 April 2018
Effective date:	20 april 2018
Revision date:	25 march 2020

In order to encourage medical workers in the Russian Federation, since 2014, a program has been in place to support citizens employed in this area. In particular, such support consists in obtaining incentive payments, the appointment of which is carried out based on the criteria specified in the governing laws and regulations. In addition, incentive payments to health workers in 2020, as before, are designed to attract more specialists to work in government agencies, since they are charged exclusively in non-profit organizations.

Legislative acts regulating the assignment of additional payments

On what basis can a healthcare professional qualify for an Intensity and Performance Benefit? Amounts in addition to the basic salary are calculated on the basis of the following laws and regulations.

Who cannot receive incentive co-payments?

The provision on incentive payments in health care clearly limits the range of workers who can apply for material supplements to their basic income as wages. A mandatory factor that makes it possible to accrue both permanent and one-time payments is the presence of a certificate in the main specialty of a medical worker - this provision is spelled out in the RF PP No. 583, and other factors (merits in work, etc.) cannot be canceled can.

In addition, the appointment of payments is possible to certain categories of doctors and medical workers, taking into account the existing restrictions. So, such additional payments are not entitled to the following categories of employees employed in the health care sector.

Those persons who belong to the administration of medical institutions. In some cases, it is allowed to receive a co-payment, but only on condition that the employee, in addition to performing his main function, is also a practicing doctor.
Medical workers who provide assistance that is classified as high-tech according to the appropriate classification.
Those employees who are members of the Health program operating in the Russian Federation. Participation in it includes providing assistance in delivering childbirth, caring for newborns, providing medical services as a pediatrician or family doctor, etc.

The principle of remuneration of medical workers

Speaking of incentive charges, it is worth considering in more detail the types of remuneration that are relevant to employees in the medical field.

Based on the Labor Code of the Russian Federation, employees of medical institutions are entitled to the following types of charges.

Basic, or basic, which are calculated based on the size of the salary and the specifics of the type of activity.
Compensatory... Their accrual is governed by norms that differ depending on the region in which the employee is employed.
Social... They can be assigned based on the health worker's membership in one of the groups on the list of recipients of social benefits.
Stimulating- appointed as a result of the analysis of activities and the performance of direct duties by a doctor or other health worker.

It should be noted that if all other charges, except incentives, are strictly controlled by federal or regional regulations, then incentives can be regulated directly by the management of the medical institution. To carry out such an action, the administration of each individual institution is obliged to issue a document - a resolution (created, of course, on the basis of the general law on payments and not contradicting its provisions). This document defines the nuances of the appointment of payments that can be applied directly to the employees of this organization. Each of the employees belonging to the category of persons that can qualify for such payments has the right to familiarize themselves with this document.

What are incentive co-payments? These are monetary charges assigned on a monthly basis based on accepted criteria for assessing the work of doctors and medical staff. In the event that at the end of the calendar year in a particular institution there is an unused part of the funds allocated solely for receiving incentive payments, it is allowed to receive one-time payments, which will be assigned based on the results of work for the current year.

The amount of incentive charges

It is worth noting that the amount of incentive co-payments is not constant - it directly depends on the amount of services related to the performance of direct duties, made by the medical officer.

The following rules apply to the amount of charges on the territory of the Russian Federation.

Payment of a cash bonus of a stimulating nature is made on the basis of a separate order from the administration of the institution.
The order is issued every month.
The amount of payments is established by the administration of the medical institution, taking into account the permissible minimum and maximum values \u200b\u200bestablished by legislative acts.

Basis for assigning copayments and assessment principles

The following factors have a decisive influence on the amount of the accrued additional payment.

The time that a specific employee worked during the month for which the payment is calculated.
Compliance with the health worker standards for the provision of first aid to the population.
Efficiency in performing work duties.
The length of service of the employee and its continuity.

Without fail, the administration, when assigning payments, must be guided by the current provisions on remuneration, as well as federal, regional acts and presidential decrees affecting the procedure for calculating and receiving such amounts.

The Faculty of Medical Law again returns to the discussion of the issue of guarantees and compensations provided by the state to medical workers. As you know, medical workers when moving to the countryside are provided with a one-time compensation payment. Today we will tell you about the procedure for providing this compensation as part of the changes for 2017.

About a lump sum compensation payment

So, according to part 12.1. Article 51 of the Federal Law of November 29, 2010 No. 326-FZ "On Compulsory Health Insurance in the Russian Federation" (hereinafter - FZ No. 326), a one-time compensation payment to medical workers is provided to medical workers who meet certain criteria who have arrived to work in a rural settlement, or a workers 'settlement, or a settlement of an urban shooting range or who have moved to work in a rural settlement, or a workers' settlement, or an urban-type settlement from another settlement.

You should know that the size of the lump-sum compensation payment to medical workers is 1,000,000 rubles.

Financing of one-time compensation payments to medical workers in 2017 is carried out at the expense of other interbudgetary transfers provided to the budget of the territorial CHI fund from the budget of the Federal CHI fund in accordance with the Federal Law of December 19, 2016 No. 418-FZ "On the budget of the Federal Mandatory Medical Insurance Fund for 2017 and for the planning period of 2018 and 2019 ”, and funds from the budgets of the constituent entities of the Russian Federation in the ratio of 60 and 40 percent, respectively.

Note that in accordance with clause 37.2 of Article 217 of the Tax Code of the Russian Federation, the one-time compensation payment is not taxable.

The purpose of such payment is to attract medical workers to rural settlements and to compensate for the costs associated with relocation and arrangement, as well as inconveniences caused by less comfortable living conditions compared to other (non-rural) settlements.

At the same time, the legislator does not at all limit medical workers who arrived to work in a rural settlement in what the amount provided will be spent on.

A medical worker, in turn, upon receiving a one-time compensation payment, must work for a certain period of time in a medical organization of a rural settlement of the constituent entity of the Russian Federation with which the specified agreement is concluded. As a rule, this period is 5 years.

It should be noted that Federal Law No. 326 does not provide any explanations as to which particular settlement can be considered a rural one.

A similar explanation is contained in the Letter of FFOMS dated 05.02.2013 No. 801/21-i "On the implementation of one-time compensation payments in 2013" (hereinafter - Letter FFOMS No. 801/21-i). On the issue of assigning settlements to rural settlements and industrial settlements, it is necessary to be guided by part 1.1 of article 10 of the Federal Law dated 06.10.2003 No. 131-FZ "On general principles of organizing local self-government in the Russian Federation" (hereinafter - FZ No. 131). Since the Letter of FFOMS No. 801/21-i refers to the old version of FZ No. 131, we will cite the current provision of FZ No. 131 on this issue.

Thus, in accordance with part 1.1 of article 10 of Federal Law No. 131, the granting of municipalities the status of an urban, rural settlement, a municipal district, an urban district, an urban district with an intracity division, an intracity district, an intracity territory of federal cities is carried out by the laws of the constituent entities of the Russian Federation.

It is worth noting that the criteria that apply to medical workers claiming a one-time compensation payment change from year to year.

So in 2017, a one-time compensation payment will be paid only to those medical workers who meet the following criteria in aggregate:

age - up to 50 years old (by the way, in 2012-2014 the age limit was up to 35 years old, in 2015 - 45 years old);
availability of higher education;
arrival at work in a rural settlement in 2016 and 2017;
availability of a concluded agreement with an authorized executive body of the constituent entity of the Russian Federation.

In practice, the authorities that are provided with such a package of documents require a medical worker to also have an employment contract between the medical worker and the state healthcare institution of the constituent entity of the Russian Federation or a municipal healthcare institution.

By the way, the FFOMS and the Ministry of Health of Russia speak about this condition in the Letter of FFOMS dated July 8, 2013 No. 5124 / 80-1 / and "On judicial practice on the consideration of disputes on the payment of a one-time compensation to medical workers who have moved to work in a rural settlement" (Letter FFOMS No. 5124 / 80-1 / i) and the Letter of the Ministry of Health of Russia dated 10.08.2012 No. 11-11 / 3089 "On the issue of making one-time compensation payments to medical workers" (Letter of the Ministry of Health No. 11-11 / 3089).

However, it is worth remembering that the letters of the FFOMS, the Ministry of Health of Russia and other authorities do not have signs of normativity and can only be of an explanatory and recommendatory nature.

The publication of such explanatory letters by the relevant authorized bodies indicates that there is no uniform procedure for providing a one-time compensation payment today.

In the absence of legal regulation (procedure) for the provision of a one-time compensation payment, the FFOMS and the Ministry of Health of Russia provide the authorized executive bodies of the constituent entities of the Russian Federation to resolve this issue independently, as indicated, for example, in a letter to FFOMS No. 801/21-i, according to which the specified bodies must normative legal acts providing for measures of social support of medical workers, as well as the procedure for concluding an agreement between a medical worker and an authorized executive body, should be submitted.

So, the Procedure for concluding an agreement with a medical worker on the provision of a one-time compensation payment in 2017 in the Moscow region was approved by the Decree of the Government of the Moscow region dated March 14, 2017 No. 145/8 (hereinafter referred to as the Procedure for MO).

In accordance with this Procedure for the Ministry of Defense, an agreement on the provision of a one-time compensation payment must provide for:

the obligation of a medical worker to work for five years at the main place of work under conditions of normal working hours established by labor legislation for this category of workers, in accordance with an employment contract concluded by a medical worker with a state health care institution of the Moscow region located in a rural settlement or a worker a settlement of the Moscow region, or an urban-type settlement of the Moscow region (hereinafter - a health care institution);
the procedure for providing a medical worker with a one-time compensation payment in the amount of one million rubles during thirty working days days from the date of the agreement with the Ministry of Health of the Moscow Region (hereinafter referred to as the Ministry);
the obligation of the medical worker to return to the budget of the Moscow region a part of the lump-sum compensation payment in the event of termination of the employment contract concluded by the medical worker with the health care institution, before the expiration of a five-year period calculated from the date of termination of the employment contract, in proportion to the period not worked by the medical worker;
the responsibility of the medical worker for failure to fulfill the obligations stipulated by the contract, including the return of a lump sum compensation payment;
provision on the consent of a medical worker to the processing of his personal data.

The MO procedure explains that an agreement with a medical worker is concluded by the Ministry after the medical worker concludes an employment contract with a healthcare institution.

At the same time, a health care institution that has entered into an employment contract with a medical worker:

checks the availability and accuracy of the documents submitted by the medical professional;
submits to the Ministry an application of a medical worker on the provision of a one-time compensation payment (please note that the deadline for submitting such an application to the Ministry has not been set. Note that earlier the health care institution should have sent an application to the Ministry within three working days from the date of the conclusion of an employment contract with a medical worker).

Also, in the Procedure for the Ministry of Defense, it is noted that a one-time compensation payment is established and paid to medical workers only at the main place of work.

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In recent years, the salaries of doctors and the entire system of remuneration of medical workers have changed significantly, which can be associated with the need to motivate employees to provide quality medical care. In turn, the level of salaries of health workers should fully depend on how high-quality medical services it provides to the population.
Government Decree No. 2190-r of November 26, 2012 provides for a phased change in the payroll system in the public sector, which involves improving the main components of wages - salary, tariff (hourly) rate, as well as additional incentive and compensation payments.

At the same time, the level of salaries of healthcare workers should fully depend on how high-quality medical services it provides to the population.

Salaries of doctors and medical workers in 2016 *

According to Rosstat, in the first half of 2016, the average salary of doctors and medical workers was 48,946 rubles.

The highest salaries for doctors are predictably recorded in the Nenets, Chukotka, Yamalo-Nenets, Khanty-Mansi - Yugra, autonomous regions; Kamchatka Territory; Magadan, Sakhalin, Tyumen regions; Moscow and the Republic of Sakha (Yakutia).

The lowest salaries of medical workers and doctors: Oryol Region, Republic of Mari El, Ulyanovsk Region, Republic of Ingushetia, Republic of Adygea, Republic of Dagestan, Kabardino-Balkar Republic, Karachay-Cherkess Republic, Republic of North Ossetia - Alania, Republic of Kalmykia.

For the full tables of salaries of doctors in 2016 in Russia, see below.

Piecework wages of health workers

The salary of a doctor can be formed according to the principle of piecework, taking into account some peculiarities. In particular, it is necessary to take into account the recommendations of the Ministry of Health of the Russian Federation, as well as the Russian Tripartite Commission (RTK). Generally speaking, the current legislation contains provisions allowing the establishment of piecework wages in the organization, while there are no exceptions for employees of medical institutions. In the case of piecework wages for health workers, the established price for the work performed is taken into account, while the tariff rate is set for the work norm performed, and does not include incentive or compensatory payments. The fact that these concepts are unequal follows from the conclusions of the courts based on the results of the consideration of civil cases. In addition, the order of the Ministry of Health of the Russian Federation No. 377, which contained a direct indication of the possibility of using piece rates to establish the salaries of medical workers, also became invalid. Today, the Ministry of Health of the Russian Federation adheres to the position that the salary of doctors should include: salary, incentive payments, compensatory payments and the tariff rate. However, if in the hospital there is still a need to establish a piece-rate form of remuneration for individual employees, then it is necessary to provide for such a form in the local act of the institution - in a collective agreement or other local act. This will not constitute a violation of applicable labor laws.

Brigade forms of remuneration

Some hospitals are considering the possibility of establishing a brigade form of remuneration in the institution, that is, when the salary of a particular doctor or other medical worker depends on the overall performance of the unit, department or mobile team.

Today, the system of remuneration of medical workers in ordinary city and regional hospitals provides for the calculation of the amount of incentive surcharges depending on the specific collective results of the work of hospital employees.

The formula for calculating the optimal average daily load on the ambulance team:

According to the author's method of V.M. Shipova and A.N. Plutnitsky, the optimal load on the ambulance team has not been determined, since the call flow is random and the frequency of calls is not regulated. But it is possible to calculate the optimal load on the ambulance crew. Based on the planned and normative data on the provision of the population with ambulances and the number of calls, we derive the formula:

318 X 10: 365 \u003d 8.7, where
318 - number of calls per 1000 population;
10.0 thousand - the number of the population;
365 - calendar days of the year;
The indicator 8.7 (9.0) calls is the average daily load on the ambulance crew.

The remuneration system in such institutions is fixed in local acts (agreements, collective agreements, regulations, etc.), while taking into account:

approved classifiers of professions, positions;
developed medical professional standards;
the views of health care professional unions;
professional communities of employers;
the volume of state guarantees in the field of wages;
the position of the Russian Trilateral Commission;
position of the Ministry of Health of the Russian Federation.

So, in the joint recommendations of the Ministry of Health of the Russian Federation and the RTK, the use of a brigade form of remuneration is not provided for. Previously, the application of the form of brigade wages for medical workers was provided for in the order of the USSR Ministry of Health No. 1180 dated November 10, 1986, but since 2009 it has lost its legal force. However, the current legislation does not prohibit taking into account the results of the team's work to calculate incentive payments to a specific medical worker. Also, the Order of the Government of the Russian Federation No. 2190-r dated November 26, 2012 states that specific incentives should be established in relation to medical workers for achieving collective results of work.

Salary ratio

The Ministry of Health of the Russian Federation has set the maximum level of the ratio of the average salary of chief doctors of hospitals and medical workers in the system of healthcare institutions. Thus, in accordance with Order No. 170 of March 28, 2013, the level of the maximum salary of the chief physician of a hospital is a multiple of 8 salaries of employees of hospitals under the jurisdiction of the Ministry of Health of the Russian Federation. The regulation on remuneration of employees of the Medical Organization was developed in accordance with the requirements of the Labor Code of the Russian Federation and other regulatory legal acts containing labor law norms.

Salary of medical workers

This section discusses all the legal features of setting salaries for medical workers, including the rules for the use of professional qualification groups, accounting for experience and the possibility of establishing an individual salary for a medical worker.

Establishing a personal salary

The salary is a certain amount of remuneration for a medical worker, which is established for him for the performance of his professional duties, provided for by a specific position. The salary does not include other additional payments. We believe that the establishment of personal salaries for health workers in state and municipal hospitals is not expressly prohibited by labor legislation, although other norms are not recommended for the following reasons. In accordance with Art. 22 of the Labor Code of the Russian Federation, a medical institution, as an employer, must provide its employees with the same wages for performing similar work. At the same time, the establishment of different salaries for the same positions is not prohibited, but it seems unjustified. The RTK adopted unified recommendations on the establishment of remuneration for employees of state and municipal institutions dated December 25, 2015, in which it is not recommended to establish salaries for employees who are in the same qualification group of different rates. It is also not recommended to indicate the range of salaries for health workers who are engaged in work of the same complexity. However, as law enforcement practice shows, nevertheless, the decision to establish an individual salary is not recognized as labor discrimination if employees occupy the same position, but perform a different amount of work of varying complexity.

How to take into account the experience

As a general rule, the length of service of a medical worker does not in any way affect the size of the official salary established for him. As we have already said, the official salary is a fixed monthly payment to an employee who has performed his job duties in the proper amount. Since the remuneration of medical workers consists not only of the official salary, their continuous medical experience should be reflected in other payments, for example, in payments of a compensatory nature. Such recommendations are established by order of the Ministry of Health and Social Development of the Russian Federation No. 818 dated December 29, 2007.

Application of occupational skill groups

Vocational qualification groups (VQGs) can be used when establishing base rates and salaries by the Government of the Russian Federation, the salary of health workers of state and municipal hospitals cannot be lower than the salaries established by the VQG. According to the decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, the interested executive bodies, together with the Ministry of Labor of the Russian Federation, can develop and submit their specific proposals on the official salaries of the PKG employees. The basis for the formation of the SCG is certain requirements for the level of qualifications of employees, which they need to carry out specific professional activities, since in accordance with labor legislation, the salary of a doctor, like any other employee, depends on his qualifications. Therefore, prior to the establishment of base salaries for specific positions by the Government of the Russian Federation, in health care institutions, PSCs can be used in the development of salary systems for health workers. This is confirmed by the provisions of Decree of the Government of the Russian Federation No. 583 of 08/05/2008, which states that the salaries of employees are established by the management of the institution based on the requirements for qualifications and work experience in a specific position (PCG). This takes into account the volume of work performed by employees and its complexity.

The ratio of the salaries of managers and health workers

The size of the official salaries of medical workers does not in any way affect the salary of the chief physician of the hospital and the salaries of his deputies. As stated in Art. 145 of the Labor Code of the Russian Federation, the remuneration of heads of state and municipal institutions is established in accordance with labor legislation, the constituent documents of the official, regional and municipal acts. The specific terms of remuneration of executive officials are reflected in their employment contracts. At the same time, a number of normative acts adopted recommendations for establishing the level of remuneration for heads of institutions: recommendations for 2016, approved by the RTK dated December 25, 2015, as well as in relation to federal institutions - RF Government Resolution No. 583 dated August 5, 2008. In these documents, it is recommended to establish a salary for the heads of the institution that is a multiple of 8 of the average salaries of all employees of the institution; in the decision of the RTK dated December 25, 2015, it is also recommended to set salaries for chief accountants and deputy chief physicians at the level of 70-90% of the salaries of hospital managers.

Salary: control of establishment

Which bodies can check the correctness of the choice of the official salary for employees of a medical institution:

labor inspectorate during inspections within the framework of state supervision over the observance of the labor legislation of the Russian Federation by a medical institution. In addition, the state labor inspectorate checks the implementation of the program for improving the remuneration system in state and municipal institutions, which was approved by the order of the Government of the Russian Federation No. 2190-r of November 26, 2012;
The Ministry of Health of the Russian Federation, as a department that exercises the powers of the founder in relation to subordinate medical institutions; territorial compulsory medical insurance funds, which check the salary amounts as part of inspections of labor costs, which are included in the structure of the tariff for paying for medical care in the compulsory medical insurance system;
other government bodies authorized to audit the financial and economic activities of the hospital.
The reporting form on the wages of employees of medical organizations in the field of compulsory health insurance was approved by Order of the FFOMS dated 26.03.2013 No. 65.

Calculation of the amount of funds aimed at remuneration of employees of the cabinet (office) of general medical practice (family doctor)

1. Number of employees

2. The number of attached population, people.

3. Funding per capita, rubles.

4. Amount of financing, rub.

5. Statement of expenditure of funds

Chief physician

Chief Accountant

Compensation payments to medical workers

Indication of compensation payments in the employment contract

Is it possible to prescribe in the labor contract of a medical worker that the amount of his compensation payments is established by the legislation of the Russian Federation? In the event that the legislator has established the minimum amount of compensation payments for medical workers, the employer must indicate in the employee's employment contract in a specific amount or as a percentage of the official salary. Compensation payments to medical workers can be provided for various reasons: for medical experience, for irregular working hours, for work in rural areas, for having a professional category, etc. Labor legislation, as a rule, sets only the minimum amount of such payments. The employer must establish the specific amounts of compensation allowances for medical workers, having prescribed such sections in the regulation on the remuneration of the hospital. Additional guarantees for employees who work in conditions deviating from normal must be spelled out in the employee's employment contract, in accordance with Art. 57 of the Labor Code of the Russian Federation. In addition, the recommendations approved by order of the Ministry of Health of the Russian Federation No. 167-n of 04/26/2013 indicate that specific factors and conditions for receiving all compensation payments should be prescribed in the regulation on wages, as well as in the employee's employment contract.

Reducing the size of compensation payments based on the results of the SAUT

Let us consider the conditions under which a health worker can be reduced the compensation payments provided to him in connection with a special assessment of working conditions (SAWC). The amount of compensation for a health worker may change with an improvement in his working conditions, which is confirmed by the conclusion of a specialist in SUT, carried out in a hospital (Article 74 of the Labor Code of the Russian Federation); As you know, guarantees and compensations for medical workers who are employed in working conditions deviating from normal are provided in accordance with the provisions of labor legislation, the collective agreement of the hospital, the employee's labor agreement, etc.

However, the employer must cancel the guarantees provided earlier in the event that safe working conditions are provided at the employee's workplace, which is confirmed by the conclusion of the state examination or SOUT. In connection with the adoption of the new law No. 426 "On SOUT", there is a transition period to a new system of job evaluation. So, if the attestation of workplaces was carried out in the hospital before 13.07.2015, then it will continue to operate for 5 years. SOUT during this period is optional. The medical institution has the right, but not the obligation, to initiate the SAWS before the expiration of the validity of the certification results.

If the preservation of working conditions, which gave the employer the right to establish compensation payments to its employees, was confirmed, then the amount of these additional guarantees cannot be changed in comparison with those payments. Which were in effect at the beginning of 2014. In accordance with the clarifications of the Ministry of Labor of the Russian Federation of 12/15/2014 regarding the application of the new rules of the SAUT, the improvement of working conditions is a decrease in the final class or subclass of working conditions at a specific place of work of an employee. So, if the working conditions of the health worker have improved, which was confirmed in the conclusion of the SAUT, the hospital management may reconsider the amount of compensation that is provided to the employee in harmful working conditions. In this case, it is necessary to remember the rules for changing the terms of the employment contract between the hospital and the employee, which are set out in detail in Art. 74 of the Labor Code of the Russian Federation.

Replacement of additional leave for harm with monetary compensation

Many employees have a desire to replace part of their annual leave with monetary compensation. Is it possible from the point of view of the law to replace the leave granted to an employee for work in harmful working conditions with monetary compensation?

Replacing vacation with compensation is possible, but it is important to comply with a number of conditions:

you can only compensate for a part of the vacation "for harmfulness" (2, 3, 4 degrees);
all employees of the Labor Code of the Russian Federation are guaranteed a minimum of 7 calendar days for work in harmful and dangerous working conditions;
if the collective agreement of the medical institution or industry-specific acts guarantee such employees more than 7 days of additional leave, then, at the employee's request, the part exceeding the guaranteed one can be replaced with monetary compensation;
the possibility of replacing parts of vacation days with the provision of monetary compensation must be expressly stipulated in the hospital's local acts or industry agreement;
the employee must express his desire to replace the additional vacation with money, his consent is formalized by an additional agreement to the employment contract.

Accounting for compensation payments when on duty at home

Remuneration for medical workers consists of a salary, compensation and incentive payments. Taking into account all these payments, payment for doctor's duties at home is also carried out.

Home duty refers to the stay of a hospital doctor at home awaiting a call to a medical facility or to a patient to provide him with urgent or emergency medical care. For such employees, special working hours and time tracking are usually established.

In accordance with the order of the Ministry of Health of the Russian Federation No. 148-n dated 04/02/2014, the time during which the medical worker was on duty at home is a worker, and it is taken into account in the summarized accounting of working time.

At the same time, the legislation does not establish specific rules for calculating doctor's salaryon duty at home. This means that all payments to the employee are taken into account in a general manner, including compensation payments, regardless of whether the doctor was on duty at home or not.

Compensation payments: control of establishment

The following government agencies and officials can verify the correctness of the establishment of compensation payments for medical workers:

territorial bodies of the labor and employment service, in the course of the state examination of working conditions. It is during such an inspection that the inspectors assess the correctness of providing medical workers with the required amount of compensation for work with harmful or dangerous working conditions;

the state labor inspectorate, which assesses the safety of working conditions, checks the provision and protection of the labor rights of medical workers during special inspections;

labor protection specialists and inspectors of trade union bodies of medical workers who carry out an independent examination of the working conditions and safety of employees in the workplace;

territorial bodies of compulsory medical insurance, in the course of inspections, the purpose of which is to check the costs of wages, which is part of the tariff for paying for medical care.

Incentive payments to health workers

Using scoring

Medical institutions of a municipal or state health care system are not obliged to use a point assessment of work performance to assess the performance of their employees. Incentive payments to medical workers should be established in the local acts of the hospital, in a collective agreement, industry agreement or other regulations that contain labor standards.

By order of the Ministry of Health of the Russian Federation No. 421 of June 28, 2013, guidelines were approved, which state that there are different mechanisms for distributing the fund of incentive supplements between employees of a particular institution. Including the introduction of a scoring system, bonuses is permissible. This means that a specific medical institution can develop and implement its own mechanisms for calculating incentive co-payments for medical workers, including the right to introduce a point-based system for distributing payments. This requires the development of appropriate criteria and indicators.

Payments PNP "Health"

Payments to medical workers within the framework of the national project "Health" are established in the regions in accordance with tariff agreements and the terms of the territorial program. Let us recall that one of the objectives of the program is material incentives for medical workers. Should the management of the medical institution keep the payments to district doctors and nurses that were previously provided to them under this program? Labor legislation in art. 135 of the Labor Code of the Russian Federation identifies sources in which additional incentive payments to employees can be established, including the conditions for the payment of bonuses.

In accordance with the program of state guarantees for 2016, which was approved by Decree of the Government of the Russian Federation No. 1382 of December 19, 2015, the structure of the tariff provided for paying for the assistance provided to the population in the compulsory medical insurance system includes incentive payments for district doctors, nurses, paramedics and obstetricians points, ambulance staff, etc.

Tariff agreements between the regional executive body, the territorial CHI fund, medical workers' trade unions, as well as medical non-profit organizations establish specific tariffs for payment of medical care provided by hospitals.

Today, when setting these tariffs, the commission authorized by the participants takes into account the amount of incentive additional payments to health workers, which were previously established by the national program "Health".

In this regard, we believe that a medical institution should provide that all such payments should be made in an amount that has already been taken into account in the tariff for the provision of medical care under the territorial compulsory medical insurance program, approved at the regional level.

Conditions under which incentive payments are not made

A medical institution must initially prescribe special conditions in the regulatory documentation, upon the occurrence of which incentive additional payments to specific health workers will not be made. The current system of remuneration for medical workers is established in the collective agreement of the hospital, in the regulation on remuneration, as well as in the employment contracts of specific employees. From the legal essence of incentive payments, it follows that their accrual to specific medical workers is not the responsibility of a medical institution - this is its right. At the same time, the order of the Government of the Russian Federation No. 2190-r of 11/26/2012 directly states that the remuneration system, as well as the conditions for receiving certain payments and remuneration, should not be interpreted by the parties in an ambiguous manner, they should be equally understandable as a health worker and the employer.

if during the inspections it was revealed that the provision of medical services to citizens was paid, while the state guarantees program provides for the provision of such services free of charge;
the imposition of a disciplinary sanction on a medical worker.

At the same time, the remuneration system for a specific medical institution may provide for other conditions for depriving a medical worker of incentive payments in a specific period.

Depreciation of medical workers

A controversial issue is the application of such a sanction as depreciation to medical workers. Note that, according to departmental recommendations, as well as the provisions of the Labor Code of the Russian Federation, it is recommended that medical institutions provide conditions for the use of incentive surcharges, but not conditions for depriving the employee of the bonus. In accordance with Government Decree No. 2190-r, measures to improve the system of incentive supplements to medical workers are carried out with the aim of correlating the size of doctors' salaries with specific results of their work. First of all, the quality of the provided medical services is taken into account, on the basis of which these or those incentive payments are applied. The bonus itself is one of the types of incentive additional payments for medical workers, therefore, the medical institution must establish specific conditions for its receipt. A specific list of disciplinary punishments is contained in Art. 192 of the Labor Code of the Russian Federation, however, such a measure as deprivation (deprivation of bonuses) is not contained in the current version of the code. This is evidenced by the judicial practice. The courts unambiguously interpret the application of the deprivation in relation to any employee of the employer as an unreasonable and not subject to application of a sanction, which is recognized as illegal by the current legislation. In this regard, we recommend that the chief doctors of hospitals avoid the application of such sanctions in relation to medical workers, in the local acts of the hospital, all the more, there should not be any conditions for deprivation.

Labor standards for incentive payments

When establishing incentive payments to health workers, certain labor standards are used, however, not all of them are advisable to use as criteria for additional payments. In particular, labor standards that are not directly provided for the purpose of assigning incentive payments and do not in any way reflect the results of the professional activity of the health worker and the quality of the medical services provided to him are not applicable. This is due to the provisions of the order of the Government of the Russian Federation No. 2190-r of 11/26/2012, which states that all incentive additional payments for employees depend on the quality of their work and the achieved professional results, and specific indicators and criteria for their activities should be reflected in the employee's employment contract based on the developed wage system. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, the specific labor standards of the institution are established by the labor rationing system in the organization. At the same time, different norms and standards can be established in a medical institution: by the number of personnel, by time, by volume, production, etc.

It is inappropriate to use the following norms to determine incentive payments:

1. The norm of the number of health workers. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 dated September 30, 2013, this norm is needed, first of all, to determine the number of employees of certain positions that are necessary to perform a certain amount of work or production and other functions. For example, such a rate may be expressed in one medical position per district, in accordance with the number of the attached population.

2. Standards of time. In accordance with the order of the Ministry of Labor No. 504, they express the specific time spent by a health worker, which he needs to provide one service (work). This indicator is primarily used to calculate the norms for the number of employees.

Service standards, in accordance with the order of the Ministry of Labor of the Russian Federation No. 504, are indicators of the number of jobs, equipment, production areas, etc., with which an employee works during a certain unit of working time. Such an indicator can be used to assess the performance of an employee when calculating incentive payments.

An approximate list of indicators for the appointment of incentive payments for the intensity and performance of work, as well as bonus payments for certain categories of workers, is recommended by the expert group of the information center "MCFER-Medicine".

Salary fund for medical workers

In medical institutions, there are several sources for the formation of the salary fund for medical personnel:

funds from budgets of different levels;
funds from off-budget sources (from the CHI funds);
cash that is received from income-generating activities.

In health care institutions that are under the jurisdiction of a region or municipality, the wage fund is formed in accordance with the relevant regulations of the subject of the Russian Federation or the municipality. In accordance with the order of the Government of the Russian Federation No. 2190-r of 11/26/212, a system of differentiated remuneration of personnel is currently envisaged, the final salary of a doctor depends on the complexity of the work performed by him, its volume, and the qualifications of the employee. The procedure for determining the salary fund of medical workers of a particular unit should be approved in the local acts of the medical institution, which establish the organization's remuneration system. In this case, the wage bill is calculated in different ways. So, in some hospitals, the staffing table is taken as a basis, in others, the amount of annual funding is taken into account.

In any case, the remuneration of medical workers has a basis - official salary, which indicated in the employment contracts. It is in relation to the size of the salary that other compulsory payments are applied - compensatory... The procedure for their accrual must be spelled out in the local acts of the hospital.

The accrual incentive payments depends on the quality indicators and volume of work performed in the hospital, as well as on other conditions described in the regulation on remuneration. It is from these components that the modern differentiated system of remuneration is formed. Thus, the final salary of a doctor directly depends on the quality, complexity and volume of his work, i.e. on the quality of medical services provided to the population.

In order to calculate the incentive part of earnings using such a system, you must follow the following procedure:

determine how many points each doctor earned during the reporting period;
summarize all points earned by employees of the department;
determine the part of the wage fund that falls on incentive payments to employees of the department;
calculate the cost of one point;
calculate the incentive part of the employee's salary, based on the cost and the amount of points earned.

Based on this, the salary fund for a medical worker is the sum of all payments due to an employee for a month worked, including incentive payments, bonuses, and other regular payments. The salary of a doctor is calculated based on the tariff lists of the hospital, as well as its approved staffing table.

*) includes doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education, providing medical services (ensuring the provision of medical services) in educational institutions, science, culture, health care, social services.

The Healthcare Modernization Program, which began in 2011, was aimed, among other things, at increasing the earnings of medical workers to 200% of the average for the respective region. For this, the concept of “incentive payments to health workers” was introduced.

Who qualifies for incentive payments in 2020

The above program has fundamentally changed the payroll system for both doctors and nurses.

However, not all healthcare workers were affected.

Stimulating:
Enterprise administration. Managers can be an exception to the rule if they are engaged in medical practice.
For physicians covered by the Health program, and more specifically:
involved in assisting in childbirth, while caring for babies;
pediatricians, general practitioners, family doctors, junior staff working in tandem with them.
Specialists providing high-tech assistance.

The payment of stimulating physicians should contribute to the revitalization of their activities, to increase the level of service to the population. More money for the one who helps people better!

Incentive payments are accrued only to those employees who have a standardized certificate in the main working specialty.

Documentary base of the Program

Federal legislation generally regulates the remuneration of public sector employees, including health workers.

In Art. 129 of the Labor Code of the Russian Federation indicates the following types of charges:

basic, otherwise referred to as basic;
compensation depending on the specifics of the region;
stimulating;
social.

The first, the main part is paid to everyone without exception. The second item indicates charges that depend on the specific working conditions. They differ by region. The incentive payments to physicians that we are interested in are calculated based on the assessment of the performance of doctors and nurses.

The basic normative legal act on which the administration of the medical institution relies is the Regulation on the establishment of remuneration systems for employees of federal budgetary, autonomous and state institutions, approved by Decree of the Government of the Russian Federation of 05.08.2008 No. 583 (hereinafter - the Regulation).

This paper says that all parts of the income, except for incentive, medicine workers are strictly regulated by central and regional legislative acts. But the stimulating ones are at the mercy of the medical institution.

The administration of the enterprise is obliged to issue a document regulating incentive payments to health workers, then familiarize workers with its content!

Where are the incentive criteria developed?

On the basis of clause 6 of the above-mentioned resolution of the Ministry of Health and Social Development, recommendations have been developed and sent to all institutions that are binding on the development of internal documents. Guided by this paper, each organization approves its own Regulation on incentive payments to medical workers. In addition, relevant acts are issued at the regional level.

Ask the administration of the medical institution about the content of the above document in order to understand exactly how charges are made.

Trade union control

When developing and approving recommendations for medical institutions, the Government of the Russian Federation consults with trade unions.

This format is called a tripartite commission, in which employers still participate. She meets annually, therefore, she supplies the administration of medical institutions with recommendations once a year.

This means that the Regulation on the stimulation of labor with money should also be approved locally only for a specified period.

It reflects the following points:

sources of funding from which incentives will be paid (a special fund is created at the enterprise);
categories of professionals falling under the Regulation;
a specific accrual scheme with a division into financing from: a means of compulsory insurance and money received from entrepreneurial activity;
criteria for the effectiveness of medical work.

Nuances of charges

Order of the Ministry of Health and Social Development of December 29, 2007 No. 818 "On approval of the list of types of incentive payments ..." contains a number of specific factors that should be encouraged, namely:

duration and continuity of experience;
results of work;
achievements related to the intensity of activity;
quality of labor.

The first two criteria are usually understood unambiguously, they are quantitative indicators. But in order to assess the level of efficiency, quality, intensity and effectiveness, we had to create a special methodology. The Ministry of Health, by order No. 421 of June 28, 2013, proposed to regional departments a list of performance indicators that should be taken into account when addressing incentive issues described in the Methodological Recommendations.

According to this document, the factors that characterize the efficiency of the work of physicians are:

how many ailments in his profile the doctor identified at an early and advanced stage;
how many wrong diagnoses he made;
whether there were cases of delays in hospitalization;
how many complications were identified after operations (other manipulations with the body);
customer complaints and complaints;
errors and inaccuracies in maintaining documents;
unsanitary conditions;
other.

A commission specially created in the organization evaluates the effectiveness. Every month, this body issues a special expert appraisal Act, which is the basis for the order on incentives.

The above criteria must be described in the Regulations on the remuneration of the enterprise. The Ministry of Health of the region is obliged to establish by its document the minimum value of each of the listed factors.

If at the end of the year it turns out that the hospital has unused funds under the Program, they can be paid to the doctors (annual bonus).

How is the combination and substitution reflected on the size of stimulating

Health workers often have to work for a comrade who is absent a priori or temporarily. This does not always lead to higher wages.

Part-time workers will be credited with incentives only if their additional obligations are duly formalized, that is, an employment contract. Doctors who replace their fellow vacationers may also be paid extra. But even this type of combination should be formalized by an additional agreement.

Combining positions under the main contract is not subject to additional incentives.

Deprivation of stimulating

Who to pay, and when to refuse, is up to the head of the organization. The law does not provide for the compulsory charge of stimulating physicians, which suggests a hypothetical probability of deprivation of this part of the salary.

This requires a serious reason, for example, disadvantages for all of the above criteria (the doctor did not do anything) or a gross violation of labor discipline.

If you are faced with a refusal to calculate any part of the salary, demand the order of the management, on the basis of which the accountant acted. Look for reasons in this paper. Only after studying them is it worth making a decision on filing a complaint.

Last changes

In connection with the work on the implementation of the so-called May decrees of the President of the Russian Federation (of 2012), in 2017 there was a serious redistribution of funding for the parts that make up the salaries of doctors. There is a decrease in stimulating medics throughout Russia.

There are two ways to reduce the size of incentive payments.

In the first case, referring to the need to comply with federal legislation, the base salary was increased. At the same time, some types of stimulants were cut down or completely canceled.

In the second case, payments were reduced, which are not regulated by state regulations. This mainly concerned rewards for the quality and intensity of work.

Since the end of 2018, the procedure for calculating and the amount of insurance premiums for compulsory medical insurance of the non-working population has changed, including in terms of the increase in the cost of medical services. An increase in such indicators should also entail a corresponding increase in the salary of medical workers, calculated based on the number of citizens served with this type of compulsory medical insurance. However, only practice will show whether the salaries of medical workers will actually change or this next reshuffle within the FFOMS budget.

In 2020, the redistribution of funds will continue in order to equalize the salaries of state employees. The salaries of medical workers should be adjusted in accordance with the average salary in the whole region.

The planned increase for nursing staff by 4.3% in 2019, by 3.8 in 2020 and by 3.4% in 2021 actually indexes wages to the inflation rate.

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