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

Document's name:
Document Number:	204/13
Type of document:
Host body:
Status:	current
Published:
Acceptance date:	03 April 2018
Effective start date:	April 20, 2018
Revision date:	March 25, 2020

On the approval of the Procedure for the provision of 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 ...

GOVERNMENT OF THE MOSCOW REGION

RESOLUTION

On approval of the procedure for granting one-time compensation payments 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 as amended by:
(Official website of the Government of the Moscow Region www.mosreg.ru, 06/26/2019);
(Official website of the Government of the Moscow Region www.mosreg.ru, 03/25/2020).
____________________________________________________________________

______________
* Name as amended, put into effect on July 7, 2019 by Decree of the Government of the Moscow Region of June 25, 2019 N 375/19 by Decree of the Government of the Moscow Region of March 25, 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 subjects 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 cities with a population of up to 50 thousand people "to the state program of the Russian Federation" Health Development " , approved by Decree of the Government of the Russian Federation of December 26, 2017 N 1640 "On approval of the state program of the Russian Federation" Health Development ", Government of the Moscow Region
(Preamble as amended, entered into force on July 7, 2019 by Decree of the Government of the Moscow Region dated June 25, 2019 N 375/19; as amended, entered into force on March 26, 2020 by Decree of the Government of the Moscow Region dated March 25, 2020 N 140 / 7.

decides:

1. Approve the attached Procedure for the provision of 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.

2. Establish an expenditure obligation for the Moscow Region related to the implementation of measures to financially secure 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 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 the authorized central executive body state power Moscow region to provide lump-sum compensation payments to medical workers.

4. Financial provision of 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, is carried out on the terms of co-financing at the expense of funds of the subsidy provided within the limits of the budget appropriations stipulated by the Law of the Moscow Region for the next financial year and planning period.
(Paragraph as amended, put into effect on March 26, 2020 by 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 to ensure the official publication of this resolution in the newspaper "Daily News. Podmoskovye", "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 " Official Internet portal of legal information" (www.pravo.gov.ru).

6. To impose control over the execution of this resolution on the First Vice-Governor of the Moscow Region Gabdrakhmanov I.N.
(Paragraph as amended, put into effect on July 7, 2019 by Decree of the Government of the Moscow Region of June 25, 2019 N 375/19.

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 up to ...

APPROVED

Government Decree

Moscow region

April 3, 2018 N 204/13
(As amended by
from July 7, 2019 by resolution
Government of the Moscow Region
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 *

______________
* Name as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7 ..

1. This Procedure governs the provision of lump-sum compensation payments to medical workers (doctors, paramedics) who are citizens of the Russian Federation who do not have unfulfilled obligations under a targeted training agreement (with the exception of medical organizations with a staffing level 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 concluded an employment contract with a medical organization subordinate to the Ministry of Health of the Moscow Region, on a full-time basis with the duration of working hours established in accordance with Article 350 of the Labor Code of the Russian Federation, with the fulfillment labor function positions included in the list vacancies medical workers in medical organizations and their structural divisions, upon replacement of which one-time compensation payments are made for the next financial year (hereinafter, respectively - a one-time compensation payment, medical workers), as well as to medical workers who have fulfilled obligations related to targeted training(targeted training), provided that they continue to work in the same medical organization located in a rural locality, or a working settlement, or an urban-type settlement, or a city with a population of up to 50 thousand people.
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

2. The amount of the 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 - the Ministry) has the right to make a decision to provide a medical worker with a one-time 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 - 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 subdivisions, upon replacement of which one-time compensation payments are made for the next financial year (hereinafter - the program register of positions).

6. A one-time compensation payment is provided on the basis of an agreement on the provision of a one-time compensation payment (hereinafter referred to as the 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 contract:

passports of a citizen of the Russian Federation;

insurance certificate of state pension insurance;

registration certificates individual in the tax authority;

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

a document confirming the completion of an internship or residency (for doctors of specialties, training for which in an internship or residency is mandatory for implementation labor activity in accordance with the Order of the Ministry of Health of the Russian Federation dated 08.10.2015 N 707n "On approval of the Qualification requirements for medical and pharmaceutical workers with higher education in the field of study "Health and medical sciences");
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

document on professional retraining(in the presence of);

certificate of a specialist (or certificate of accreditation of a specialist);

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

specialist certificate issued Federal Service on supervision in the field of healthcare of Roszdravnadzor, or its territorial bodies(for persons who have received medical training in universities of foreign states, who are citizens of the Russian Federation);

employment contract;

a work book or information about labor activity received in a multifunctional center for the provision of state and municipal services on paper;
(Paragraph as amended, put into effect on March 26, 2020 by Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

order of appointment;

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

licenses to carry out medical activities by a health care institution.

9. The contract is concluded on the basis of an appeal from 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 probationary period if such a period is set for a medical worker upon employment.

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 lump sum compensation payment, signed by the medical worker and the head of the medical organization, signs the said agreement and sends two copies of the agreement on the provision of a lump sum compensation payment to the medical organization.

12. If there are grounds for refusing to conclude an agreement, provided for in paragraph 13 of this Procedure, the Ministry, within the 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 a medical worker.

13. The 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 an agreement that does not correspond to the form of the agreement approved by the Ministry;

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

14. If the reasons that served as grounds for refusing to conclude an agreement are eliminated, the medical worker has the right to re-apply for a lump-sum compensation payment in accordance with paragraphs 9 and 10 of this Procedure.

15. Ministry:

maintains 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 assumes the obligation to:

1) perform labor obligations within 5 years from the date of conclusion of the contract for positions in accordance with employment 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 and 107 of the Labor Code of the Russian Federation);

2) to return to the budget of the Moscow Region a part of the one-time compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract until 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 due to conscription for military service (in accordance with paragraph 1 of part one of Article 83 of the Labor Code of the Russian Federation) or extend the term the duration of the contract for the period of non-performance functional duties(at the choice of a medical worker).

Revision of the document, taking into account
changes and additions prepared
JSC "Kodeks"

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 (as amended on March 25, 2020 of the year)

Document's name:	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 (as amended on March 25, 2020 of the year)
Document Number:	204/13
Type of document:	Decree of the Government of the Moscow Region
Host body:	Government of the Moscow Region
Status:	current
Published:	Official website of the Government of the Moscow Region www.mosreg.ru, 04/09/2018
Acceptance date:	03 April 2018
Effective start date:	April 20, 2018
Revision date:	March 25, 2020

In order to encourage medical workers in the Russian Federation, since 2014 there has been a program aimed at supporting citizens employed in this field. In particular, such support consists in receiving incentive payments, the assignment of which is carried out on the basis of criteria specified in the governing laws and regulations. In addition, incentive payments to medical workers in 2020, as before, are designed to attract more specialists to work in government institutions, since they are accrued exclusively in non-profit organizations.

Legislative acts regulating the appointment of surcharges

Based on what medical officer can qualify for payment for intensity and high performance? Amounts additional to the basic salary are accrued on the basis of the following legislative and regulatory acts.

Who is not eligible for incentive payments?

The regulation on incentive payments in health care clearly limits the circle of workers who can claim to receive material supplements to their basic income as wages. A mandatory factor that makes it possible to accrue both permanent and lump-sum payments is that a medical worker has a certificate in the main specialty - 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 for certain categories of doctors and medical workers, subject to existing restrictions. So, such additional payments are not due to the following categories of employees employed in the healthcare sector.

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

The principle of remuneration of medical workers

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

Based Labor Code The Russian Federation employees of medical institutions are entitled to the following types of accruals.

Basic, or basic, which are calculated on the basis of the salary and the specifics of the type of activity.
Compensatory. Their accrual is regulated by norms that differ depending on the region in which the employee is working.
Social. They may be assigned depending on the health care worker's affiliation to any of the groups included in the list of recipients of social payments.
Stimulants- appointed as a result of the analysis of activities and the performance of direct duties by a doctor or other health worker.

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

What are incentive payments? These are monetary accruals assigned monthly on the basis of accepted criteria for evaluating the work of doctors and medical staff. In the event that a particular institution at the end of the calendar year has an unused part of the funds allocated exclusively for receiving incentive payments, it is allowed to receive lump-sum payments that will be assigned based on the results of the work for the current year.

The amount of incentive charges

It is worth noting that the amount of additional payments related to incentives is not constant - it is directly dependent on how much services related to the performance of direct duties were made by the medical officer.

Regarding the amount of accruals in the territory of the Russian Federation, the following rules apply.

The 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 established by legislative acts.

Grounds for assigning an additional payment and evaluation principles

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

The time that a particular employee worked during the month for which the payment is accrued.
Fulfillment by the health worker of standards for the provision of first aid to the population.
Efficiency in the performance of work duties.
Duration seniority employee and his continuity.

Without fail, the administration, when assigning payments, must be guided by the current provisions on wages, as well as federal, regional acts and presidential decrees affecting the procedure for accruing 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 countryside a lump sum payment is provided. Today we will talk about the procedure for providing this compensation as part of the changes for 2017.

About the one-time compensation payment

So, according to section 12.1. article 51 federal law dated November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (hereinafter - Federal Law No. 326), a lump-sum compensation payment to medical workers is provided to medical workers who meet certain criteria, who arrived to work in a rural settlement, or a work settlement, or settlement of an urban shooting range or who moved to work in a rural settlement, or a working settlement, or an urban-type settlement from another settlement.

You should be aware that the amount of a one-time 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 Federal Law No. health insurance for 2017 and for the planning period of 2018 and 2019”, and the budget funds of the constituent entities of the Russian Federation in the ratio of 60 and 40 percent, respectively.

Note that in accordance with paragraph 37.2 of Article 217 of the Tax Code of the Russian Federation, a one-time compensation payment is not subject to taxation.

The purpose of such a payment is to attract medical workers to rural settlements and compensate for the costs associated with moving and settling, as well as the inconvenience 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 come to work in a rural settlement in what the amount provided will be spent on.

The medical worker, in turn, upon receipt of a lump-sum compensation payment, must work for a certain period of time in a medical organization of a rural settlement of that subject of the Russian Federation with which the specified contract is concluded. Typically, this period is 5 years.

It should be noted that Federal Law No. 326 does not provide any explanation as to which locality can be considered rural.

A similar explanation is contained in the Letter of the FFOMS dated 05.02.2013 No. 801/21-i “On the implementation of lump-sum compensation payments in 2013” (hereinafter - the Letter of the FFOMS No. 801/21-i). On the issue of attributing settlements to rural settlements and workers' settlements, it is necessary to be guided by part 1.1 of article 10 of the Federal Law of October 6, 2003 No. 131-FZ "On general principles organizations local government in the Russian Federation" (hereinafter - Federal Law No. 131). Since the FFOMS Letter No. 801/21-i refers to the old version of the Federal Law No. 131, we will cite the current provision of the Federal Law No. 131 on this issue.

So, according to part 1.1 of article 10 of the Federal Law No. 131, granting municipalities the status of a city, rural settlement, municipal district, urban district, urban district with intracity division, intracity district, 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 applying for a one-time compensation payment change from year to year.

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

age - up to 50 years (by the way, in 2012-2014 the age limit was up to 35 years, in 2015 - 45 years);
availability of higher education;
arriving at work in a rural area in 2016 and 2017;
the existence of a concluded agreement with the 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 from the medical worker also an employment contract between the medical worker and government agency health care of a constituent entity of the Russian Federation or a municipal health care institution.

By the way, the FFOMS and the Ministry of Health of Russia speak about this condition in the Letter of the FFOMS dated 07/08/2013 No. 5124 / 80-1 / and “On judicial practice in resolving disputes on the payment of lump-sum compensation to medical workers who moved to work in a rural settlement” (Letter FFOMS No. 5124/80-1/i) and Letter of the Ministry of Health of Russia No. 11-11/3089 dated August 10, 2012 “On the Issue of Lump-sum Compensatory 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 today there is no single procedure for providing a lump sum compensation payment.

In the absence of legal regulation (procedure) for the provision of a lump-sum compensation payment, the FFOMS and the Ministry of Health of Russia provide authorized executive authorities of the constituent entities of the Russian Federation to decide this question independently, which is indicated, for example, in the letter of the FFOMS No. 801/21-i, according to which the said bodies should submit to the FFOMS the regulatory legal acts providing for measures of social support for medical workers, as well as the procedure for concluding a contract between a medical worker and an authorized executive body .

Thus, 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 Decree of the Government of the Moscow Region dated March 14, 2017 No. 145/8 (hereinafter referred to as the Procedure for the Moscow Region).

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

the obligation of a medical worker to work for five years at the main place of work under the 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 public healthcare institution of the Moscow Region, located in a rural settlement or working a settlement in the Moscow Region, or an urban-type settlement in the Moscow Region (hereinafter referred to as a healthcare institution);
the procedure for providing a medical worker with a one-time compensation payment in the amount of one million rubles within thirty business days days from the date of conclusion of an 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 one-time compensation payment in the event of termination of the employment contract concluded by the medical worker with the healthcare institution, before the expiration of the five-year period calculated from the date of termination of the employment contract, in proportion to the period not worked out by the medical worker;
the responsibility of a medical worker for failure to fulfill the obligations stipulated by the contract, including the return of a one-time compensation payment;
provision on the consent of a medical worker to the processing of his personal data.

The procedure for the Ministry of Defense explains that the contract with a medical worker is concluded by the Ministry after the conclusion by the medical worker of an employment contract with a healthcare institution.

At the same time, a healthcare institution that has concluded an employment contract with a medical worker:

checks the availability and authenticity of the documents submitted by the medical worker;
submits to the Ministry an application from a medical worker for a one-time compensation payment (please note that there is no deadline for submitting such an application to the Ministry. Note that earlier the healthcare institution had to send an application to the Ministry within three working days from the date of 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 their 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 healthcare workers should fully depend on how high-quality medical services they provide to the population.
Government Decree No. 2190-r dated November 26, 2012 provides for a phased change in the system of calculating wages 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 they provide to the population.

Salaries of doctors and medical workers in 2016*

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

The highest salaries of doctors are predictably recorded in the Nenets, Chukotsky, Yamalo-Nenets, Khanty-Mansiysk - 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-Balkarian Republic, Karachay-Cherkess Republic, Republic of North Ossetia-Alania, Republic of Kalmykia.

See the full tables of doctors' salaries in 2016 in Russia below.

Partial wages for medical workers

The salary of a doctor can be formed according to the principle of piecework wages, taking into account some features. 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 (RTC). Generally speaking, the current legislation contains provisions that allow organizations to establish piecework wages, while there are no exceptions for employees of medical institutions. When piecework wages for medical workers, the established price for the work performed is taken into account, while the tariff rate is set for the completed labor norm, and does not include incentive or compensation payments. The fact that these concepts are not equivalent follows from the conclusions of the courts on the basis 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. To date, the Ministry of Health of the Russian Federation adheres to the position that the salary of doctors should include: salary, incentive payments, compensation payments and tariff rate. However, if in the hospital there is still a need to establish a piecework form of remuneration for individual employees, then it is necessary to provide for such a form in the local act of the institution - in collective agreement or other local act. This will not be a violation of current labor laws.

Brigade forms of remuneration

Some hospitals are considering institutional team pay, whereby the salary of a particular doctor or other healthcare worker is dependent on the overall performance of the unit, department, or field team.

Today, the system of remuneration of medical workers in ordinary city and district hospitals provides for the calculation of the amount of incentive payments, 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 V.M. Shipova and A.N. Plutnitsky, the optimal load on the ambulance team has not been determined, since the flow of calls is random and the frequency of calls is not regulated. But it is possible to calculate the optimal load on the ambulance team. Based on the planned and normative data on providing the population with ambulances and the number of calls, we derive the formula:

318 X 10: 365 = 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 team.

The system of remuneration 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;
opinions trade unions health workers;
professional communities of employers;
the volume of state guarantees in the field of wages;
position of the Russian tripartite commission;
position of the Ministry of Health of the Russian Federation.

Thus, the joint recommendations of the Ministry of Health of the Russian Federation and the RTK do not provide for the use of a brigade form of remuneration. Previously, the use 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 from 2009 it lost its legal force. However, the current legislation does not prohibit taking into account the results of the work of the team to calculate incentive payments to a particular medical worker. Also, the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012 states that specific incentives should be established for medical workers for achieving collective work results.

The ratio of parts of the salary

The Ministry of Health of the Russian Federation has set the maximum level of the ratio of the average salary of the chief doctors of hospitals and medical workers in the system of healthcare institutions. Thus, in accordance with Order No. 170 dated March 28, 2013, the level of the marginal salary of the head doctor 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 the 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 covers all legal features establishing salaries for medical workers, including the rules for applying professional qualification groups, accounting for seniority and the possibility of setting an individual salary for a medical worker.

Setting a personal salary

The salary is a certain amount remuneration of a medical worker, which is established for him for the performance of his professional duties provided for by a specific position. Salary does not include other additional benefits. We believe that the establishment of personal salaries for medical workers of state and municipal hospitals is not directly prohibited by labor legislation, although it is not recommended by other norms 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 pay 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 the work of employees of state and municipal system dated December 25, 2015, in which it is not recommended to set different salaries for employees who are included in the same qualification group. It is also not recommended to indicate the range of official 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 different amounts of work of varying complexity.

How to take into account experience

As a general rule, the length of service of a medical worker does not affect the size of the official salary established for him. As we said before official salary is a fixed monthly payment of an employee who performed his labor 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 compensation payments. 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

Professional qualification groups(PCG) can be used when establishing base rates and salaries by the Government of the Russian Federation, the salary of medical workers of state and municipal hospitals cannot be lower than the salaries established by the PCG. According to the order of the Government of the Russian Federation No. 2190-r dated November 26, 2012, interested executive bodies together with the Ministry of Labor of the Russian Federation, they can develop and submit their specific proposals for the official salaries of the PCG of employees. The basis for the formation of the PCG are certain requirements for the level of qualifications of employees that they need to carry out a specific professional activity, because in accordance with labor legislation, the salary of a doctor, like any other employee, depends on his qualifications. Therefore, before the establishment of basic salaries for specific positions by the Government of the Russian Federation, in healthcare institutions, PCGs can be used in the development of systems for remuneration of medical workers. This is also 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 set by the management of the institution based on the requirements for qualifications and work experience in a particular 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 official salaries of medical workers in no way affect the salary of the head doctor of the hospital and the salaries of his deputies. As stated in Art. 145 of the Labor Code of the Russian Federation, remuneration for the heads of state and municipal institutions is established in accordance with labor legislation, constituent documents of an official, regional and municipal acts. The specific terms of remuneration of senior officials are reflected in their employment contracts. At the same time, a number of normative acts adopted recommendations on setting the level of remuneration for heads of institutions: recommendations for 2016, approved by the RTK of 12/25/2015, and also in relation to federal institutions - Decree of the Government of the Russian Federation No. 583 of 08/05/2008. In these documents, it is recommended to establish a salary for the heads of the institution, a multiple of 8 average salaries of all employees of the institution; The decision of the RTC dated December 25, 2015 also recommended that salaries for chief accountants and deputy chief physicians be set at 70-90% of the salaries of hospital managers.

Salary: establishment control

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

Labour Inspectorate during inspections within state supervision for the observance by the medical institution of the labor legislation of the Russian Federation. In addition, the State Labor Inspectorate conducts inspections of the implementation of the program for improving the wage system in state and municipal institutions, which was approved by the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012;
Ministry of Health of the Russian Federation, as an agency that exercises the powers of the founder in relation to subordinate medical institutions; territorial MHI funds, which check the size of salaries as part of the audit of labor costs, which are included in the structure of the tariff for medical care in the MHI system;
other state bodies authorized to conduct audits of the financial and economic activity hospitals.
The reporting form on the wages of employees of medical organizations in the field of compulsory medical insurance was approved by Order of the FFOMS dated March 26, 2013 No. 65.

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

1. Headcount

2. Number of attached population, pers.

3. Per capita financing standard, rub.

4. Amount of financing, rub.

5. Report on the 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 employment contract of a health 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 employment contract of the employee in a specific amount or as a percentage of the official salary. Compensatory payments to medical workers can be provided for various reasons: for medical experience, for irregular working hours, for work in rural areas, for the presence of a professional category, etc. Labor legislation, as a rule, establishes only the minimum amount of such payments. The employer must establish the specific amounts of compensatory allowances for medical workers by prescribing such sections in the regulation on the remuneration of the hospital. Additional guarantees for employees who work in conditions that deviate from normal must be specified 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 the order of the Ministry of Health of the Russian Federation No. 167-n dated April 26, 2013, suggest that specific factors and conditions for receiving all compensation payments should be prescribed in the salary regulation, as well as in the employee’s employment contract.

Reducing the amount of compensation payments based on the results of the SOUT

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

However, the employer must cancel the previously provided guarantees if the employee's workplace provides safe working conditions, which is confirmed by the conclusion of the state examination or SUT. In connection with the adoption of the new law No. 426 "On SOUT", there is a transition period to new system job evaluations. So, if the hospital carried out certification of workplaces before 07/13/2015, then it will continue to be valid for 5 years. SOUT during this period is not necessary. The medical institution has the right, but is not obliged, to initiate the conduct of the SOUT before the expiration 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 from those payments. which were valid at the beginning of 2014. In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 15, 2014 regarding the application of the new rules of the SOUT, the improvement of working conditions is the reduction of the final class or subclass of working conditions at a particular 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 SOUT, the hospital management may review the amount of compensation that is provided to the employee during harmful conditions labor. At the same time, it is necessary to remember the rules for changing the terms of the employment contract between the hospital and the employee, which are detailed in Art. 74 of the Labor Code of the Russian Federation.

Replacing additional leave for harmfulness 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 provided to an employee for working in harmful working conditions with monetary compensation?

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

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

Accounting for compensation payments when on duty at home

The remuneration of medical workers consists of salaries, compensation and incentive payments. Taking into account all these payments, payment for the doctor's duty at home is also carried out.

Home duty refers to the stay of a hospital doctor at home waiting for a call to a medical facility or to a patient for urgent or emergency medical care. In relation to such employees, a special regime of work and accounting of working hours is usually established.

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

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

Compensation payments: control of establishment

The following state bodies and officials can check the correctness of the establishment of compensation payments to 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 audit that the inspectors assess the correctness of providing medical workers with the necessary amount of compensation for working with harmful or dangerous working conditions;

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

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

territorial bodies of compulsory medical insurance, during inspections, the purpose of which is to verify the cost of wages, which is part of the tariff for paying for medical care.

Stimulus payments to medical workers

Usage scoring

Medical institutions of the municipal or state system health care providers are not required to use performance scores to evaluate the performance of their employees. Incentive payments to health care workers should be established in 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 dated June 28, 2013, methodological recommendations were approved, which state that there are different mechanisms for distributing the incentive fund between employees of a particular institution. Including the introduction of a scoring system, bonuses is acceptable. This means that a particular medical institution can develop and implement its own mechanisms for accruing incentive payments to medical workers, including the right to introduce a points system for distributing payments. To do this, it is necessary to develop appropriate criteria and indicators.

PNP "Health" payments

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. Recall that one of the tasks of the program is material incentives medical workers. Should the management of a medical institution keep payments to district doctors and paramedical staff 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 paying 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 dated December 19, 2015, the structure of the tariff provided for paying for the assistance provided to the population in the MHI system includes incentive payments for district doctors, nurses, employees of feldsher and obstetric points, ambulance workers, etc.

In tariff agreements between the regional executive authority, the territorial CHI fund, trade unions of health workers, as well as medical non-profit organizations, specific tariffs are set for payment of medical care provided by hospitals.

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

In this regard, we believe that the medical institution should provide that all such payments should be made in the amount that is already included 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

The medical institution must initially prescribe in the regulatory documentation special conditions, upon the occurrence of which incentive payments to specific health workers will not be made. The current system of remuneration of 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 an obligation of a medical institution - it is its right. At the same time, in the order of the Government of the Russian Federation No. 2190-r dated November 26, 2012, it is directly stated that the remuneration system, as well as the conditions for receiving certain payments and remunerations, should not be interpreted by the parties ambiguously, they should be equally understandable as a health worker as well as the employer.

if during the inspections the fact of providing medical services to citizens for a fee is revealed, while the program of state guarantees provides for the provision of such services free of charge;
overlay disciplinary action to a medical worker.

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

Reimbursement of medical workers

The issue of applying to medical workers such a sanction as deprecation of bonuses is controversial. It should be noted that according to departmental recommendations, as well as the provisions of the Labor Code of the Russian Federation, in medical institutions it is recommended to provide conditions for the use of incentive bonuses, but not conditions for depriving the employee of the bonus due. In accordance with Government Decree No. 2190-r, measures to improve the system of incentive payments to medical workers are carried out in order to correlate the salary of doctors with the specific results of their work. First of all, the quality of the medical services provided is taken into account, based on what certain incentive payments are applied. The bonus itself is one of the types of incentive payments for medical workers, therefore, the medical institution must establish specific conditions for receiving it. 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 of bonuses (deprivation of bonuses) is not contained in the current version of the code. This is also said arbitrage practice. The courts unambiguously interpret the application of bonus deductions in relation to any employee of the employer as an unreasonable and unenforceable sanction, which current legislation recognized as illegal. In this regard, we recommend that the chief physicians of hospitals avoid the application of such sanctions in relation to medical workers; the local acts of the hospital, all the more, should not contain any conditions for depriving them of bonuses.

Labor standards for incentive payments

When establishing incentive payments to health workers, certain labor standards are used, however, not all of them should be used as criteria for additional payments. In particular, labor standards are inapplicable, which are not directly provided for the purposes of assigning incentive payments and in no way reflect the results of the professional activity of a medical worker and the quality of the medical services provided to him. This is due to the provisions of the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, which states that all incentive bonuses for employees depend on the quality of their work and the achievements professional results, and specific indicators and criteria for their performance should be reflected in labor contract employee on the basis of the developed system of remuneration. 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, in a medical institution, different norms and standards: by the number of personnel, by time, by volume, output, 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 of 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 norm can be expressed in one medical position per site in accordance with the number of 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 that is necessary for him to provide one service (performance of work). This indicator is primarily used to calculate the norms of 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 assigning incentive payments for the intensity and effectiveness of work, as well as bonus payments for certain categories workers recommended by the expert group of the information center "ICFER-Medicine".

Medical workers' payroll

In medical institutions, there are several sources of formation of the fund for the remuneration of medical staff:

funds from the budget different levels;
funds from extrabudgetary sources (from CHI funds);
cash received from income-generating activities.

In healthcare institutions that are under the jurisdiction of the region or municipality, the wage fund is formed in accordance with the relevant regulations of the subject of the Russian Federation or municipality. In accordance with the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 212, a system of differentiated remuneration of personnel is currently provided, the final salary of a doctor depends on the complexity of the work performed by him, its volume, as well as the qualifications of the employee. The procedure for determining the wage fund for medical workers of a particular unit should be approved in the local acts of the medical institution, which establish the system of remuneration of the organization. At the same time, the payroll fund is calculated in different ways. So, in some hospitals, the staffing is taken as the basis, in others, the amount of annual funding is taken into account.

The remuneration of medical workers in any case has a basis - official salary indicated in the employment contracts. It is in relation to the amount of salary that other mandatory payments are applied - compensatory. The procedure for their accrual should be prescribed in the local acts of the hospital.

The accrual incentive payments depends on the quality and volume of work established by 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 according to such a system, it is necessary to follow the following order:

determine how many points each doctor earned for reporting period;
sum up all the points earned by the employees of the department;
determine the part of the wage fund that accounts for 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 wage fund of a medical worker is the sum of all payments due to the employee for the 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 institutions of education, science, culture, healthcare, social services.

Launched in 2011, the Healthcare Modernization Program aimed, among other things, to increase the salaries of medical workers up to 200% of the average for the respective region. For this, the concept of “stimulating payments to health workers” was introduced.

Who is entitled to incentive payments in 2020

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

However, not all health care workers have been affected by it.

Stimulants are not allowed:
Enterprise administration. Managers may be an exception to the rule if they are in the practice of medicine.
Physicians who fall under the Health program, and more specifically:
involved in providing assistance during childbirth, while caring for babies;
pediatricians, district therapists, family doctors, junior staff working with them in tandem.
Professionals providing high-tech assistance.

The payment of incentives to physicians should contribute to the revitalization of their activities, to improve the level of service for the population. More money for those who help people better!

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

Documentary base of the Program

Federal legislation generally regulates the remuneration of state employees, including medical 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 necessarily paid to everyone without exception. The second paragraph indicates accruals that depend on specific working conditions. They vary by region. Incentive payments to doctors, which are of interest to us, are calculated based on an assessment of the effectiveness of the work of doctors and nurses.

The basic legal act on which the administration of a medical institution relies is the Regulation on the establishment of wage systems for employees of federal budgetary, autonomous and state-owned institutions, approved by Decree of the Government of the Russian Federation of August 05, 2008 No. 583 (hereinafter referred to as the Regulation).

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

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

Where incentive criteria are developed

On the basis of paragraph 6 of the above resolution of the Ministry of Health and Social Development, recommendations were developed and sent to all institutions, which are mandatory for implementation when developing 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 the content of the above document in order to understand exactly how the accruals are made.

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 also take part. It meets annually, therefore, it also provides recommendations to the administrations of medical institutions once a year.

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

It reflects the following points:

sources of financing from which incentives will be paid (a special fund is created at the enterprise);
categories of specialists subject to the Regulations;
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 the work of physicians.

Accrual nuances

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

duration and continuity of experience;
results of work;
achievements associated with the intensity of activity;
the 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 dated June 28, 2013, proposed to regional departments a list of performance indicators that should be taken into account when addressing incentive issues described in methodological recommendations.

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

how many ailments in his profile the doctor revealed at an early and advanced stage;
how many misdiagnosis he made;
whether there were cases of untimely hospitalization;
how many complications were revealed after operations (other manipulations with the body);
complaints and complaints from customers;
errors and inaccuracies in the maintenance of documents;
unsanitary conditions;
other.

The commission specially created in the organization carries out an assessment of efficiency. On a monthly basis, this body issues a special expert evaluation Act, which is the basis for an order on incentives.

The above criteria must be described in the Regulation on the remuneration of the enterprise. The Ministry of Health of the region is obliged to establish in 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 doctors (annual bonus).

How does combination and substitution affect the amount of stimulating

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

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

The combination of positions under the main contract is not subject to additional incentives.

Deprivation of stimulants

To whom to pay, and when to refuse, the head of the organization decides. The law does not stipulate the obligation to accrue incentives to physicians, which implies a hypothetical probability of being deprived of this part of the salary.

This requires a serious reason, for example, minuses on all of the above criteria (the doctor did nothing) or a gross violation of labor discipline.

If you are faced with a refusal to accrue any part of the salary, demand an order from 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 to file 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 (dated 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 incentives for physicians throughout Russia.

Reduction of the size of incentive payments occurs in two ways.

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

In the second case, they reduced payments that are not regulated by state regulations. This mainly affected 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 remuneration of medical workers, calculated based on the number of citizens served with this type of CHI. However, only practice will show whether the remuneration of medical workers will actually change or whether this is another castling within the framework of the FFOMS budget.

Redistribution to continue in 2020 Money in order to equalize the wages of state employees. Remuneration of health workers should be adjusted in accordance with average salary in general for the region.

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

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