Features and regulation of the work of medical workers. Improving the organization of labor of personnel Features of the organization of labor in a medical organization

To improve the organization of labor at any enterprise, it is advisable to implement the principles scientific organization labor.

The scientific organization of labor in health care institutions is as follows:

1. Regulation of labor functions based on job descriptions. Work in this direction involves a periodic revision of the existing organizational schemes for the work of nursing staff, replacing them with more advanced and rational forms of distribution of labor functions. In particular, in large hospital departments with a capacity of at least 60 beds, along with two round-the-clock nursing posts, it is advisable to create a day post for manipulation (injection) nurses, who must perform all planned intravenous, intramuscular and subcutaneous injections. As a result, ward nurses have more time to participate in medical rounds, more successful implementation doctor's appointments and nursing work. In outpatient clinics, thanks to the redistribution of the time of district nurses for receiving patients at the polyclinic and for performing medical appointments at home, teams of paramedics are being created to serve lonely and elderly patients at home. In addition to carrying out injections, the simplest studies (measuring temperature, pulse, etc.), performing procedures (banks, enemas), nursing teams can perform such work as taking materials for laboratory tests, taking an ECG, carrying out various physiotherapeutic procedures, massage, physiotherapy exercises ...

2. Centralization of treatment-diagnostic and auxiliary-economic services and restructuring of the work of these services "into departments". This organizational form makes it possible to reduce the time spent by nurses on performing unusual functions - supplying departments with sterile materials and instruments, food, linen, medicines, as well as delivering the results of laboratory and instrumental examinations of patients to the departments. This organizational form greatly facilitates the work of nurses and nurses.

3. Improvement of forms of medical documentation and methods of its maintenance. With regard to the organization of work of ward nurses, for example, the unification of documents intended for recording medical and diagnostic measures prescribed by a doctor and their implementation is of particular importance. In the work of nurses of outpatient clinics, standard forms of referrals for laboratory instrumental studies, as well as unified prescription prescriptions, are widely used.

4. Use of systems of organizational in-house communication. The work of ward nurses is greatly facilitated by the use of search-and-call alarms, designed to emergency call the medical staff to the patient. At the same time, along with light ringing alarms, two-way communication is widely used. The latter has a number of advantages and allows the nurse, in the event of an emergency call to the patient, to clarify the reason for the call. In addition, the time required for a nurse to invite patients to procedures and to the dining room, to send them to laboratory and instrumental studies, etc. is reduced.

5. Rational organization of workplaces (equipment and layout, creation of hygienic comfort and aestheticization of the working environment). The use of organizational equipment - means for convenient placement at workplaces of various medical documents (forms, recipe files, paper trays, filing cabinets, cradles for stationery), devices for placing equipment, laboratory glassware, medicines, reagents (stands, racks, fixing devices , racks, wall cassettes) - greatly facilitates the work of nursing staff.

6. Improvement of social and psychological relations in health care institutions. This is an important element of the NOT for both the work of doctors and the work of paramedics. Important role at the same time, such organizational measures as material and moral stimulation of labor, planning social development collective, improving the style and methods of leadership, the use of the educational power of traditions.

Improving the organization of work in health care institutions presupposes a consistent implementation of a system of organizational measures, among which perspective and current work planning also occupies an important place. The main requirement for the current annual planning of work in a medical institution is the maximum specificity and validity of each stage of work.

The introduction of recommendations for improving the organization of work in the practice of medical and preventive institutions, as a rule, is associated with the need to use technical means- office equipment, intra-office communication equipment, etc. This raises the need to develop organizational and technical projects, often it is necessary to reconstruct mass-produced devices in relation to the specific conditions of medical institutions, and sometimes create samples of non-standard office equipment.

It is advisable to highlight the following main stages:

1. consultations and organizational and methodological measures;

2. organizational and technical design;

3. registration of applications for equipment; technical implementation of equipment (installation, assembly, commissioning);

4. organizational implementation.

Non-financial incentives are of great importance for improving the organization of personnel labor. Currently, various types of non-material incentives exist separately, one cannot say about the operation of a single system of non-material incentives, therefore, the main direction for improving non-material incentives at the studied enterprise should be the creation of a single system of non-material incentives.

The main stages of creating such a system should be:

· Management training and retraining of the organization's management;

· Creation of a program of social policy of the organization, organization of cultural and mass sporting events, additional training, etc .;

· Creation of a subsystem of moral incentives.

There are three main directions for improving the use of socio-psychological methods in staff motivation:

· Maintaining a favorable psychological climate in the team;

· Development of a conflict management system;

· Formation and development of organizational culture.

The main problem of the Central District Hospital is understaffing. This leads to the fact that the provision of medical services does not take place in full. The problem of providing qualified personnel for facilities in remote and rural regions remains. This is largely due to the fact that the existing shortage of medical workers is not replenished by graduates - specialists of medical educational institutions. The state provides various benefits to solve this problem, but these measures do not bring any significant result.

It is worth noting that staff turnover has been revealed in the Central Regional Hospital, young specialists are delayed for an average of 2 years, permanent staff are formed mainly by specialists who have been working in the hospital for a long time. To solve this problem, various measures are being taken: service housing is provided, bonuses are paid for work in countryside at a rate of 25%. But these measures, again, give only a temporary result. As a kind of this problem, the lack of narrow specialists to work on medical equipment stands out. To solve this problem, the necessary specialists are involved from outside (Uralsk) and work on Saturdays. This leads to the impossibility of conducting some types of examinations on a daily basis. The proximity of the regional center with more qualified specialists makes it easier for many residents of the region to go to Uralsk to undergo examination and receive the necessary treatment. Thus, the medical institutions of Uralsk create competition with the CRH in the provision of medical services. Accordingly, the number of actually served population is less than the planned one, which means that the state order is not being fulfilled.

To solve all of the above problems, I propose, in addition to the already existing types of benefits and incentive methods, to attract and consolidate, as well as to improve the qualifications of health workers, to offer employees an attractive professional development plan. In addition, the need was identified for the development of educational and methodological activities for medical personnel, in terms of strengthening advanced training courses with practical exercises in the form of direct work with modern equipment and using modern technologies for providing medical care.

It is worth remembering that the most important factors for employees are:

· Good relationships with colleagues;

• a sense of the benefits brought;

· Good wages;

· Stability of employment;

· Opportunities for professional development and career growth.

This means that in order to solve the problem of shortage and improve the qualifications of personnel, the greatest attention should be paid to precisely these factors.

You should also not forget about ensuring the safety and labor protection of health workers. The safety policy should cover five main areas of responsibility for health workers. These include the following:

1. Ensuring the safe condition of existing and new equipment and production systems and maintaining it constantly. This includes providing personnel with protective clothing, training in the use of equipment, evacuation plans, etc.

2. Ensuring labor protection during the use, processing, storage and transportation of pharmaceutical substances. This provides for an adequate system of accounting for them, especially hazardous substances, as well as their correct labeling.

3. Provision of information, training, instruction and supervision. This area is of particular importance. Everyone should be aware of the possible dangers in a given situation, not just the people directly working on this equipment.

4. Ensuring the safety of the workplace, as well as entrances and exits. Specific requirements must be consistent with fire safety requirements: fire exits must be easily accessible and clearly marked. In any case, this is one of the conditions for obtaining a certificate of compliance with fire safety measures.

The above five areas relate to the safety of healthcare workers, but the manager also has a responsibility to the people who do not work for him: visitors.

It should be noted that the company has a problem with computer equipment. Personal computers are at the disposal of both non-core CRH personnel (not medical personnel) and doctors. The PCs used are quite old, often there are problems with the operation of basic programs and office applications, sometimes the equipment breaks down and it takes several days to return it to working condition, which leads to delays in work. Here you can recommend the management to allocate money for better software and high-quality antivirus programs, as well as periodically update outdated equipment.

In the age of computerization, you can also propose to develop this area of work organization. It is possible to advise a more complete computerization of the hospital, perhaps the creation of a common local network with the organization's website, where an employee, using a personal password, will be able to view his personal data - information about payroll by month, about bonuses, allowances, vacation pay, etc., your job description, professional development plan, job appraisal, etc. The manager will be able to view the data of his subordinates. Also, with the help of this site, it will be possible to inform employees about safety rules, job responsibilities, rights. On the site it will be possible to create a constantly updated centralized database of normative materials used in the institution.

I would also like to touch upon the problem of high-quality medical education, since it is very closely related to the organization of work in any healthcare institution. Currently, there is a problem of the quality of training and retraining of medical personnel and the insufficient level of scientific research in the republic. One of the reasons for this is the imperfect regulatory legal framework governing the conditions for admission, training and quality control in the system of medical and pharmaceutical education, in the development of which it was not taken into account medical specificity, as a result of which a system of general approaches is applied to the training of future doctors.

The quality of training of medical personnel and the level of scientific research is also influenced by the material and technical base of medical educational and scientific organizations, which is practically not updated, which makes this area uncompetitive in the international market.

Medical universities and scientific organizations do not have sufficiently equipped educational and clinical bases, do not have the necessary modern equipment to carry out scientific research. One of the reasons for this is the insufficient funding provided for the training of students on the state educational order in medical universities, which does not allow using the modern technologies, purchase the necessary equipment and visual aids. Heads of medical educational institutions are forced to solve the problem of lack of financial resources by accepting students, often with a low level of knowledge, for a contractual form of education. The annual increase in student enrollment on a paid basis is also of concern.

Labor activity of healthcare workers is associated with great physical and emotional stress, the need in some cases to work in difficult and dangerous conditions for life and health. This determines some of the features of legal regulation. labor relations in this area of activity: additional requirements when concluding an employment contract, preferential working hours and rest time, special rules for part-time work, etc. In addition to the general provisions of the Labor Code of the Russian Federation, the provisions of Federal Law No. 323-FZ dated November 21, 2011 apply to medical workers. On the basics of protecting the health of citizens in the Russian Federation ", as well as a number of other by-laws legal documents... The main document regulating the work of a medical worker is an employment contract concluded with an employer.

Working hours

The legislator enshrined special legal regulation of the work of medical workers, including by establishing for them a reduced duration of working hours (part 5 of article 92 and part 1 of article 350 of the Labor Code of the Russian Federation (hereinafter - the Labor Code of the Russian Federation)), taking into account the provisions Art. 251 and 252 of the Labor Code of the Russian Federation, providing for the possibility of establishing the features of legal regulation for certain categories of workers in connection with the nature and conditions of work. These measures are aimed at compensation for the specified category of workers for the adverse effects of various factors, increased psychophysical stress due to the specifics and nature of medical and other activities to protect the health of the population, and, therefore, cannot be considered as violating the constitutional rights of citizens and the principle of equality enshrined in Art. 19 (parts 1 and 2) of the Constitution of the Russian Federation.

The stress in the work process inherent in medical activity has always been compensated for by medical workers by shorter working hours and the provision of additional annual paid leave. Therefore, for all medical workers, Art. 350 of the Labor Code of the Russian Federation, a reduced working time is established - no more than 39 hours per week. For certain categories of medical workers, depending on their position and (or) specialty, by the Decree of the Government of the Russian Federation of February 14, 2003 No. 101 "On the duration of the working time of medical workers, depending on their position and (or) specialty" (hereinafter - Resolution No. 101) in accordance with the Lists of positions, the working hours are set at 36, 33, 30 or 24 hours per week. For those job titles of medical workers that are not included in the indicated Lists, the duration of working hours is regulated by Art. 350 of the Labor Code of the Russian Federation.

For your information

It should be noted that not all workers in a medical organization belong to the category of medical workers. For example, these are administrative and economic personnel, who are assigned a normal working time of 40 hours. At the same time, it should be taken into account that the working time specific employee is established in an employment contract on the basis of a sectoral agreement and a collective agreement based on the results of a special assessment of working conditions.

To determine those who belong to the category of "medical worker", it is necessary to be guided by the provisions of the Federal Law of November 21, 2011 No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (hereinafter - Law No. 323-FZ). According to Art. 2 of the law "a medical worker is an individual who has a medical or any other education, works in a medical organization and whose labor (official) duties include carrying out medical activities, or an individual who is an individual entrepreneur who directly carries out medical activities."

Then the question arises: what is medical activity? The answer also contains Art. 2 of Law No. 323-FZ: "medical activity is professional activity in the provision of medical care, medical examinations, medical examinations and medical examinations, sanitary and anti-epidemic (preventive) measures and professional activities related to transplantation (transplantation) of organs and (or) tissues, circulation of donor blood and (or) its components for medical purposes ”.

Order of the Ministry of Health of Russia dated July 25, 2011 No. 801n approved the Nomenclature of positions for medical and pharmaceutical personnel and specialists with higher and secondary vocational education health care institutions, which contains both the positions of employees to be replaced by persons with higher (secondary) medical education, and positions of employees to be replaced by persons with other higher (secondary) vocational education. Thus, in the event that an employee with a higher (secondary) non-medical professional education, in accordance with his labor (official) duties established in the employment contract and job description, carries out medical activities in the sense that Art. 2 of Law No. 323-FZ, it can be classified as a medical worker.

As for the heads of medical organizations and the heads of their structural divisions, if, in accordance with their labor (official) duties established in the labor contract and job description, they carry out medical activities, they can also be classified as medical workers.

In accordance with clause 1 of Appendix 2 to Resolution No. 101, doctors of medical and preventive organizations, institutions: polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices, when conducting exclusively outpatient reception of patients, are entitled to a shortened 33-hour working week.

According to Art. 33 of Law No. 323-FZ, primary health care includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation healthy way life and sanitary and hygienic education of the population. Primary medical and specialized health care is provided by general practitioners, district therapists, pediatricians, district pediatricians and general practitioners (family doctors), specialist doctors, including specialist doctors of medical organizations providing specialized including high-tech medical care. This type of medical care is provided on an outpatient basis and in a day hospital.

Thus, within the framework of the provision of primary health care, district therapists, surgeons, neurologists, otorhinolaryngologists, ophthalmologists and others, in addition to outpatient reception of patients, carry out preventive examinations, medical examination, home care, health education and other preventive work, therefore, they do not may only conduct outpatient appointments and are not eligible for a reduced 33-hour work week.

In this regard, part of the working time of doctors in the framework of providing primary health care to the population, evenly on days of the week, is allocated to these types of work, based on the 39-hour duration of their working week.

A doctor - a dentist-surgeon, a doctor - a maxillofacial surgeon of medical and prophylactic organizations, institutions can be assigned a 33-hour working week, if their official duties do not provide for other work, namely: medical examination, engaging in other sanitary-preventive work, organizing treatment at home. Doctors - dentists-surgeons and doctors - maxillofacial surgeons working in hospitals are established with a 39-hour working week.

Summarized recording of working hours

In accordance with the current labor legislation in organizations where, according to the working conditions, the daily or weekly working hours established for this category of workers cannot be observed, it is possible to introduce a summarized accounting of working hours. The procedure for introducing the summarized accounting of working hours is established by the rules of the internal work schedule organizations.

Medical organizations that have hospitals provide the population with medical care regardless of the time of day and days of the week, therefore, in the internal labor regulations, a summarized accounting of working hours or shift work is established for medical workers for their duty in the evening and at night, on Sundays and holidays in accordance with the approved work schedule.

With the accumulated working time, the duration of the working time should not exceed the normal number of working hours for a specific accounting period of time. The normal number of working hours for the reference period is determined based on the weekly working hours established for this category of medical workers. For workers working part-time (shift) or part-time working week, the normal number of working hours for the reference period is reduced accordingly.

The use of accumulated working time is based on the fact that the established current legislation the duration of the working week is provided by the schedule on average for the accounting period. Scheduled daily and weekly working hours may deviate to a certain extent from the established working hours. In this case, the emerging flaw (processing) must be corrected in the established accounting period (month, quarter, etc. periods). The number of working hours according to the schedule should be equal to the number of working hours according to the established rate for this period. The accounting period cannot exceed one year, and for the working time of workers employed in work with harmful and (or) hazardous working conditions - three months (part 1 of article 104 of the Labor Code of the Russian Federation).

Organization of shift work

Article 91 of the Labor Code of the Russian Federation obliges the employer to keep records of the time actually worked by each employee. With regard to medical organizations, the employer (chief physician) or a person authorized by him is obliged to maintain work schedules for medical workers.

In medical organizations with hospitals, workers alternate in shifts evenly and, as a rule, the transition from one shift to another is made every week at the hours determined by the shift schedule. As for the workers of outpatient medical organizations, they move from shift to shift every other day.

The rational organization of outpatient and polyclinic care to the population largely depends on correctly drawn up schedules, which are an integral part of the work plan of the polyclinic and its structural units. They regulate the start and end times of daily work, the number and duration of work shifts, their alternation and the calendar of days off for medical personnel. Schedules are drawn up for a certain accounting period by structural divisions, groups of personnel (medical, middle, junior, etc.) and for each occupied position (main, combined and replaced, part-time) separately.

The duration of a shift (duration of work during the day) on different days of the week may deviate from the established duration of the working day, but the sum of the duration of all shifts per month must necessarily correspond to the monthly balance of working hours. The duration of one shift should not exceed 12 hours. The duration of the break between shifts cannot be less than twice the duration of the work shift. The number of days off per month for each employee must correspond to the number of days off provided for the calendar. The schedules should reflect the registered types of work performed by the doctor: admission to the clinic, including dispensary, home visits, and other preventive work.

Shift schedules are communicated to the employee. As a rule, no later than one month before its implementation.

The time of changing clothes before and after the end of the working day (shift) is not included in the working hours.

Rest and meal breaks

In accordance with Art. 108 of the Labor Code of the Russian Federation during the working day (shift), the medical worker must be given a break for rest and meals lasting no more than two hours and at least 30 minutes, which is not included in working hours. However, in those jobs where, due to working conditions, it is impossible to provide a break for rest and meals, the employer is obliged to provide the employee with the opportunity to rest and eat during working hours. The list of such works, as well as places for rest and eating are established by the internal labor regulations. This rule is also applicable to medical workers who have both 6.5-hour and shorter working hours.

Example

For medical workers working at stations (departments) of emergency medical care, where to install exact time for eating and resting is impossible, the internal labor regulations establish an approximate time, for example, from 13.00 to 16 hours. A similar approach is used in the internal labor regulations and for ambulance drivers.

Duration of work on the eve of non-working holidays

According to Art. 95 of the Labor Code of the Russian Federation, the duration of a working day or shift immediately preceding a non-working holiday is reduced by one hour both for workers with normal working hours and for those who work on reduced working hours (including this applies to medical workers ), regardless of the reason for its reduction. However, it should be remembered that the duration of work at night (including for medical workers who have a reduced working time) is equal to the duration of work in the daytime (that is, the duration of work (shift) at night for one hour is not reduced) in cases where it is necessary due to working conditions, as well as in shift work with a six-day working week with one day off. The list of these works can be determined by a collective agreement, a local normative act.

If a non-working holiday follows a day off, then the working day preceding that day off cannot be shortened. If there is a pre-holiday in the week, the working hours for that week are adjusted accordingly. This rule applies to both five-day and six-day workweeks.

The main form of compensation for overworking on the pre-holiday day in continuously operating organizations and in certain types of work, where it is impossible to reduce the duration of work (shift), is to provide the employee with additional rest time. Compensation for such overtime should be included in the shift schedule. If in the organization this issue is not regulated by the shift schedule or collective agreement, then additional rest time is provided by agreement of the parties. Replacement of overtime with payment according to the norms established for overtime work is allowed only with the consent of the employee.

Duty of medical workers, including at home

The duty function of medical workers, performed outside the normal hours of work, is similar to the duty of duty of medical workers, performed according to the schedule.

In accordance with the norms of the Labor Code of the Russian Federation, the labor function of the employee must be defined in the employment contract. Any work that is in addition to it must also be reflected in the employment contract. Based on this principle, it can be concluded that additional types of work specified, in particular, in subparagraph "g" of clause 2 of the Resolution of the Ministry of Labor of Russia dated 08.30.2003 No. 41 can be formalized either as a combination of professions (positions), or as part-time, for example, internal, if there are positions in the staffing table of a medical organization.

As mentioned above, the duty of medical workers is a specific job and, of course, must be formalized within the framework of an employment contract. In this case, the wages for duty should also be included in the average earnings of medical workers.

However, it should be borne in mind that in accordance with the Labor Code of the Russian Federation, any additional work or type of work is performed only with the consent of the employee himself. For example, the question is often asked about the legality of attracting doctors from outpatient departments of hospitals, dispensaries, maternity hospitals, etc., on duty in hospitals. Such shifts are possible only with the personal consent of the employee himself and if such functions are recorded in the due duties of the medical worker.

As for the involvement of medical workers working in hospitals, on duty at the hospital, such functions should also be taken into account in the employee's job responsibilities.

The head of a medical organization may, within the limits of his authority, approve the workload rate for an employee.

In 2013, in Art. 350 of the Labor Code of the Russian Federation, amendments were made, which establish that in order to implement the program of state guarantees for free provision of medical care to citizens in an emergency or urgent form, medical workers of medical organizations, with their consent, may be on duty at home.

Medical workers had been involved in this type of activity earlier, but the corresponding norm was canceled in 2008, because it contradicted the current labor legislation, and until 2013 there was no legal definition of the concept of duty at home in the legislation.

But no one canceled the specifics of the activities of medical workers, and the medical organization was obliged to provide citizens with emergency medical care and ensure the smooth operation of the organization on weekends and non-working holidays, at night, including the elimination of accidents, etc. Therefore, in 2011 followed the order of the Chairman of the Government of the Russian Federation to the Ministry of Health and Social Development of the Russian Federation to develop a draft federal law on amending the Labor Code of the Russian Federation, fixing the peculiarities of the work of doctors and nurses when they are on duty at home.

In Art. 350 of the Labor Code of the Russian Federation provides a definition of duty at home - this is the stay of a medical worker of a medical organization at home, waiting for a call to work (to provide medical assistance in an emergency or urgent form).

In addition, it is established that when taking into account the time actually worked by a medical worker of a medical organization, the time of duty at home is taken into account in the amount of 1/2 hour of working time for each hour of duty at home. The total duration of the working time of a medical worker of a medical organization, taking into account the time of duty at home, should not exceed the standard working time of a medical worker of a medical organization for the relevant period. Special attention should be paid to the fact that shifts are introduced only with the consent of the employee.

The specifics of the working time regime and recording of working time when medical workers of medical organizations carry out duties at home are established by order of the Ministry of Health of Russia dated 02.04.2014 No. 148n "On approval of the Regulation on the specifics of working hours and recording of working hours when medical workers of medical organizations are on duty at home" ...

For medical workers on duty at home, the rules of the internal labor schedule establish a summarized recording of working hours.

The start and end times of duty at home are determined by the work schedule approved by the employer, taking into account the opinion of the representative body of workers.

In the event of a call to work of a medical worker on duty at home, the time spent on providing medical care and the time it takes for a medical worker to travel from home to the place of work (places of emergency and urgent medical care) and back are taken into account in the amount of an hour of working time for each hour of medical assistance and the medical worker's travel from home to the place of work (the place of medical assistance in emergency and urgent form) and back. At the same time, the time of duty at home in the accounting period is adjusted in such a way that the total duration of the working time of a medical worker of a medical organization, taking into account the time of duty at home, taken into account in the amount of one second hour of working time for each hour of duty at home, does not exceed the standard working time of a medical an employee of a medical organization for the corresponding period.

The procedure for recording the time a medical worker travels from home to the place of work (the place of medical care in emergency and urgent form) and back is established by a local regulatory act in agreement with the representative body of employees.

The employer is obliged to keep records of the time spent by the employee at home in the waiting mode for a call to work, the time spent on providing medical assistance, and the time spent by the medical worker from home to the place of work (places of emergency and urgent medical care) and back in case of calling him to work while on duty at home.

Example

The doctor has a shorter working time of 39 hours per week. In a medical organization, a mode of work has been established for him, providing for the provision of medical care at the workplace for 29 hours a week and on duty at home (the doctor must be ready to be called to the workplace) for 20 hours a week. In total, working hours will be 49 hours per week. At the same time, 20 hours of the time spent on duty at home is taken into account by the doctor as half an hour for each hour of duty (including duty at night), i.e., the duration of the recorded working time will total the same 39 hours as during normal operation. If, while on duty at home, the doctor is called to work for 3 hours, then the remaining time on duty at home is reduced by 6 hours, so that the amount is 39 hours.

The trade union of healthcare workers of the Russian Federation for six months took an active part in the working group under the committees of the State Duma on labor, social policy and people with disabilities, health protection in the preparation of the draft law. The trade union suggested that medical workers, with their consent, should be on duty at home outside the hours established for a particular employee, and the duration of this duty should not exceed the monthly norm of working hours for the accounting period established for the employee. In addition, the Trade Union proposed, in the event of a call from a medical worker on duty at home, to work the time spent on providing medical assistance and the time it takes to get from home to the place of work and back, to pay at least double the salary (official salary) , calculated per hour of work, taking into account all the established monthly allowances and surcharges. However, the proposals of the Trade Union did not find support from the deputy corps and representatives of the ministries of health and finance of the Russian Federation.

After amendments to Art. 350 of the Labor Code of the Russian Federation, medical workers, with their consent, can be set on duty at home in the form of staying at home awaiting a call to work (to provide medical assistance in an emergency or urgent form) within the normal working hours.

When taking into account the time actually worked by a medical worker, the time of duty at home is taken into account in the amount of 1/2 hour of working time for each hour of duty at home. As a result, medical workers in this situation actually work in the regime of an extended working day, which is contrary to labor legislation in terms of compliance with the working hours.

These circumstances entail the unwillingness of workers to carry out duty, thereby increasing the tension of the psychological climate in teams, medical workers refuse to be on duty within the normal working hours.

In order to generalize the established practice of the implementation of Art. 350 of the Labor Code of the Russian Federation in terms of medical workers on duty at home, the Central Committee of the Trade Union monitored the registration and payment of these duties.

The monitoring results showed that due to insufficient staffing of medical personnel (as well as a shortage of established posts) to carry out duty at home within the established norm of working hours, as provided for in the law, is quite problematic, and in some cases it is impossible (this was indicated by 20 regional organizations of the Trade Union). At the same time, the practice of registering and paying for shifts at home is not uniform.

The existing system of on-duty shifts at home within the normal working hours is actually voluntary-compulsory, and in the presence of only one or two specialists, it turns into round-the-clock shifts. In most cases, home shifts are carried out outside the normal working hours, while payment is carried out either as overtime work, either as part-time work, or in the form of compensation payments. At the same time, the heads of medical organizations are placed within the strict framework of Art. 99 of the Labor Code of the Russian Federation, which provides for restrictions on attracting workers to overtime work - 120 hours. In practice, the time of work carried out in the form of duty at home significantly exceeds this norm.

In this regard, the Central Committee of the Trade Union again appealed to the Health Protection Committee of the State Duma of the Federal Assembly of the Russian Federation with a proposal to return to the discussion of the issue of the implementation of Art. 350 of the Labor Code of the Russian Federation regarding the implementation of duties at home by medical workers.

Keywords

PRIVATE HEALTHCARE SYSTEM / MEDICAL WORKER / PAYMENT SYSTEMS / EXTERNAL ASSOCIATION/ RESTRICTIONS / PRIVATE HEALTH-CARE SYSTEM / MEDICAL WORKER / REMUNERATION SYSTEMS / EXTERNAL PLURALITY / RESTRICTIONS

annotation scientific article on economics and business, the author of the scientific work - Natalya Vladimirovna Zhelomeeva

Based on the analysis of the works of modern authors, the systems of remuneration in organizations in the Russian Federation are considered. Attention is focused on the peculiarities of remuneration of workers who work part-time. It is emphasized that attraction medical professionals on a part-time basis is a common practice in private medical organizations in modern Russia... The necessity to remove legislative restrictions on working hours in relation to part-time medical workers is substantiated in order to prevent the payment of "gray" wages. In this regard, it is proposed to introduce into the Labor Code of the Russian Federation a norm according to which the duration of working hours medical professionals entering into an employment contract with organizations private health care system on terms external combination(and the corresponding remuneration), is established by agreement of the parties and can be increased in comparison with the statutory normal working hours. analysis of works of modern scholars. A special attention is paid to medical workers having secondary jobs in organizations of the private health-care system. For such organizations in Russia, secondary-job employing is a common practice. The author substantiates the necessity of providing more freedom of parties of labor contracts without time limit determined by the Government of the Russian Federation and the Russian Ministry of Labor to prevent payments of illegal salary. Some changes to the Labor Code of the Russian Federation are proposed. In particular, the author suggests to introduce a rule under which parties of a secondary-job labor agreement may establish limits of working time by their consent and extend it. Key words: private health-care system, medical worker, remuneration systems, external plurality, restrictions

The text of the scientific work on the topic "Legal regulation of remuneration of medical workers in organizations of the private health care system"

N.V. Zhelomeeva

LEGAL REGULATION OF PAYMENT FOR MEDICAL WORKERS IN ORGANIZATIONS OF THE PRIVATE HEALTHCARE SYSTEM

Based on the analysis of the works of modern authors, the system of remuneration of labor in organizations of the private health care system in the Russian Federation is considered. Attention is focused on the peculiarities of remuneration of workers who work part-time. It is emphasized that the attraction of medical workers on a part-time basis is a common practice in private medical organizations in modern Russia.

The necessity to remove legislative restrictions on working hours in relation to part-time medical workers is substantiated in order to prevent the payment of "gray" wages. In this regard, it is proposed to introduce into the Labor Code of the Russian Federation a norm according to which the duration of the working time of medical workers who enter into an employment contract with organizations of the private health care system on the basis of external part-time employment (and the corresponding remuneration) is established by agreement of the parties and can be increased in comparison with legally enshrined normal working hours.

Keywords: private health care system, medical worker, remuneration systems, external combination, restrictions

One of the subjects of labor relations in the field of medical activity is a medical worker. A number of studies are devoted to the analysis of its legal status [Golovina 2013; Ivanova 2012; Khnykin 2005 and others]. The systems of remuneration of medical workers in organizations of the private health care system existing abroad were considered by Russian and foreign authors [Indeikin 2004; Simo 2007; Schiff 2003].

Studying local legal acts and collective agreements healthcare organizations in the Russian Federation, we can conclude that the following remuneration systems operate in private healthcare organizations: time wages and a fee for service, which is formed from the cost of treatment prevailing in the labor market and “payment for case "(depending on the source of funding for medical services).

Currently in science labor law allocate time-based and piecework wages. Time pay is determined by the amount of time worked and is made on the basis of salary (official salary). The advantages of this payroll system are the simplicity of payroll calculation and the ability to plan costs for it. The disadvantages include the lack of connection between the quantity and quality of labor, the lack of incentives for workers to improve their qualifications.

fication [Romanov 2010: 32-34]. Nevertheless, time wages help to solve the problem of “gray” wages [Soifer, Zheltov 2007: 80].

At the same time, in organizations of the private health care system, they use it as a simple time-based wage ( salary adjusted depending on the amount of time worked by the employee) and time-bonus (salary consists of a salary and a monthly bonus).

In case of piecework payment, the performed labor operation is paid. Payment is made on the basis of piece rates (calculated value derived from the tariff rate and output rate). Usually in organizations of the private health care system, a direct piece-rate system of remuneration is used, in which piece-rates are constant and are not affected by the amount of work performed.

At present, an indirect piece-rate system of remuneration is widespread, in which the wages of auxiliary workers (middle and junior medical personnel) are made dependent on the results of the work of the main workers (doctors). In addition, when providing packages of medical services or when urgent need to perform one-time work, a piece-work system of remuneration is used. Incentive payments applied in this case

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EDUCATION PRACTICE SCIENCE

due to their economic nature, it is necessary to regulate less than compensatory ones, since they are more strongly influenced by the peculiarities of the functioning of a particular organization [Salikova 2003: 252].

In order to save money or due to a lack of personnel, organizations in the private health care system often hire part-time workers. Wage at the same time it is calculated in accordance with the requirements of Art. 285 of the Labor Code of the Russian Federation.

According to Art. 284 of the Labor Code of the Russian Federation, the daily maximum duration of working hours when working part-time cannot exceed four hours. There are different rules for healthcare professionals. By virtue of Part 2 of Art. 350 of the Labor Code of the Russian Federation, by decision of the Government of the Russian Federation, the duration of part-time work can be increased for medical workers living and working in certain areas (in rural areas and

In some private system organizations

health care, the norms of part-time working hours established by the Government of the Russian Federation and the Ministry of Labor of the Russian Federation are not observed

kakh urban type). According to the Decree of the Government of the Russian Federation of November 12, 2002 No. 813 "On the duration of part-time work in health care organizations of medical workers living and working in rural areas and in urban-type settlements", it should not exceed eight hours a day and 39 hours a week. The function of concretizing the regulation of part-time work for certain categories of workers, including medical workers, was entrusted by the Government of the Russian Federation to the Ministry of Labor of the Russian Federation (Resolution of the Government of the Russian Federation of April 4, 2003 No. pharmaceutical workers and cultural workers ").

The Ministry of Labor of Russia has supplemented the list of territories approved by Decree of the Government of the Russian Federation No. 813, in respect of which an increased duration of working hours is established concurrently for medical workers (sub. part-time teaching, medical, pharmaceutical workers and cultural workers ").

External part-time work by medical workers is a common occurrence. In particular, doctors who consult patients in one organization in the morning take jobs in another organization in the afternoon. At the same time, working conditions (labor function, working hours, wages, etc.) at the main place of work and part-time jobs can often be the same. The main place of work will be the organization where the medical worker previously got a job.

In some organizations of the private health care system, the norms of part-time working hours established by the Government of the Russian Federation and the Ministry of Labor of the Russian Federation are not observed. This situation arises due to the large number of patients in need of consultation and treatment, the constant shortage of medical workers, as well as the desire of the medical workers themselves to receive higher salaries.

The question arises: how to register these hours worked in the organizations of the private health care system? How and in what amount to make a payment? Part-time work in excess of the established norms of working hours is not allowed, overtime work in this case is also impossible. Therefore, the organizations of the private health care system do not reflect such working hours in their official documents, which are subsequently provided to the inspection and regulatory authorities; Pension Fund, Social Insurance Fund and Compulsory Health Insurance Funds.

In order to comply with labor laws and the principles of the availability of medical care and the inadmissibility of refusing to provide it, as well as in connection with the special status of workers in this category, I propose to legally allow organizations of the private health care system to conclude labor contracts for external part-time by agreement of the parties, without restrictions on the duration of working hours established by the Ministry of Labor of Russia and the Government of the Russian Federation.

At the same time, I cannot agree with the position of S. V. Romanov, O. P. Abaeva and M. V. Khazov, who propose to apply Part 1 of Art. 329 of the Labor Code of the Russian Federation, which prohibits workers whose work is directly related to the management of vehicles or traffic management, part-time work, directly

but related to vehicle management or vehicle traffic control [Romanov, Abaeva, Khazov 2017]. The legislator here has established a completely different approach to determining the time frame for part-time work. Priority should be given to the principles of the availability of medical care and the inadmissibility of refusal to provide it. In addition, when establishing the duration of part-time working hours, in any case, regardless of the position, the psychophysiological capabilities of the medical worker should be taken into account, the availability of time sufficient for him to perform his labor functions.

To comply with the specified conditions of Art. 350 of the Labor Code of the Russian Federation must be supplemented with the following rule: “If there is an agreement of the parties, it is allowed for medical workers to conclude an agreement on external combination

nizations of the private health care system with an increase in the duration of working hours in comparison with the established by this Code, other federal laws and decrees of the Government of the Russian Federation. The specific duration of the working time is established by agreement of the parties to the employment contract. "

In order for this provision to be applied, the wording of Part 2 of Art. 284 of the Labor Code of the Russian Federation must be changed as follows: "The restrictions on the duration of working hours when working part-time, established by part one of this article, do not apply in cases where an employee at the main place of work has suspended work in accordance with part two of article 142 of this Code or is suspended from work in accordance with parts two or four of Article 73 of this Code, or in other cases established by law. "

Bibliography

Golovina S. Yu. Features of the labor law status of medical workers // Medical Law. 2013. No. 6. S. 22-26.

Ivanova N.A. Features of legal regulation of labor of medical workers in the context of health care reform: author. dis. ... Cand. jurid. sciences. Yekaterinburg: Publishing house. house "Ural state. jurid. acad. ", 2012. 30 p.

Indeikin E.N. Salaries of medical workers // Chief physician. 2004. No. 2. S. 29-36.

B. E. Romanov Business activities in health care: method. allowance. Petrozavodsk: Publishing house of PetrSU, 2010.112 p.

Romanov S.V., Abaeva O.P., Khazov M.V. Contemporary problems normative legal regulation of the labor of medical workers in combination // Medical Law. 2017. No. 1. S. 46-49.

Salikova N.M. Labor payment in the Russian Federation. Legal research: monograph. Yekaterinburg: Publishing house. house "Ural state. jurid. acad. ", 2003. 364 p.

Simo K. Approaches to improving the organization of remuneration of medical workers. Overseas experience// Healthcare manager. 2007. No. 5. S. 4-21.

Soifer V.G., Zheltov O.B. Legal problems wages: theory and practice // Labor law. 2007. No. 6. S. 77-83.

Khnykin G.V. Legal regulation of labor of medical workers: practical. allowance. M .: Jurist, 2005.159 p.

Schiff R. Remuneration of doctors: international experience and options // Schiff R., Brooks R. Lectures on the organization and economics of health care. Yekaterinburg: SV-96, 2003.S. 151-170.

Natalya Vladimirovna Zhelomeeva - postgraduate student of the Labor Law Department of the Ural State Law University (Yekaterinburg), leading legal adviser of the Ural Institute of Cardiology. 620137, Russian Federation, Yekaterinburg, st. Komsomolskaya, 21. E-mail: [email protected]

Russian law

EDUCATION PRACTICE SCIENCE

Legal Regulation of Payment for Labor of Medical Workers in the Organizations of Private Health-Care System

The article considers the systems of remuneration in the organizations of the private health-care system in the Russian Federation on the basis of the analysis of works of modern scholars. A special attention is paid to medical workers having secondary jobs in organizations of the private health-care system. For such organizations in Russia, secondary-job employing is a common practice.

The author substantiates the necessity of providing more freedom of parties of labor contracts without time limit determined by the Government of the Russian Federation and the Russian Ministry of Labor to prevent payments of illegal salary. Some changes to the Labor Code of the Russian Federation are proposed. In particular, the author suggests to introduce a rule under which parties of a secondary-job labor agreement may establish limits of working time by their consent and extend it.

Key words: private health-care system, medical worker, remuneration systems, external plurality, restrictions

Golovina S. Yu. Osobennosti trudopravovogo statusa meditsinskikh rabotnikov, Meditsinskoe pravo, 2013, no. 6, pp. 22-26.

Ivanova N. A. Osobennosti pravovogo regulirovaniya truda meditsinskikh rabotnikov v usloviyakh reformirovaniya zdravookhraneniya: avtoref. dis. ... kand. yurid. nauk. Ekaterinburg: Izd. dom "Ural" skaya gos. yurid. akad. ", 2012.30 p.

Indeikin E. N. Zarabotnaya plata meditsinskikh rabotnikov, Glavnyi vrach, 2004, no. 2, pp. 29-36.

Romanov B. E. Predprinimatel "skaya deyatel" nost "v zdravookhranenii: metod. Posobie. Petrozavodsk: Izd-vo PetrGU, 2010.112 p.

Romanov S. V., Abaeva O. P., Khazov M. V. Sovremennye problemy normativno-pravovogo regulirovaniya truda meditsinskikh rabotnikov po sovmestitel "stvu, Meditsinskoe pravo, 2017, no. 1, pp. 46-49.

Salikova N. M. Oplata truda v Rossiiskoi Federatsii. Pravovoe issledovanie: monogr. ... Ekaterinburg, Izd. dom "Ural" skaya gos. yurid. akad. ", 2003.364 p.

Simo K. Podkhody k sovershenstvovaniyu organizatsii oplaty truda meditsinskikh rabotnikov. Zarubezhnyi opyt, Menedzher zdravookhraneniya, 2007, no. 5, pp. 4-21.

Soifer V. G., Zheltov O. B. Pravovye problemy oplaty truda: teoriya i praktika, Trudovoe pravo, 2007, no. 6, pp. 77-83.

Khnykin G. V. Pravovoe regulirovanie truda meditsinskikh rabotnikov: prakt. posobie, Moscow, Yurist, 2005.159 p.

Shiff R. Oplata truda vrachei: mezhdunarodnyi opyt i varianty. Shiff R., Bruks R. Lektsii po organizatsii i ekonomike zdravookhraneniya. Ekaterinburg, SV-96, 2003, pp. 151-170.

Natalia Zhelomeeva - a post-graduate student of the Labor law Chair of the Ural State Law University, lead counsel at the Ural Institute of Cardiology (Yekaterinburg). 620137, Russian Federation, Yekaterinburg, Komsomol "skaya str., 21. E-mail: [email protected]

One of the most important tasks of communist construction is the creation of the material base of communism, under which a steady increase in labor productivity and its scientific organization are noted. In modern conditions, NOT is a labor organization based on the achievements of science and advanced experience, systematically introduced into production.

Mechanization and automation of labor contribute to the continuous increase in its productivity, the preservation of human health and the gradual transformation of labor into the first vital necessity. NOT stands for consistent and steady improvement in the organization of work.

Further improvement of the health care system is unthinkable without the introduction of the elements of NOT in all its links. The purpose of NOT is to improve medical care for the population, to further improve its quality, to ensure optimal sanitary and hygienic working conditions for medical personnel, maximum labor productivity and effective expenditure of working time, prevention of occupational diseases, and the use of the labor process as a therapeutic and prophylactic factor. Labor should give medical workers moral satisfaction.

Physiology of labor solves the main problem - about fatigue of the body, at the same time identifying those measures that will help reduce it. Fatigue can occur as a result of the labor process, as well as as a result of any shortcomings in the organization of labor in production. The productivity of a tired person is much lower than that of a well-rested person. If the fatigue that develops during the work shift is so significant that it cannot be eliminated during the daily and weekly rest, overwork occurs - which is a painful process, the elimination of which requires medical assistance. Therefore, NOT provides for the fight against increased fatigue.

The scientific organization of labor in medical institutions is of great national economic importance. As an incentive to improve the quality of medical care for the population, it helps to reduce morbidity, disability, and increases work capacity and labor productivity.

The subject of NOT is the most rational distribution of personnel, reasonable division and cooperation of labor, equipping and equipping the workplace that excludes unproductive waste of time and labor, the introduction of methods and techniques that facilitate the work of medical personnel. The centralized supply of linen, foodstuffs, medicines, etc. allows the middle and junior medical personnel to significantly reduce the time to visit the pharmacy, catering facility and pay more attention to the direct service of patients in the departments.

Examining the actual time spent on various elements of the treatment process can identify and reduce the wasted time and labor of medical personnel.

The work schedule of nursing staff is drawn up depending on the profile of the department, the number of patients in it, etc. Patient care should be as close as possible to the individual, which can be achieved by attaching each nurse and junior nurse to certain wards.

When organizing her workplace, a nurse must comply with sanitary and hygienic requirements, norms and rules that make it possible to create maximum comfort for both patients and staff.

A nurse's workplace should have everything you need. It should be equipped in such a way as to eliminate the unnecessary waste of time looking for the necessary medicines, instruments, documentation, etc. All departments should be equipped with light and sound alarms according to the "patient - nurse on duty" scheme, which ensures a quick response of the nurse to the call. The organization of telephone or intercom communication between all departments of the hospital significantly reduces wasted time. Nursing medical posts should be provided with the tools necessary for each department, a special stand, which lists the studies required for various diseases, the rules for preparing patients for them and taking material for analyzes.

A two-stage system of patient care significantly improves their care and the work of nursing and junior medical personnel. Mechanization of the work of junior nurses makes their work much easier. To reduce the unproductiveness of the labor costs of district nurses, it is necessary to gradually release them from performing unskilled preparatory work before going to the site. Nurses receive standardized assignments, ready-made styling with the required amount sterile syringes and other materials written out on special standard prescription forms and patient addresses,

The preparatory work is centralized in one place, entrusting it to specially designated persons. The central sterilization laboratory of the polyclinic should supply sterile material and equipment for nurses. It is necessary to provide district nurses with the polyclinic's vehicles and provide them with certain benefits for travel on public transport while on duty. It was found that nurses of the therapeutic and pediatric departments spend 38.8% of their working time to serve patients at home and the same amount on moving around the site. Since work on the site is more responsible and associated with increased emotional stress, the need for more qualifications, the issue of material and moral incentives for district nurses working in more difficult conditions has now been resolved.

Rationalization of the work of senior nurses should be carried out by reducing the time spent on writing by introducing various ready-made standard forms, timesheets, schedules, applications for materials, simplifying the accounting system, centralizing the receipt and issuance of medicines, inventory, materials.

In many polyclinics, posts of a paramedic on duty, a nurse, dispatch centers, etc. have been organized. This reduces the time patients spend visiting the polyclinic, as well as free the district doctor from performing 5-10% of visits per day that do not require the mandatory competence of the therapist.

In the process of the formation of the NOT it turned out that the nurses in the hospital are very busy with the maintenance of medical records, especially economic activities, which does not require medical knowledge, which reduces the efficiency of their work with a significant expenditure of physical strength. The rationalization of the work of nurses cannot be carried out in isolation from medical work. All practical activities of doctors and nurses, all types and forms of NOT may lose their significance and do not give an effect if the staff violates the principles of deontology. NOT and care for the culture of medical personnel, for its proper conduct and treatment of patients is a single process, links in one chain.

Forms of division and cooperation of labor, if they are chosen correctly and meet the specific conditions of a given medical institution, must certainly contribute to saving time, reducing material costs, increasing labor efficiency. Practice shows that rational division and cooperation of labor contribute to an increase in its content, qualifications and creative activity of medical workers; the monotony and monotony of labor are eliminated, and fatigue is reduced. Improving working conditions and rational organization workplace of medical personnel. The ongoing work on the introduction of NOT convincingly testifies to its great efficiency.

Commentary on Article 350 of the Labor Code of the Russian Federation

At present, the duration of the working time of medical workers is established by the Decree of the Government of the Russian Federation of February 14, 2003 N 101 "On the duration of the working time of medical workers, depending on their position and (or) specialty."

In accordance with this Resolution, medical workers have a reduced working time depending on their position and (or) specialty:

A 36-hour working week is established for secondary doctors (except medical registrar archive, medical statistics) and junior medical personnel of medical organizations and institutions (departments, hospitals, centers, wards, offices), work in which, due to working conditions, gives the right to a shortened 36-hour working week. This also includes doctors - heads of structural divisions (except for a statistician doctor) and some other categories of medical workers of organizations and healthcare institutions.

According to the working conditions, medical institutions in which a 36-hour working week is established include: infectious diseases hospitals, dermatovenerologic dispensaries, leper colony, medical institutions for the prevention and control of AIDS and infectious diseases, psychiatric (neuropsychiatric), neurosurgical, narcological medical organizations and institutions (including children) that provide medical care and service to patients.

33-hour work is provided for:

for doctors of treatment-and-prophylactic organizations, institutions (polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices), conducting exclusively outpatient reception of patients;

for doctors and nurses, physiotherapeutic treatment-and-prophylactic organizations, institutions (departments, offices) working full-time on medical ultra-short-wave frequency (VHF) generators with a power of over 200 W, as well as dentists, dentists-orthopedists, doctors - dentists-orthodontists, dentists for children, dentists-therapists, dentists, dental technicians (except for a dentist-surgeon, a doctor-maxillofacial surgeon), dental treatment-and-prophylactic organizations, institutions (departments, offices).

A 30-hour working week is established for doctors, including doctors - heads of institutions (departments, offices, laboratories), middle and junior medical personnel of tuberculosis (anti-tuberculosis) healthcare organizations and their structural units.

In addition, a 30-hour work week is provided for:

For doctors, including doctors - heads of departments, laboratories, for middle and junior medical personnel of pathological departments, laboratories, dissection rooms, morgues, carrying out work directly related to corpses and cadaveric material;

For doctors and nurses whose work is directly related to X-ray diagnostics, fluorography, for nurses of X-ray, fluorographic rooms and installations, performing at least half a working day work directly related to assisting a doctor in carrying out work on X-ray diagnostics, fluorography, on X-ray therapy installation with visual control, and for some other categories of medical workers defined in the said Decree of organizations and healthcare institutions;

For doctors, middle and junior medical personnel of institutions of the state service of medical and social expertise (main bureau of medical and social expertise, bureau of medical and social expertise), carrying out examination of citizens with tuberculosis;

For doctors - forensic experts of the bureau of forensic medical examination, including doctors - heads of department, department, middle and junior medical personnel, whose work is directly related to corpses and cadaveric material.

A 24-hour working week is established for doctors, middle and junior personnel, whose work is directly related to radioactive substances and sources of ionizing radiation, carrying out gamma therapy and experimental gamma irradiation with gamma drugs in radio manipulation rooms and laboratories.

So, the differences in the working hours of medical workers are due to the category of workers to which they belong.

Remuneration for health workers also has its own characteristics. In particular, they are paid salaries in accordance with the position held and the category established by the UTS, taking into account the availability of a qualification category, academic degree and honorary title. The procedure for obtaining qualification categories by specialists with higher and secondary specialized education is established by Order of the Ministry of Health of Russia dated 09.08.2001 N 314 "On the procedure for obtaining qualification categories." Qualification categories are assigned attestation commission, created in accordance with the established procedure and are valid for 5 years from the date of issuance of the order on their assignment.

The grades of wages and tariff coefficients of medical workers when determining rates (salaries) on the basis of the UTS are determined by categories of workers:

Junior attendants (from the 2nd to the 4th grade);

Nursing staff (from 4th to 12th grade);

Medical staff (from 9th to 16th grade).

Heads of healthcare institutions are assigned grades from 7th to 18th, taking into account the indicators of referring healthcare institutions to groups for their remuneration, set out in the appendix to the Order of the Ministry of Health of Russia dated 10.15.1999 N 377.

A number of medical professionals enjoy the right to additional leave. This is due to work in harmful working conditions. In particular, the Decree of the Government of the Russian Federation of 03.04.1996 N 391 "On the procedure for granting benefits to employees at risk of contracting the human immunodeficiency virus in the performance of their official duties" to health care workers performing work associated with the corresponding risk, the duration of the annual paid leave of 36 workers days, taking into account the annual additional leave for work in hazardous working conditions. These leaves are granted to employees of healthcare organizations who diagnose and treat HIV-infected people, employees of organizations whose work is related to materials containing the human immunodeficiency virus, in accordance with the Procedure approved by the Resolution of the Ministry of Labor of Russia dated 08.08.1996 N 50.

The procedure for the part-time work of medical workers is established by the Decree of the Ministry of Labor of Russia of June 30, 2003 N 41 "On the specifics of part-time work of pedagogical, medical, pharmaceutical workers and cultural workers." In accordance with it, medical workers have the right to carry out part-time work, that is, to perform other regular paid work on the terms of an employment contract in their free time from their main job at the place of their main work or in other organizations, including in a similar position, specialty, profession. , and in cases where a reduced working time is established (with the exception of work in respect of which sanitary and hygienic restrictions are established by regulatory legal acts of the Russian Federation).

The duration of part-time work of medical and pharmaceutical workers during a month may not exceed half of the monthly norm of working hours, calculated from the established duration of the working week, and is established by agreement between the employee and the employer for each labor contract.

Decree of the Government of the Russian Federation of 12.11.2002 N 813 "On the duration of part-time work in healthcare organizations of medical workers living and working in rural areas and in urban-type settlements" established the duration of part-time work in healthcare organizations of medical workers living and working in rural areas and in urban-type settlements - no more than 8 hours a day and 39 hours a week.

Another commentary on Art. 350 of the Labor Code of the Russian Federation

1. This article provides an opportunity to concretize a number of features of the regulation of work and rest of medical workers to the Government of the Russian Federation.

These features are:

1) reduced working hours, determined by the Government of the Russian Federation (no more than 39 hours per week), which should depend on the position and (or) specialty;

2) an increased standard for the duration of part-time work, the introduction of which is possible by decision of the Government of the Russian Federation, adopted taking into account the opinion of the relevant All-Russian Trade Union and the All-Russian Association of Employers, for medical workers who live and work in rural areas and in urban-type settlements;

3) the provision of additional annual paid leave to certain categories of medical workers with a duration established by the Government of the Russian Federation.

Along with Art. 350 of the Labor Code of the Russian Federation, the peculiarities of work and rest of medical workers are provided for by Part 3 of Art. 92 of the Labor Code of the Russian Federation (regarding the establishment of reduced working hours), part 2 of Art. 142 of the Labor Code of the Russian Federation (in relation to the prohibition of the suspension of work at ambulance and emergency stations), part 6 of Art. 282 of the Labor Code of the Russian Federation (regarding the procedure for establishing the specifics of regulating part-time work), sub. "b" part 1 of Art. 413 of the Labor Code of the Russian Federation (in terms of prohibiting and declaring illegal strikes at ambulance and emergency stations).

2. The special nature and working conditions of these workers are due to the very nature of the medical activity carried out by the employer (an individual or legal entity(an organization) that has entered into an employment relationship with an employee, or another entity endowed, in cases stipulated by federal laws, with the right to conclude employment contracts).

Due to the risky and creative nature of medical activity, the work of medical workers is characterized by significant independence. It is this circumstance that is the reason that in many cases related to the performance of these employees of their duties to the patient, the importance of the imperative instructions of his employer is not decisive. The medical worker independently, in accordance with the standards of medical care, provides such assistance to the patient.

This rule is not enshrined in the Labor Code of the Russian Federation. However, it follows directly from the nature of medical activity.

A definite reflection of this independence are following rules, enshrined in Art. 58 of the Law of the Russian Federation of July 22, 1993 N 5487-1 "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" ( Russian newspaper... 1993.18 aug. N 158; hereinafter - Fundamentals of Health):

1) the attending physician cannot be a physician studying at a higher medical educational institution, or educational institution postgraduate vocational education;

It is the burden of responsibility arising from the independence in making vital decisions for the patient that is the reason for establishing a shorter working time and providing, in certain cases, an additional annual paid leave.

Another circumstance affecting the regulation of the work of medical workers is the public (constitutional) significance of their work, which manifests itself in the fact that with their help the implementation of the constitutional rights of citizens to health care and medical care is ensured (part 1 of article 41 of the Constitution of the Russian Federation).

This circumstance, as well as the shortage of medical workers in organizations providing medical care in rural areas and in urban-type settlements, determines the possibility of increasing the duration of part-time work.

3. The commented article does not establish the conditions for assigning persons to the category of "medical worker". Meanwhile, these conditions can be found in Art. 54 of the special law - Fundamentals of health protection.

As a general rule, for recognition as a medical professional, it is necessary that the person concerned has a special higher education and has special documents (diploma and (or) titles, as well as a specialist certificate and a license to carry out medical activities). However, for a person working in a medical organization, such a license is not required, since it must be possessed by the organization as its employer.

These conditions apply not only to the person who works under an employment contract in a medical organization. They must correspond and individual entrepreneur who independently carries out medical activities (i.e. independently provides himself with work and is an employee only in a broad sense). The unification of a wide range of persons with fundamentally different legal statuses under one name "medical worker" seems to be not very successful, since it requires a special interpretation when applying the corresponding norm of the Fundamentals of Health Protection.

As for the certificate of a specialist, the only body stipulated by the legislation that has the authority to issue a certificate is the professional medical association of the constituent entity of the Russian Federation (Article 62 of the Fundamentals of Health Protection). However, there is still no specific legal regulation of the procedure and conditions for issuing this certificate of a specialist. In view of this, in practice, the presentation of this certificate for the admission of an employee to the performance of duties in the medical profession is now not required.

The nomenclature of positions of medical workers working in the budgetary sphere is established by the Decree of the Government of the Russian Federation of October 14, 1992 N 785 "On differentiation in the levels of remuneration of workers in the budgetary sphere on the basis of the Unified Tariff Schedule" and the annex approved by it (SZ RF. 1995. N 10).

This nomenclature, as well as the Nomenclature of specialties of medical workers, are concretized by the Regulations on the remuneration of health care workers of the Russian Federation, approved by Order of the Ministry of Health of the Russian Federation of October 15, 1999 N 377 (BNA. 1999. N 46), Order of the Ministry of Health of the Russian Federation of August 19, 1997 N 249 "On the nomenclature of specialties of nursing and pharmaceutical personnel" with the approved applications (Health. 1997. N 11) and the Resolution of the Ministry of Labor and Social Development of the Russian Federation of August 27, 1997 N 43 "On the coordination of wage grades and tariff - qualification characteristics for the positions of healthcare workers in the Russian Federation "(BMT RF. 1997. N 9).

4. In accordance with Art. 54 of the Fundamentals of Health Protection, in exceptional cases, persons who do not have a completed higher medical or pharmaceutical education may be admitted to engage in medical or pharmaceutical activities in the positions of workers with secondary medical education. The procedure for such admission must be established by the federal executive body in the field of health care (currently there is no such procedure).

Doctors who have not worked in their specialty for more than 5 years may be admitted to practical medical or pharmaceutical activities after undergoing retraining in the relevant educational institutions or on the basis of a screening test conducted by the commissions of professional medical associations. Workers with secondary medical education who have not worked in their specialty for more than 5 years may be admitted to practical medical or pharmaceutical activities after confirming their qualifications in the relevant state or municipal system health care or based on a screening test conducted by commissions of professional medical associations. The correspondence of the specialties of paramedical personnel to the positions of specialists is established on the basis of the List of compliance of specialties of paramedical and pharmaceutical personnel to the positions of specialists, approved by Order of the Ministry of Health of the Russian Federation of January 19, 1999 N 18 (Health. 1999. N 4).

5. A special procedure for admission to medical activity is provided for persons who have received medical training in foreign countries. They are admitted to medical activities in the Russian Federation only after passing an exam in the relevant educational institutions of the Russian Federation in the manner prescribed by the Government of the Russian Federation, as well as after obtaining a license to carry out medical or pharmaceutical activities, unless otherwise provided by international treaties of the Russian Federation. The above procedure is established by the Regulations on the procedure for admission to medical and pharmaceutical activities in the Russian Federation of persons who have received medical and pharmaceutical training in foreign countries, approved by the Government of the Russian Federation of February 7, 1995 N 119 (SZ RF. 1995 N 7). These requirements do not apply to persons who received medical and pharmaceutical training in the former USSR.

6. Despite the breadth of the legal definition of the concept of "medical worker", enshrined in Art. 54 of the Fundamentals of Health Protection, this definition does not formally cover those health workers who participate in the implementation of medical activities as part of a single team with persons with secondary or higher professional medical education and without whom, in some cases, it is impossible to properly provide medical care. Such workers, in particular, include representatives of junior medical personnel (housewives, nurses), medical psychologists, ambulance drivers, highly skilled workers employed in important and important jobs (for example, servicing medical equipment such as artificial hearts and lungs ), etc.

The close relationship of their work with the work of workers who directly provide medical care endows in many cases this work with the same actual features that are characteristic of the work of the latter. It follows that, by virtue of the constitutional principle of equality guaranteed by the state, regardless of including official position and other circumstances (part 2 of Art. 19 of the Constitution of the Russian Federation), the regulation of labor relations with the participation of workers who provide medical care should have the same features that are characteristic of the regulation of the work of workers who directly provide medical care.

The consequence of this circumstance is the regulation by the same normative legal act of relations related to the peculiarities of work of both categories of health workers, and the use in these acts of the term "medical worker", which means both categories of these persons (Decree of the President of the Russian Federation of May 13, 1992 No. N 508 "On additional measures to stimulate the work of health workers" (RF Air Force. 1992. N 20. Art. 1133)).

7. Depending on their position and (or) specialty, medical workers are divided into four categories with working hours 36, 33, 30 and 24 hours a week (Resolution of the Government of the Russian Federation of February 14, 2003 N 101 "On the duration of the working time of medical workers, depending on their position and (or) specialty "(SZ RF. 2003. N 8)). Relations connected with the establishment of reduced working hours for medical workers are regulated, in addition, by the Decree of the Council of People's Commissars of the USSR of December 11, 1940 N 2499 "On the duration of the working day of medical workers" (Collection of decrees and orders of the government of the USSR. 1940. N 32. Art. 806).

To stimulate the work of medical workers, special amounts of allowances and surcharges were established by the already mentioned Decree of the President of the Russian Federation of May 13, 1992 N 508 "On additional measures to stimulate the work of health workers", which was specified by the Decree of the Ministry of Labor and Employment of the Russian Federation of June 8 1992 N 17 "On the amount of allowances and additional payments for health care workers and social protection of the population" (BMT RF. 1992. N 7 - 8). In these acts, the concept of "medical worker" is actually identified with the concept of "health worker", which is considered not only middle, but also junior medical personnel, as well as workers of ambulance and emergency medical care, including drivers of ambulance vehicles.

It should be especially noted that the duration of part-time work in healthcare organizations located in rural areas and in urban-type settlements can be no more than 8 hours a day and 39 hours a week (Decree of the Government of the Russian Federation of November 12, 2002 N 813 " On the duration of part-time work in health care organizations of medical workers living and working in rural areas and in urban-type settlements "(SZ RF. 2002. N 46)).

General practitioners (family doctors) and nurses of general practitioners (family doctors) have an annual additional paid 3-day leave for continuous work in these positions over 3 years (Decree of the Government of the Russian Federation of December 30, 1998 N 1588 "On establishing general practitioners (family doctors) and nurses of general practitioners (family doctors) of the annual additional paid 3-day leave for continuous work in these positions "(SZ RF. 1999. N 2)).

In a systematic form, many of the rules specifying the features of the work of medical workers provided for by higher-level regulatory legal acts are contained in the previously mentioned Regulation on the remuneration of health workers in the Russian Federation, approved by Order of the Ministry of Health of the Russian Federation of October 15, 1999 N 377.

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