Search

This article discusses the employment of women in Russia. The author argues in times of high unemployment women are more vulnerable of becoming unemployed, generally do not receive social support, and are more at risk when it comes to poverty.

Russian cities of different sizes, socioeconomic profiles, and government capacity can show very different mixtures-and effectiveness of targeted and non-targeted social policies. Poverty and fiscal limitations particularly at the sub national level are often more serious problems than inadequate social targeting.

The study of the process of professional development of medical specialists does not lose its relevance, since this process needs constant improvement of its mechanisms for the formation and use of the professional and qualification potential of the personnel of medical organizations. Of great interest is the analysis of this process in dynamics (over a five-year period), which allows us to identify not only its current shortcomings, but also those that are sustainable. Special attention is paid to persistent imperfections.

The study of the level of appropriateness of the institutions for assessing qualifications of medical specialists with regard to their purpose is relevant due to a number of manifestations of the dysfunction of these institutions and the need to eliminate them. It is advisable to analyze these phenomena not only in general, but also from individual angles, including in the context of their functioning in outpatient and inpatient conditions. This perspective allows us to identify additional aspects of the dysfunction. The study was carried out on the basis of statistics of the Moscow Healthcare Department and materials of two surveys of medical specialists conducted in 2019 and 2022 by the Department. Opinions of medical personnel in polyclinics and hospitals about advantages and disadvantages of the work of institutions of accreditation and certification to get a qualification category were studied. The shortcomings were associated with the dysfunction factors. It is established that these shortcomings are ranked according to the level of significance. The most significant out of them (high workload and lessened incentives for advancement in skills) are characteristic of both types of medical institutions and their divisions, but more pronounced in outpatient settings. It is shown that a number of shortcomings were eliminated by legislation and due to the development of the infrastructure for continuing medical education. However, some shortcomings cannot be eliminated within the institutions themselves, and further reforming of the healthcare system is required.

Violation of the interconnected system of institutions for assessing the qualifications of medical specialists can be associated with two main circumstances. The first circumstance is the emergence of new institutions with duplicate tasks and organizational forms, and the second is the withdrawal from the system of an institution that performs the necessary system function. Two relatively new institutions, namely the independent assessment of qualifications (IAQ) and certification for the title of «Moscow Doctor», are considered from the point of view of these circumstances. The paper reveals that there is a convergence of the rules of the Institute of accreditation with the Institution of IAQ of qualifications, which can result in significant duplication of their activities. Therefore, it is necessary to resolve the issue of its possible unification with the Institution of accreditation while the IAQ is at the experimental stage and has not been put into practice. A certain similarity of the principles of activity can be traced in such institutions as certification for the qualification category and certification for the title of «Moscow doctor». Both of these institutions identify and rank the qualifications of specialists exceeding the basic level. The fundamental innovation of certification for the status of «Moscow Doctor» is that this institution actually introduces a qualification category that is higher than the current highest category. At the same time, this institution shows the importance of the institution of certification for a category whose existence is being questioned.

Continuing medical education (CME) is embedded in the structure of the institutes of qualification assessment. These are institutes of accreditation of specialists and their certification for obtaining a qualification category. CME has become an element of accreditation. So far, an absolute minority of specialists have been accredited. Therefore, the study focuses on the analysis of the implementation of CME. The materials of the expert survey of medical personnel were used. It was found that respondents generally have a positive opinion of the CME system. But its organization has significant drawbacks. Their impact on the provision of high-quality medical services to the population and on the social security of doctors in the field of professional development is negative. Specialists bear the main share of responsibility for the choice of programs and forms of training. And their supply and quality do not always meet the needs of doctors. The system of scoring participation in the CME often forces specialists to make a choice in favor of a set of points, but at the expense of real knowledge. It is revealed that the CME is not built into the institute of certification for qualification category, although the level of qualification of specialists certainly depends on it. This is caused by an unjustified decline in the prestige of this institution.

In the health care sector, due to a long cycle of accumulation of human capital, a change of profession often leads to a disruption of this cycle. Therefore, stable employment in the workplace for medical specialists is preferable and should be accompanied by permanent qualification growth within the framework of the profession. Labour mobility to a large extent contradicts this process. One of its most powerful incentives is dissatisfaction with earnings, and this article presents an analysis of the impact of this dissatisfaction on readiness for vocational and labour mobility, based on a questionnaire survey of doctors and nurses of Moscow health care system. A reference group of specialists with proactive attitude towards vocational and professional growth has been singled out. Its assessments of satisfaction with the size of earnings and with correspondence between earnings and labour contribution showed that the dissatisfaction with the inadequacy of earnings is widely spread. This dissatisfaction relates to both base salary and incentive payments against labour contribution. An increase in base salary and in incentive payments together with a simultaneous increase in the share of incentive payments should be the basis for adjusting the wage system. A more accurate accounting of the workload (which has grown as a result of optimization) in earnings is also relevant for paramedical personnel. Should the authorities fail to do this, the undesirable staff turnover, which is already high, may increase even further.