Why are doctors silent?

I thought this was a really interesting piece, and a very important one to anyone interested in public healthcare. The original source appears to be a Moscow paramedic writing under a pseudonym.  Apologies for the machine translation,  but you get the main points.

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The secret side of medicine or why doctors are silent?
In recent years, in private conversations, I often ask: Why are silent your colleagues? It would seem, who does not like doctors to sound the alarm about the real state of affairs in medicine. Why are they silent? Try to understand.

It is such a red booklet. In Soviet times, Certificate no. It was enough for the diploma and the certificate of completion of residency. And I was able to change the medical field. A doctor therapist, wanted to be a neurologist. No issues. I went for a course at TSGOLIUV (Institute of Advanced Medical), retrained and became a neurologist. He worked as a doctor on ER, tired, age approached ... Retired and settled in the district health center. During his studies in residency could also work divisional therapist or doctor soon. So it was in Soviet times. Now this shop closed down. In the late 90s there were certified specialist. Since 2005, the Graduate Certificate - a document required when applying for a job.

Why have them? For a better health care to? To rid society of incompetent doctors (society, certainly thought so) ... No Way!

After graduation, the young doctor gets a diploma. But at the time of graduation - he is a nobody! Empty space. Diploma in Medical University of Russia to treat does not. A compulsory primary specialization internship or residency. Dr. drawn to "work" in the hospital, lays there and work record two years running. Free. Type of learning. The series "Interns" all looked? A scholarship. I, personally, with the passage of residency in 2002-2004 received a scholarship in 1200 (one thousand two hundred) per month. And what does he live? Usually works part-paramedic or nurse if bothered at the time he graduated from medical school and have an appropriate certificate. Usually continues to work in the same place, where he worked as a student. Virtually all medical students work part-time somewhere. Or - is spinning as he can. I was lucky - at that time still took part time medical doctor at the emergency room, the doctor's office.

He graduated doctor internship and received a certificate of completion of residency and the coveted Certificate. And, finally, became a full doctor. Got a job! Ended his torment? Certainly not! He does not know what awaits him in the future ...

Dr. enslaved. The fact that the work can take only in strict accordance with the special specified in the certificate. People got the certificate of "medical emergency" and will only work on an ambulance. Local therapist or somewhere in the hospital it will take longer - get certified in internal medicine, cardiology, neurology, etc. doctor quarreled with his superiors - was fired. That's all. Amba. Sailed ... or relocating, or skate to work far away, or get out of medicine - a different ambulance not nearby.

What do the doctor? Change the medical profession? Certainly not! Change majors only through the primary specialization - that is repetition of residency or internship in a different specialty. And here lies the ambush. Free residency is given only once - after graduation. Repeated passage of residency - a fee. Cost, depending on the specialty of two to five thousand dollars per year or more. A study two years. Spread immediately an amount equal to the cost of a decent car, luggage postdoctoral work book and walk two years on the job. In full. Completely free of charge (on the contrary for the "study" you have already paid) ... What are you going to eat? Your problems ... In time work is not easy to get. Medical assistant or nurse did not take - strikes on the basis that there is a medical diploma - sorry ... for part-time work need a valid certificate.

Specialty and can be changed through the passage of a certification cycle - a few months out of work. Of course, for a fee ... But looking at what kind. The therapist, for example, can find the certification cycle and transitioned to a cardiologist or neurologist. Or surgeon can be retrained from one surgical specialization is close to it. Anesthesiologist, for example, can be retrained through the cycle only doctor of functional diagnostics. Retrained on the therapist, for example - repetition residency ... funny? As the saying goes, "the anesthesiologist - a clever therapist." Not funny ...

And here lies another ambush ... Think Certificate lifetime? Certainly not! It is valid for only five years. And then it has to be acknowledged. Confirmation Certificate - six months training with job. The employer must send to school. And can not send, either accidentally or intentionally ... And then the doctor with an expired certificate is in absolute bondage. Works like ... Just do not dismiss arose - certificate has expired - kick up the ass. And fuck where built up, until the certificate is confirmed ... Thank Gd, I have the certificate to the current ...

Doctor fired with an expired certificate. What's next? And here lies another ambush ...

What is in the salary of physicians? Of salary, allowances for harm and for length of service. Interest cap and increase in three years, five years, seven years, ten years. Not work more than a month - for example studying at their own expense, confirmed the certificate. Employment history never lay. And experience - BURNT. No one will care what worked in their profession for twenty years. Get a job and you will receive as an intern after the internship. Experience as burns if left the state in commercial medicine. He worked as a doctor for twenty years on the ambulance, had quarreled with his superiors. Resigned. Worked for six months on a commercial ambulance. Changed bosses - decided to return to the state 03. Experience burned. Twenties "wheel" was not. Will receive a salary as an intern. Repeated passage of residency - the record can be lost ...

There is still such a thing as a "category." Depending on years of service and goodwill write heads can work "to the category." Qualifying categories are second, the first and highest. What gives the category? Very big raise. For example, as they say in the media, of the Moscow doctor may soon receive a hundred thousand rubles a month. Can. With the experience of more than ten years working in the critical care team profile and the higher category. No star will receive about fifty thousand. Young - and part-time category - about thirty. Category is valid for five years. Then it must be acknowledged. For "bad behavior" - a complaint, reprimand - a category, you can remove or not to give a chance to confirm. "Category cut." Who would want to "rock the boat"? Young professionals to understand life a little. Doctors with experience, expertise and categories - have something to lose.

That's why doctors are silent and be silent. That would not happen. Will shy away from the media ... The vow of silence.

What about the medical assistant and a nurse? And they have the same thing. Certificate, only a medical assistant or nursing, category, length ... The system is the same.

What is fired in medicine? If clean. Without scandals and bases. It would seem - to work strictly according to instructions, perform their duties in an exemplary and all will be well ... No Way! Each physician fills a huge amount of various documents. All those who had to deal with doctors saw - doctors constantly write something. That's the whole point. What documentation is available to any fault. Many of the orders and instructions of the Ministry of Health cunning way contradictory. You can take any history, map ambulance, a card in the clinic and found "grave shortcomings in the design of clinical work and medical records." And a reprimand. Several reprimands in a row - and firing in 'service for the discrepancy. " Or an ultimatum - on their own or on the article. Example of life - the sensational story of a few years ago. Chief Ambulance substation, Honored Doctor of the Russian Federation, more than fifteen years of supervised substation. Did not want to retire and make room for new young protégé chief physician. Commission came to check, this week announced four reprimands and thrown on the article. Who worked at the Moscow soon - know the story ...

That is so arranged secret side of medicine. It is obvious why doctors are silent? Who is not clear - read the text first.

P.S. And once the medical profession - was "free" profession ...

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