Healthcare workers’ issues are topical now. doctors now. Even in Ukraine, where doctors are usually criticized, now they have a more reverent attitude towards society. Doctors at the forefront of the war with coronavirus. They literally risk their lives - about 500 became ill (90 in the last 24 hours), 7 died. At the same time, healthcare workers in Ukraine receive perhaps the smallest salaries. In February, doctors on average received $ 275, that is, 1,5 times less than the average salary in the country. Moreover, medical workers themselves complain that their real salary is even lower. For only $ 273 a month, they must work hard in terms of the harsh epidemic, at the risk of being infected due to the lack of protective equipment.
In late March, the Cabinet decided to add motivation to doctors who work with coronavirus patients. The Cabinet of Ministers approved an hourly wage for them, and parliament passed Law No. 3275 on salary increases of 300%. But in parallel with the increase in salaries, layoffs are also taking place.
Do doctors have the incentive to continue the work and are there enough specialists for medical facilities in an epidemic?
Salaries of Ukrainian doctors are among the lowest in the world. For comparison: according to Glassdoor, a resource for job search, in the US, doctors receive more than $ 16,700 per month.
Despite such a record salary, they plan to introduce coronavirus co-payments in the United States. They have already been agreed also in Uzbekistan. Doctors receive about 6% of their monthly salary per day, that is, an additional $ 510 with an average salary of $ 283.
Ukrainian doctors say that they have not yet received additional payments: there were no orders from the heads of most institutions. Although the Minister of Health Maksym Stepanov assures that the money was already allocated to the regions, and the government would soon resolve the issue.
But there is no evidence that the doctors could really count on those triple payments. Basically, their salaries are formed by various allowances, for example, for seniority and intensity of work.
The average salary of the infectionists we interviewed is about $ 140 per month. The final salary is about $ 625. Including allowances for the treatment of coronavirus, doctors can count on amounts of up to 1,000 USD. But when calculating the profits for this category of doctors, we should take into account the fact that infectious disease specialists were forced to agree to lower salaries, so they massively fired.
For a doctor with an average salary, the payout will be a little more than $ 800 per month. A nurse who works with coronavirus patients will receive a little less than $ 550.
In 2003, Ukraine has issued an order on the terms of remuneration for medical and other workers for the period of work to eliminate epidemics, which already provides for a triple salary in situations similar to the current one. In addition, for some time an option was considered to make bets not triple, but double. So the surcharge could be only about $ 260. But the authorities nevertheless changed their minds about correcting the mistake.
Ambulance workers were excluded from the lists of those who can count on an increase. Doctors from Zaporizhia city even recorded a video message to the president. As a result, Minister Stepanov had to make excuses. But it is still unknown whether X-ray laboratory assistants who are also in contact with the virus and are in a high-risk zone would get the additional payments. Other doctors, who will fight other diseases during the epidemic will not receive payments.
A separate question is where to get money for allowances, given that in quarantine conditions there is not enough resources even for unemployment benefits. It was planned that the funds would be taken from the Stabilization Fund in the amount of 3,8 billion USD. But payments, most likely, will be transferred to the local budgets. Strana.ua has published a letter from the Ministry of Health, allegedly addressed to the heads of regional and Kyiv city state administrations.
So far, it seems that the situation is really being steered by the local authorities. In Lviv, doctors were promised that their salary would be increased by $ 370, in Kyiv (minus the existing increase) - from $36 to $330, for which $ 33 million have already been officially allocated. The head of Mariupol also reported that local doctors received a salary supplement of $ 370 on average.
But is there enough money for the regions? Back in December, doctors were not systematically paid extra. The Cabinet of Ministers then decided to send $ 1,7 million in the region, allegedly due to the "inefficient allocation of local budgets."
In April, Ukrainian reform of "secondary medicine" began, that is, it was related to the hospitals. Doctors expected that they would get higher salaries, but everything turned out differently. They were supposed to spend 5% of GDP on healthcare, but in the end, it turned out that 2.8% were included into the budget. Doctors say that such funding will not even cover the cost of treatment for Ukrainians, especially during an epidemic.
The Ministry of Health forbade hospitals to provide some services during quarantine, which negatively impacts the budgets of the hospitals. And given that 85% of the funding goes to salaries, doctors might simply not have enough money. Many of them already feel financial hunger, especially those who do not work with coronavirus patients. Some hospitals warn "about changing wage conditions." The doctor will not receive less than the minimum wage, but bonuses may be canceled.
In Sumy, 47 workers of the maternity hospital of the Blessed Virgin Mary were fired. Most of them belonged to the privileged categories: single mothers or those who have 1-2 years left before retirement. According to the doctors, they had a choice: moving to a lower position or dismissal.
The chairman of the free medical trade union assures that health department demands setting how many people were fired this month and what job would they apply for in the coming months. The National Health Service says that institutions would get money in advance, but this does not help.
Dismissal of medical staff occurs in conditions of total understaffing. Before quarantine, the Ministry of Health reported that there were only about 70% of the required number of doctors in Ukraine. Italy, Spain, Germany have the highest rates among the European countries in terms of medical stuff – 41-42 doctors for 10,000 people. Ukraine has 16 - 20 doctors per 10,000 people.
Ukraine does not suffer from the shortage of doctors though. As of April 7, in the US, the number of cases of coronavirus reaches 400,000, while in Ukraine there are less than 1,500.
The world shortage of personnel is compensated by attracting medical students or retired doctors to work. In the UK, about 20,000 former employees were called to work for an additional payment. In Ukraine, such a reserve is not that large, as doctors continue to work even after retirement.
Some countries are attracting doctors from abroad. Ukrainians are in high demand in the United States, although previously they have been often denied in obtaining work visas. Doctors from the former Soviet Union massively move to Europe: about 20,000 doctors from the countries of the former USSR work there. 1,137 foreigners work in Polish state-owned clinics, and every third is Ukrainian.
Italy directly requested the help of doctors from around the world. Since there is no critical shortage of doctors in the country, Zelensky sent 20 of our doctors abroad. Although many were outraged by this since this decision looked like a beautiful diplomatic gesture. Even China, whose situation is not much better now, has sent its medical workers to help Italians.
After Ukrainian doctors arrive from Italy, they would be placed for a two-week observation. At the same time, they would have to continue heir work, help patients, share the experience with their colleagues. Recent studies show that coronavirus could build up in the body, so doctors could infect patients in the hospital, as well as their colleagues.
Given the current situation in the Ukrainian healthcare system and the high demand abroad, after the end of the epidemic, doctors might begin to emigrate more actively. At the same time, Zelensky states that quarantine is a good opportunity to force Ukrainians migrating abroad to stay in the country.
"People who see no prospects, especially in terms of quarantine, are firing. But for the most part, doctors sincerely want to help Ukrainians and do not want to quit. If they had decent wages, they would be happy with everything and would not want to go abroad," pediatrician Leonid Dubey tells.
Would Ukraine have enough doctors to treat coronavirus disease? It depends not only on their dedication and patriotism but also directly on the ability of the authorities to provide physicians with remedies and a decent salary.