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

Who is entitled to incentive payments in 2020

The above program fundamentally changed the accrual system wages both doctors and nurses.

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

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

The payment of incentives to physicians should contribute to the revitalization of their activities, to improve the level of service for the population. More money who is the best at helping people!

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

Documentary base of the Program

Federal legislation generally regulates the remuneration of state employees, including medical workers.

In Art. 129 of the Labor Code of the Russian Federation indicates the following types of charges:

• basic, otherwise referred to as basic;
• compensation depending on the specifics of the region;
• stimulating;
• social.

The first, the main part is necessarily paid to everyone without exception. The second paragraph indicates accruals that depend on specific working conditions. They vary by region. Incentive payments to doctors, which are of interest to us, are calculated based on an assessment of the effectiveness of the work of doctors and nurses.

Basic legal act, on which the administration of the medical institution relies, is the Regulation on the establishment of wage systems for employees of federal budgetary, autonomous and state-owned institutions, approved by Decree of the Government of the Russian Federation dated 05.08.2008 No. 583 (hereinafter referred to as the Regulation).

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

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

Where incentive criteria are developed

On the basis of paragraph 6 of the above resolution of the Ministry of Health and Social Development, recommendations were developed and sent to all institutions, which are mandatory for implementation when developing internal documents. Guided by this paper, each organization approves its own regulation on incentive payments medical workers. In addition, relevant acts are issued at the regional level.

Ask the administration of the medical institution the content of the above document in order to understand exactly how the accruals are made.

Union control

When developing and approving recommendations for medical institutions, the Government of the Russian Federation consults with trade unions.

This format is called a tripartite commission, in which employers also take part. It meets annually, therefore, it also provides recommendations to the administrations of medical institutions once a year.

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

It reflects the following points:

• sources of financing from which incentives will be paid (a special fund is created at the enterprise);
• categories of specialists subject to the Regulations;
• a specific accrual scheme with a division into financing from: a means of compulsory insurance and money received from entrepreneurial activity;
• criteria for the effectiveness of the work of physicians.

Accrual nuances

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

• duration and continuity of experience;
• results of work;
• achievements associated with the intensity of activity;
• the quality of labor.

The first two criteria are usually understood unambiguously, they are quantitative indicators. But in order to assess the level of efficiency, quality, intensity and effectiveness, we had to create a special methodology. The Ministry of Health, by order No. 421 dated June 28, 2013, proposed to regional departments a list of performance indicators that should be taken into account when addressing incentive issues described in the Guidelines.

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

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

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

The above criteria must be described in the Regulation on the remuneration of the enterprise. The Ministry of Health of the region is obliged to establish in its document the minimum value of each of the listed factors.

If at the end of the year it turns out that the hospital has accumulated unused funds under the Program, they can be paid to doctors ( annual bonus).

How does combination and substitution affect the amount of stimulating

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

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

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

Deprivation of stimulants

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

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

If you are faced with a refusal to accrue any part of the salary, demand an order from the management on the basis of which the accountant acted. Look for reasons in this paper. Only after studying them is it worth making a decision to file a complaint.

Last changes

In connection with the work on the implementation of the so-called May Decrees of the President of the Russian Federation (dated 2012), in 2017 there was a serious redistribution of funding for the parts that make up the salaries of doctors. There is a decrease in incentives for physicians throughout Russia.

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

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

In the second case, they reduced payments that are not regulated by state regulations. This mainly affected rewards for the quality and intensity of work.

Since the end of 2018, the procedure for calculating and the amount of insurance premiums for compulsory medical insurance of the non-working population has changed, including in terms of the increase in the cost of medical services. An increase in such indicators should also entail a corresponding increase in the remuneration of medical workers, calculated based on the number of citizens served with this type of CHI. However, only practice will show whether the remuneration of medical workers will actually change or whether this is another castling within the framework of the FFOMS budget.

In 2020, the redistribution of funds will continue in order to equalize the wages of state employees. The remuneration of medical workers should be brought in accordance with the average salary in the region as a whole.

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

The Faculty of Medical Law again returns to the discussion of the issue of guarantees and compensations provided by the state to medical workers. As you know, when moving to a rural area, medical workers are provided with a one-time compensation payment. Today we will talk about the procedure for providing this compensation as part of the changes for 2017.

About the one-time compensation payment

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

You should be aware that the amount of a one-time compensation payment to medical workers is 1,000,000 rubles.

Financing of one-time compensation payments to medical workers in 2017 is carried out at the expense of other interbudgetary transfers provided to the budget of the territorial CHI fund from the budget of the Federal CHI Fund in accordance with Federal Law No. and for the planning period of 2018 and 2019”, and the budget funds of the constituent entities of the Russian Federation in the ratio of 60 and 40 percent, respectively.

Note that in accordance with paragraph 37.2 of Article 217 tax code RF lump-sum compensation payment is not subject to taxation.

The purpose of such a payment is to attract medical workers to rural settlements and compensate for the costs associated with moving and settling, as well as the inconvenience caused by less comfortable living conditions compared to other (non-rural) settlements.

At the same time, the legislator does not at all limit medical workers who have arrived to work in a rural settlement in what the amount provided will be spent on.

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

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

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

So, according to part 1.1 of article 10 of the Federal Law No. 131, granting municipalities the status of a city, rural settlement, municipal district, urban district, urban district with intracity division, intracity district, intracity territory of federal cities is carried out by the laws of the constituent entities of the Russian Federation.

It is worth noting that the criteria that apply to medical workers applying for a one-time compensation payment change from year to year.

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

• age - up to 50 years (by the way, in 2012-2014 the age limit was up to 35 years, in 2015 - 45 years);
• availability of higher education;
• arriving at work in a rural area in 2016 and 2017;
• the existence of a concluded agreement with the authorized executive body of the constituent entity of the Russian Federation.

In practice, the authorities that are provided with such a package of documents also require a medical worker to have an employment contract between a medical worker and a state health care institution of a constituent entity of the Russian Federation or a municipal health care institution.

By the way, oh this condition say the FFOMS and the Ministry of Health of Russia in the Letter of the FFOMS dated July 8, 2013 No. 5124 / 80-1 / and “On judicial practice in resolving disputes about the payment of lump-sum compensation to medical workers who moved to work in a rural settlement” (Letter of the FFOMS No. 5124 / 80- 1/i) and Letter of the Ministry of Health of Russia No. 11-11/3089 dated August 10, 2012 “On the issue of making lump-sum compensation payments to medical workers” (Letter of the Ministry of Health No. 11-11/3089).

However, it is worth remembering that the letters of the FFOMS, the Ministry of Health of Russia and other authorities do not have signs of normativity and can only be of an explanatory and recommendatory nature.

The publication of such explanatory letters by the relevant authorized bodies indicates that unified order There is currently no lump-sum compensation available.

In the absence legal regulation(of the procedure) for granting a lump-sum compensation payment, the FFOMS and the Ministry of Health of Russia provides authorized executive authorities of the constituent entities of the Russian Federation to resolve this issue independently, as indicated, for example, in letter FFOMS No. 801/21-i, according to which regulatory legal acts providing for measures social support medical workers, as well as the procedure for concluding an agreement between a medical worker and an authorized executive body.

Thus, the Procedure for concluding an agreement with a medical worker on the provision of a lump-sum compensation payment in 2017 in the Moscow Region was approved by Decree of the Government of the Moscow Region dated March 14, 2017 No. 145/8 (hereinafter referred to as the Procedure for the Moscow Region).

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

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

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

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

• checks the availability and authenticity of the documents submitted by the medical worker;
• submits to the Ministry an application from a medical worker for a one-time compensation payment (please note that there is no deadline for submitting such an application to the Ministry. Note that earlier the healthcare institution had to send an application to the Ministry within three working days from the date of conclusion of an employment contract with a medical worker).

Also, in the Procedure for the Ministry of Defense, it is noted that a one-time compensation payment is established and paid to medical workers only at their main place of work.

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Labor activity medical personnel specific - sometimes you have to work around the clock. However, not all healthcare workers work in safe environments (where exposure to harmful and/or dangerous production factors excluded or their impact levels do not exceed the established standards). Many physicians are affected by harmful and dangerous production factors. The Labor Code and other regulatory legal acts provide for a number of guarantees and benefits for employees working in such working conditions. You will learn about this by reading the article.

General rules

Every employee has the right to workplace, which meets the state regulatory requirements for protection, as well as complete reliable information about working conditions and labor protection requirements at the workplace.

Article 209 of the Labor Code of the Russian Federation defines working conditions as a combination of factors in the working environment and the labor process that affect the performance and health of an employee. A production factor is considered harmful, the impact of which on an employee can lead to his illness. And dangerous - the impact of which on the worker can lead to his injury. However, the conditions themselves do not become harmful or dangerous - to identify such factors, certification of workplaces is carried out according to working conditions.

Note. If, according to the results of certification or on the basis of the conclusion state expertise working conditions at the workplace are recognized as safe, then compensation (including annual additional paid leave) is not due to the employee (part 4 of article 219 of the Labor Code of the Russian Federation).

Article 219 of the Labor Code of the Russian Federation establishes that each employee, in addition to the basic rights established by Art. 21 of the Labor Code of the Russian Federation, is entitled to compensation established in accordance with the Labor Code of the Russian Federation, a collective agreement, an agreement, a local normative act, an employment contract, if he is engaged in hard work, work with harmful and (or) dangerous conditions. The amount of such compensations is established by Decree of the Government of the Russian Federation of November 20, 2008 N 870 "On the establishment of reduced working hours, annual additional paid leave, increased wages for workers engaged in heavy work, work with harmful and (or) dangerous and other special conditions labor" (hereinafter - Resolution N 870).

Increased or additional compensation for hard work, work with harmful and (or) dangerous conditions may be established by a collective agreement, a local regulatory act, taking into account the financial and economic situation of the employer.

On February 13, 2013, Rostrud issued an explanation on the procedure for providing guarantees and compensations to persons employed in work with harmful and (or) dangerous conditions. In particular, this department, taking into account the Decision of the Armed Forces of the Russian Federation of January 14, 2013 N AKPI12-1570, recommended that employers use the List of industries, workshops, professions and positions with harmful working conditions, work in which gives the right to additional leave and a shorter working day to determine the amount of compensation (hereinafter - the List), and Instructions for its use. Therefore, in harmful and dangerous conditions, for example, work is performed:

- in infectious, fungal and tuberculosis (anti-tuberculosis) hospitals;

- in anti-leprosy institutions and departments, offices and points;

- in psychiatric (psycho-neurological), neurosurgical, drug treatment facilities, departments, wards and offices, as well as nursing homes (departments) for the mentally ill;

- in physiotherapy rooms (departments);

– in dental clinics, departments and offices;

— in pathological departments and laboratories;

- in specialized MTEC for tuberculosis and mentally ill patients;

- at stations (departments) of ambulance and emergency medical care and departments of mobile emergency and advisory medical care of regional, regional and republican hospitals;

- in sanitary facilities.

Compensation for harmful and dangerous working conditions

Decree N 870 provides that the following compensations are established for persons employed in heavy work, work with harmful and (or) dangerous and other special working conditions, based on the results of attestation of workplaces:

- reduced working hours - no more than 36 hours per week in accordance with Art. 92 of the Labor Code of the Russian Federation;

- annual additional paid leave - at least seven calendar days;

- increase in wages - at least 4% of the tariff rate (salary) established for various types of work with normal working conditions.

Let's consider them in more detail.

Reduced hours of work

Working hours - the time during which the employee, in accordance with the internal labor regulations and the terms of the employment contract, must perform labor obligations. Normal working hours cannot exceed 40 hours per week (Article 91 of the Labor Code of the Russian Federation). However, Art. 350 of the Labor Code of the Russian Federation for medical workers, a reduced working time is set - 39 hours per week. If the health worker also works in harmful or dangerous conditions, the duration of his work should not exceed 36 hours per week by virtue of Art. 92 of the Labor Code of the Russian Federation.

It should be noted that not only the Labor Code regulates the reduced working hours of medical workers: the employer must also take into account some federal laws and decrees of the Government of the Russian Federation. Thus, medical and other workers involved in the diagnosis and treatment of HIV-infected people, as well as persons whose work is related to materials containing the human immunodeficiency virus, should be given reduced working hours on the basis of Art. 22 of the Federal Law of March 30, 1995 N 38-F3 "On the Prevention of the Spread in the Russian Federation of a Disease Caused by the Human Immunodeficiency Virus (HIV)". At the same time, the working time for them is determined in accordance with Appendix 1 to Resolution N 101 and is 36 hours a week.

Health workers directly involved in the provision of anti-tuberculosis care are also supposed to work less (Article 15 of the Federal Law of June 18, 2001 N 77-FZ "On Preventing the Spread of Tuberculosis in the Russian Federation"). The list of positions of medical, veterinary and other workers directly involved in the provision of such assistance was approved by Order of the Ministry of Health of the Russian Federation N 225 dated May 30, 2003, the Ministry of Defense of the Russian Federation N 194, the Ministry of Internal Affairs of the Russian Federation N 363, the Ministry of Justice of the Russian Federation N 126, the Ministry of Education N 2330, the Ministry of Agriculture of the Russian Federation N 777 , Federal Border Guard Service of the Russian Federation N 292. Note that in accordance with Appendix 3 to Decree N 101, medical workers of tuberculosis healthcare organizations and their structural divisions should be reduced to 30 hours a week.

Medical staff performing work in psychiatric (psycho-neurological) healthcare facilities, institutions, departments, wards and offices, institutions social services population and their structural divisions intended to serve citizens suffering from mental illness, on the basis of Art. 22 of the Law of the Russian Federation of 02.07.1992 N 3185-1 "On psychiatric care and guarantees of the rights of citizens in its provision" are also entitled to reduced working hours, which, by virtue of Appendix 1 to Resolution N 101, is 36 hours a week for them.

In addition, Decree N 101 establishes:

– 33-hour working week for medical workers of health facilities (polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices), physiotherapy facilities and offices, dental departments, offices and health facilities;

— 24-hour week for medical workers who directly carry out gamma therapy and experimental gamma irradiation with gamma drugs in radio manipulation rooms and laboratories.

Please note that for doctors employed in jobs with harmful or dangerous working conditions, where reduced working hours are established, the maximum allowable duration of daily work (shift) cannot exceed:

- with a 36-hour work week - eight hours;

- with a 30-hour work week or less - six hours.

For some categories of health workers, the duration of daily work is specified within the List. For example, for doctors, middle and junior medical personnel, as well as a cleaner for industrial premises of pathoanatomical departments and laboratories, the working day (shift) cannot be more than five hours.

A collective agreement may provide for an increase in the duration of daily work (shift) subject to compliance with the maximum weekly working hours and hygienic standards of working conditions (Article 94 of the Labor Code of the Russian Federation).

Annual additional paid leave

Based on Art. 350 of the Labor Code of the Russian Federation, certain categories of medical workers may be granted additional annual paid leave. At the same time, the minimum duration of leave for work in harmful and dangerous working conditions is established by Decree N 870 and is seven calendar days.

Paragraph 2 of Decree N 870 determines that the minimum duration of additional annual paid leave, depending on the class of working conditions and the conditions for providing this compensation, should be established by the Ministry of Labor. However, to date, the relevant regulatory legal act has not been issued (which does not relieve employers from the obligation to provide additional annual paid leave). Prior to its adoption, the employer must provide leave of at least seven days. Of course, vacation can be more, but only if it is provided for by a collective agreement or local regulatory act.

If the profession or position of the employee who is entitled to compensation is included in the List and the duration of vacation indicated in it is greater than that provided for by Decree N 870, then the List should be guided by the determination of the amount of compensation (Decision of the Armed Forces of the Russian Federation of 14.01. .

Note! When setting the duration of additional paid leave in a local regulation or a collective agreement, you need to focus on the List. For instance, medical statistician, paramedical employees of infectious and fungal health facilities, a cloakroom attendant employed in a dressing room for patients, are entitled to an additional vacation of 12 working days. The head doctor, his deputy doctor (with irregular working hours) of children's psychiatric hospitals have the right to 24 working days of rest. A psychiatrist, middle and junior medical staff involved in providing medical care to the mentally ill - for 30 working days, and doctors of anti-plague institutions - for 36 working days.

It should be noted that if, based on the results of certification of workplaces, the working conditions of a medical worker are found to be harmful or dangerous, the employer will have to provide additional paid leave, regardless of whether the name of the position occupied by the medical worker is included in the List or not (Determination of the Constitutional Court of the Russian Federation dated 07.02.2013 N 135-O).

Additional paid leave is also established by the Decree of the Ministry of Labor of the Russian Federation of 07/08/1993 N 133. In particular, an additional leave for work with harmful working conditions of 30 working days was established for psychologists and physiologists directly and full-time for those working with the mentally ill, for medical directors (with irregular working hours) of psychiatric (psychoneurological), neurosurgical, narcological treatment and prophylactic institutions, departments, wards and offices, nursing homes (departments) for the mentally ill and their deputies, as well as chief psychiatrists of health authorities directly involved in the provision of psychiatric care.

It may turn out that a health care worker is entitled to receive additional leave for work in harmful or dangerous conditions for several reasons. In this case, vacations are not summed up, but only one of them is provided - a longer one.

Labor legislation establishes that additional paid vacations are added to the annual basic paid vacation. But a question may arise here. As you can see, in general, additional leave should be provided in working days. But, according to Art. 120 of the Labor Code of the Russian Federation, the duration of annual basic and additional paid holidays is calculated in calendar days. How to convert working days of vacation into calendar days?

Rostrud explained in Letter N 625-BB ​​dated February 1, 2002: a certain number of days of the main vacation in calendar days are counted from the start date of the vacation, and then a certain number of days of additional vacation in working days per six-day working week and find out the date last day holidays. After that, the total vacation period is converted into calendar days. The resulting number of calendar days will be the total duration of the annual paid leave.

For example, on March 13, 2013, an employee goes on annual paid leave of 28 calendar days. For harmful working conditions, he is entitled to additional paid leave of 12 working days. In this case, the last day of vacation will be 04/23/2013. Now we translate the total vacation period from 03/13/2013 to 04/23/2013 into calendar days, we get a vacation lasting 42 calendar days.

Increased pay

In accordance with Art. 147 of the Labor Code of the Russian Federation, remuneration for labor of persons employed in heavy work, work with harmful and (or) dangerous conditions, is established at an increased rate compared to tariff rates, salaries (official salaries) established for various types of work with normal working conditions, but not below the sizes established by the labor legislation - 4% of the tariff rate (salary).

As with additional leave, the specific minimum amounts of such increases, depending on the class of working conditions, should be established by the Ministry of Labor, but this has not yet been done. Until the adoption of the relevant regulatory legal act, the legislation of the former USSR that regulates these issues continues to operate - the Decree of the Central Committee of the CPSU, the Council of Ministers of the USSR and the All-Union Central Council of Trade Unions of September 17, 1986 N 1115 and the Decree of the State Committee for Labor of the USSR and the Secretariat of the All-Union Central Council of Trade Unions of October 3, 1986 N 387 adopted in accordance with it / 22-78. According to the said resolutions, surcharges are provided in the following amounts:

- at work with difficult and harmful working conditions - 4, 8, 12%;

- in jobs with especially difficult and especially harmful working conditions - 16, 20, 24%.

The specific amount of the increase in wages for work in harmful and dangerous conditions for medical employees is established by the employer, taking into account the opinion of the representative body of employees.

Guarantees for work in harmful and dangerous working conditions

In addition to the compensations established by Decree N 870, medical workers for work in harmful and dangerous conditions are entitled to other compensations and guarantees. Let's consider them.

Medical examinations

Medical employees engaged in heavy work and work with harmful and (or) dangerous working conditions (including underground), as well as in work related to traffic, undergo mandatory preliminary (upon employment) and periodic (for persons under the age of 21 - annual) medical examinations (examinations) to determine suitability for the performance of assigned work and the prevention of occupational diseases (Article 213 of the Labor Code of the Russian Federation).

Harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the procedure for their conduct are determined by Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 N 302n.

Note that for some categories of medical workers, it is mandatory to undergo a psychiatric examination. Thus, Decree of the Government of the Russian Federation of April 28, 1993 N 377 established a list of medical psychiatric contraindications for the implementation of certain types of professional activity and activities associated with the source heightened danger. This list includes the following dangerous and harmful substances:

— antibiotics (production and use in medical practice);

- infected material and material infected with helminths (work in contact with infectious and helminth-infected material, with infectious patients);

– laser radiation (all types of work with lasers, work with ultrasonic medical equipment).

In addition, for medical workers of surgical hospitals, maternity hospitals (departments), children's hospitals (departments), departments of pathology of newborns, premature babies, psychiatric contraindications for work are also established, therefore, these workers are required to undergo a psychiatric examination.

Rules for passing a mandatory psychiatric examination by employees performing certain types activities, including those associated with sources of increased danger (with the influence of harmful substances and adverse production factors), as well as those performing their duties in conditions of increased danger, are approved by Decree of the Government of the Russian Federation of September 23, 2002 N 695. In accordance with these rules, an examination of a medical worker is carried out medical board, created by the body health care management at least once every five years.

Means of protection

Based on Art. 212 of the Labor Code of the Russian Federation, the employer is obliged to issue special clothes, special footwear and other personal protective equipment, washing and neutralizing agents that have passed mandatory certification or declaration of conformity, to medical employees employed in work with harmful and (or) dangerous conditions. Moreover, the employer must ensure the acquisition and issuance in accordance with standard norms. For example, standard industry norms for the issuance of personal protective equipment to employees of healthcare organizations and social protection population, medical research organizations and educational institutions, production of bacterial and biological preparations, materials, educational visual aids, for the procurement, cultivation and processing of medical leeches are approved by the Decree of the Ministry of Labor of the Russian Federation of December 29, 1997 N 68. In accordance with these standards, doctors and paramedical personnel of operating rooms, dressing and plaster rooms, generic and postpartum wards of healthcare facilities and institutions of forensic medical examination, a waterproof apron, rubber gloves, and when working in operating rooms with power tools, additionally dielectric galoshes are required.

Intersectoral rules for providing workers with special clothing, special footwear and other personal protective equipment were approved by Order of the Ministry of Health and Social Development of the Russian Federation dated 01.06.2009 N 290n. But the standard norms for providing employees of the disaster medicine service with special clothing and footwear were approved by Order of the Ministry of Health and Social Development of the Russian Federation dated November 18, 2004 N 201: medical workers of field hospitals, mobile medical teams, medical teams of healthcare institutions and formations of the disaster medicine service can count on them. In accordance with the rules approved by the same order, the issuance of special clothing and footwear is made to employees of the disaster medicine service, whose official and professional duties are related to ensuring the constant readiness of the forces and means of the disaster medicine service and who participate in the performance of work in emergency zones.

Note. It is not allowed to replace milk with sour cream, butter, as well as the issuance of milk or other equivalent food products for one or several shifts in advance, as well as for past shifts.

Therapeutic nutrition and milk

At jobs with harmful working conditions, milk or other equivalent products are issued free of charge. food products(Article 222 of the Labor Code of the Russian Federation). The norms and conditions for the free distribution of milk are approved by the Order of the Ministry of Health and Social Development of the Russian Federation dated February 16, 2009 N 45n. Thus, medical workers working in hazardous conditions are entitled to 0.5 liters of milk per shift, regardless of its duration. If the time of work in hazardous working conditions is less than the established duration of the work shift, milk is issued when work is performed under the specified conditions for at least half of the work shift. Instead of milk, a health worker may be given equivalent food products, the list and norms for issuing which are given in Table 1 of the Norms and conditions for the free distribution of milk. The issuance of other products is not provided for by the legislation of the Russian Federation.

Instead of fresh milk, workers involved in the production or processing of antibiotics are given fermented milk products enriched with probiotics (bifidobacteria, lactic acid bacteria), or colibacterin prepared from whole milk.

Let us pay attention to the fact that the issuance of milk or other equivalent products to health workers according to the established norms, upon a written application of the employee, can be replaced by a compensation payment in an amount equivalent to the cost of milk and other equivalent products, if this is provided for by a collective or labor agreement (clause 10 of the Rules and Conditions free delivery of milk, part 1 of article 222 of the Labor Code of the Russian Federation).

At work with especially harmful working conditions, therapeutic and preventive nutrition is provided free of charge. The list of industries, professions and positions, work in which gives the right to receive free medical and preventive nutrition in connection with especially harmful working conditions, the norms and rules for issuing nutrition are approved by Order of the Ministry of Health and Social Development of the Russian Federation of February 16, 2009 N 46n. In accordance with this order, therapeutic and preventive nutrition is due to doctors, nurses, managers and specialists directly working in medical pressure chambers, as well as doctors of all categories and specialties performing medical and sanitary support for work related to the destruction of chemical weapons.

Pension provision

By general rule Men who have reached the age of 60 and women who have reached the age of 55 are entitled to an old-age labor pension. However, medical workers who work in harmful or dangerous conditions may be granted early retirement.

In particular, an old-age labor pension is assigned earlier than the specified age (for men at 50 years old, for women at 45), if they have worked, respectively, for at least 10 years and 7 years and 6 months in jobs with harmful working conditions and have an insurance record of at least 20 and 15 years. Such a right, for example, can be exercised by doctors, paramedical and junior medical personnel, barmaids and other workers engaged in sanitary and domestic maintenance of the underground parts of the organization.

In addition, the following are eligible for early retirement:

— middle medical personnel of X-ray departments (offices), as well as those employed in X-ray angiographic rooms;

- medical workers directly serving patients in tuberculosis and infectious diseases institutions;

- middle and junior medical personnel in leper colonies, psychiatric hospitals, boarding schools for mentally retarded children, underground hospitals (in spent salt mines);

— doctors, middle and junior medical personnel of burn and purulent departments, departments and chemotherapy rooms of oncological institutions;

- junior nurses(nurses) of pathoanatomical departments, prosector morgues;

- junior nurses for patient care, employed in x-ray departments;

— medical and pharmaceutical workers who became infected while on duty official duties human immunodeficiency virus.

Note. Direct patient care is work performed in conditions of contact between a medical worker and a patient: massage, injections, procedures, manipulations, food distribution and feeding of patients, their carrying, sanitization, washing, etc.

State programs related to the healthcare sector were introduced already in 2011, although the prerequisites for increasing the remuneration of medical workers to 200% of the average salary in the region appeared much earlier. The main goals of the programs are to ensure the availability of medical care by attracting additional staff and doctors to work in polyclinics, as well as encouraging individual medical workers for their efforts. In particular, incentive payments were approved for medical workers, designed to orient employees of medical institutions to the result.

Who is eligible to apply for incentive payments to health workers

The condition for the accrual of incentive payments is the availability of a certificate in the main specialty of the established form.

The system for accruing incentive payments has radically changed the scheme for calculating the salaries of doctors and paramedical personnel, but the program applies only to certain categories of medical workers. Incentive accruals do not rely on:

• representatives of the administration of the medical institution (those heads who are practicing doctors are entitled to participate in the program);
• health workers involved in the provision of high-tech care;
• health program participants (deliveries, newborn caregivers, pediatricians, family doctors, community physicians and nursing assistants helping them).

On the remuneration of medical workers

The Labor Code establishes the following types of payments to public sector employees:

• basic (basic, fixed, paid to all employees without exception);
• compensatory (changing depending on the region and depending on the conditions for the implementation of labor activity);
• social;
• stimulating (depending on the merits of the employee and the assessment of the effectiveness of his activities).

Of all the types of accruals listed above, only incentive payments to health workers are regulated by the administration of the medical institution itself, the rules for assigning other payments are established by federal and regional regulations. The management of the institution is obliged to fix the procedure for paying incentive bonuses in a local regulatory act and familiarize all employees of the clinic with its provisions.

How much incentive payments are accrued to health workers

The amount of the incentive supplement to wages is not fixed - the amount of the allowance will depend on the volume of services provided by the health worker. Every month, the administration of the clinic issues an order on financial incentives for employees who deserve a bonus. Each medical institution sets the amount of the additional payment at its own discretion, but taking into account the main mandatory provisions of the methodology developed by the local Ministry of Health.

When assigning an incentive bonus to each employee, the following indicators are evaluated:

• actual hours worked during the month;
• the fact of compliance with the standards of medical care for the population;
• assessment of the effectiveness of the work of a medical worker.

Whatever criteria the employer evaluates when calculating incentive payments, he must indicate them in the local Regulation on remuneration. At the same time, the minimum allowances within the institution should not be lower than the regional indicators prescribed in the legal acts of the Ministry of Health of the constituent entity of the Russian Federation.

Who develops the criteria for encouraging health workers

Initially, recommendations regarding the calculation of incentive payments and methods for determining their amounts come from the Ministry of Health and Social Development. All medical institutions are guided by them, setting incentive payments in the amount not lower than the minimum amounts specified in the Regulations of the Ministry of Health. The decisions made by the administration of the polyclinic regarding salary increments are recorded in the local Regulations on incentive payments, which should indicate the criteria for evaluating the work of employees, the minimum and maximum amounts of additional payments.

What is union control?

Before approving the Regulations on the appointment of incentive bonuses, higher authorities consult with trade unions. Such a scheme for the adoption of regulations is called a tripartite commission, where employers participate. It is collected every year, that is, medical institutions receive guidance on setting payments also annually. Therefore, local Regulations on incentive payments should be reviewed regularly. The document states:

• criteria for evaluating the performance of employees;
• the procedure for calculating payments (should be divided into payments financed from the FSS budget and from funds received in the course of entrepreneurial activity);
• categories of health workers who may receive additional payments;
• sources of financing of salary supplements (a separate fund should be created in the clinic).

Features of accrual of incentive payments

Situations in which a healthcare worker deserves a financial incentive include:

• high quality of work;
• the presence of achievements in the chosen field of activity;
• positive results of work;
• duration and continuity seniority.

If the length of service and the results of the work can be unambiguously characterized, then evaluate the effectiveness of the implementation official duties and the quality of the work done by quantitative indicators is impossible, and therefore a special technique was developed. In accordance with its provisions, labor efficiency can be assessed by the following indicators:

• non-compliance with the rules of sanitary treatment of premises and equipment;
• the presence of errors and inaccuracies in the compiled documents;
• the presence of patient complaints;
• the number of identified postoperative and other complications;
• the presence of cases of hospitalization carried out out of time;
• the assumption of incorrect and inaccurate diagnoses;
• the number of identified diseases according to the profile of medical activity (at early and late stages of development);
• other indicators.

The decision on the effectiveness of the work of health workers remains with a commission specially created within the medical institution. Based on the results of the assessment of the activities of employees, an assessment Act is drawn up - it becomes the basis for the accrual of incentive payments. If, at the end of the year, there is a surplus in the fund set up for the payment of allowances, the doctors receive an annual bonus.

How do job combinations and substitutions affect health worker incentives?

If the combination of positions is spelled out in the text of the employment contract, it will not be encouraged by incentive payments.

Health workers often work for an absent doctor, but this does not always mean that they will be entitled to a salary supplement. Part-time workers can count on incentive salary bonuses only if the additional activity was registered in statutory order - an employment contract. The same applies to health workers temporarily replacing their colleagues.

Why incentive payments to health workers can be canceled

Who will receive a stimulating bonus to the salary, and who will be left without additional payments, is decided by the administration of the medical institution. At the legislative level, there are no instructions on the mandatory payment of incentive bonuses to health workers. But if the clinic has a Regulation on incentive payments, then there must be a reason for refusing to accrue - violations of labor discipline, lack of positive indicators in work, negligent attitude towards patients, and so on.

If a health worker never receives incentive payments, although he works hard and does not make mistakes, you should contact the accounting department of the enterprise, demand the Order on the basis of which wages were calculated, and look for reasons why allowances are not made. If it turns out that the denials of copayments have no basis, you can file a complaint.

Legislative acts on the topic

	On the types of payments to employees of institutions
Decree of the Government of the Russian Federation of 05.08.2008 No. 583	Approval of the Regulations on the establishment of wage systems for employees of federal budgetary, autonomous and state institutions
	The list of factors for which material incentives rely
Order of the Ministry of Health of the Russian Federation of June 28, 2013 No. 421	List of performance indicators used to address issues of employee incentives

Common Mistakes

Error: The obstetrician-gynecologist demands a stimulating salary increase for the fact that she replaced the absent doctor for a whole month and temporarily performed his duties.

V last years salaries of doctors and the entire system of remuneration of medical workers have changed significantly, which can be associated with the need to motivate employees to provide quality medical care. In turn, the level of salaries of healthcare workers should fully depend on how high-quality medical services they provide to the population.
Government Decree No. 2190-r dated November 26, 2012 provides for a phased change in the system of calculating wages in the public sector, which involves improving the main components of wages - salary, tariff (hourly) rate, as well as additional incentive and compensation payments.

At the same time, the level of salaries of healthcare workers should fully depend on how high-quality medical services they provide to the population.

Salaries of doctors and medical workers in 2016*

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

Most high salaries doctors are predictably recorded in the Nenets, Chukotsky, Yamalo-Nenets, Khanty-Mansiysk - Yugra, autonomous regions; Kamchatka Territory; Magadan, Sakhalin, Tyumen regions; Moscow and the Republic of Sakha (Yakutia).

The lowest salaries of medical workers and doctors: Oryol region, Republic of Mari El, Ulyanovsk region, Republic of Ingushetia, Republic of Adygea, Republic of Dagestan, Kabardino-Balkarian Republic, Karachay-Cherkess Republic, Republic of North Ossetia-Alania, Republic of Kalmykia.

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

Partial wages for medical workers

The salary of a doctor can be formed according to the principle of piecework wages, taking into account some features. In particular, it is necessary to take into account the recommendations of the Ministry of Health of the Russian Federation, as well as the Russian Tripartite Commission (RTC). Generally speaking, the current legislation contains provisions that allow organizations to establish piecework wages, while there are no exceptions for employees of medical institutions. When piecework wages for medical workers, the established price for the work performed is taken into account, while the tariff rate is set for the completed labor norm, and does not include incentive or compensation payments. The fact that these concepts are not equivalent follows from the conclusions of the courts on the basis of the consideration of civil cases. In addition, the order of the Ministry of Health of the Russian Federation No. 377, which contained a direct indication of the possibility of using piece rates to establish the salaries of medical workers, also became invalid. To date, the Ministry of Health of the Russian Federation adheres to the position that the salary of doctors should include: salary, incentive payments, compensation payments and tariff rate. However, if in the hospital there is still a need to establish a piecework form of remuneration for individual employees, then it is necessary to provide for such a form in the local act of the institution - in a collective agreement or other local act. This will not be a violation of current labor laws.

Brigade forms of remuneration

Some hospitals are considering setting up facility-wide pay arrangements, ie where the salary of a particular doctor or other healthcare worker is dependent on the overall performance of a unit, department, or field team.

Today, the system of remuneration of medical workers in ordinary city and district hospitals provides for the calculation of the amount of incentive payments, depending on the specific collective results of the work of hospital employees.

The formula for calculating the optimal average daily load on the ambulance team:

According to the author's method V.M. Shipova and A.N. Plutnitsky, the optimal load on the ambulance team has not been determined, since the flow of calls is random and the frequency of calls is not regulated. But it is possible to calculate the optimal load on the ambulance team. Based on the planned and normative data on providing the population with ambulances and the number of calls, we derive the formula:

318 X 10: 365 = 8.7, where
318 - number of calls per 1000 population;
10.0 thousand - the number of the population;
365 - calendar days of the year;
The indicator 8.7 (9.0) calls is the average daily load on the ambulance team.

The remuneration system in such institutions is fixed in local acts (agreements, collective agreements, regulations, etc.), while taking into account:

• approved classifiers of professions, positions;
• developed medical professional standards;
• opinions of trade unions of medical workers;
• professional communities of employers;
• the volume of state guarantees in the field of wages;
• position of the Russian tripartite commission;
• position of the Ministry of Health of the Russian Federation.

Thus, the joint recommendations of the Ministry of Health of the Russian Federation and the RTK do not provide for the use of a brigade form of remuneration. Previously, the use of the form of brigade wages for medical workers was provided for in the order of the USSR Ministry of Health No. 1180 dated November 10, 1986, but from 2009 it lost its legal force. However, the current legislation does not prohibit taking into account the results of the work of the team to calculate incentive payments to a particular medical worker. Also, the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012 states that specific incentives should be established for medical workers for achieving collective work results.

The ratio of parts of the salary

The Ministry of Health of the Russian Federation has set a limit level for the ratio average salary chief physicians of hospitals and medical workers in the system of healthcare institutions. Thus, in accordance with Order No. 170 dated March 28, 2013, the level of the marginal salary of the head doctor of a hospital is a multiple of 8 salaries of employees of hospitals under the jurisdiction of the Ministry of Health of the Russian Federation. The regulation on the remuneration of employees of the Medical Organization has been developed in accordance with the requirements Labor Code RF and other normative legal acts containing labor law norms.

Salary of medical workers

This section covers all legal features establishing salaries for medical workers, including the rules for applying professional qualification groups, accounting for seniority and the possibility of setting an individual salary for a medical worker.

Setting a personal salary

The salary is a certain amount of remuneration for the work of a health worker, which is established for him for the fulfillment of his professional duties assigned to a particular position. Salary does not include other additional payments. We believe that the establishment of personal salaries for medical workers of state and municipal hospitals is not directly prohibited by labor legislation, although it is not recommended by other norms for the following reasons. In accordance with Art. 22 of the Labor Code of the Russian Federation, a medical institution, as an employer, must provide its employees with the same pay for performing similar work. At the same time, the establishment of different salaries for the same positions is not prohibited, but it seems unjustified. The RTC adopted unified recommendations on the establishment of remuneration for employees of institutions of the state and municipal system dated December 25, 2015, in which it is not recommended to establish different rates and salaries for employees who are included in the same qualification group. It is also not recommended to indicate the range of official salaries for health workers who are engaged in work of the same complexity. However, as law enforcement practice shows, nevertheless, the decision to establish an individual salary is not recognized as labor discrimination if employees occupy the same position, but perform different amounts of work of varying complexity.

How to take into account experience

As a general rule, the length of service of a medical worker does not affect the size of the official salary established for him. As we said before official salary is a fixed monthly payment of an employee who performed his labor duties in the proper amount. Since the remuneration of medical workers does not consist only of the official salary, it is necessary to display their continuous medical experience in other payments, for example, in compensation payments. Such recommendations are established by order of the Ministry of Health and Social Development of the Russian Federation No. 818 dated December 29, 2007.

Application of occupational skill groups

Professional qualification groups(PCG) can be used when establishing base rates and salaries by the Government of the Russian Federation, the salary of medical workers of state and municipal hospitals cannot be lower than the salaries established by the PCG. According to the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, interested executive bodies, together with the Ministry of Labor of the Russian Federation, can develop and submit their specific proposals for the official salaries of the PCG employees. The basis for the formation of the PCG are certain requirements for the level of qualification of employees, which they need to carry out a specific professional activity, because in accordance with labor legislation, the salary of a doctor, like any other employee, depends on his qualifications. Therefore, before the establishment of basic salaries for specific positions by the Government of the Russian Federation, in healthcare institutions, PCGs can be used in the development of systems for remuneration of medical workers. This is also confirmed by the provisions of the Decree of the Government of the Russian Federation No. 583 of 08/05/2008, which states that the salaries of employees are set by the management of the institution based on the requirements for qualifications and work experience in specific position(PCG). This takes into account the volume of work performed by employees and its complexity.

The ratio of the salaries of managers and health workers

The official salaries of medical workers in no way affect the salary of the head doctor of the hospital and the salaries of his deputies. As stated in Art. 145 of the Labor Code of the Russian Federation, the remuneration of the heads of state and municipal institutions is established in accordance with labor legislation, founding documents official, regional and municipal acts. The specific conditions of remuneration of senior officials are reflected in their employment contracts. At the same time, a number of normative acts adopted recommendations on setting the level of remuneration of heads of institutions: recommendations for 2016, approved by the RTC dated 12/25/2015, federal institutions- Decree of the Government of the Russian Federation No. 583 of 05.08.2008. In these documents, it is recommended to establish a salary for the heads of the institution, a multiple of 8 average salaries of all employees of the institution; The decision of the RTC dated December 25, 2015 also recommended that salaries for chief accountants and deputy chief physicians be set at 70-90% of the salaries of hospital managers.

Salary: establishment control

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

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

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

1. Headcount workers

2. Number of attached population, pers.

3. Per capita financing standard, rub.

4. Amount of financing, rub.

5. Report on the expenditure of funds

Chief Physician

Chief Accountant

Compensation payments to medical workers

Indication of compensation payments in the employment contract

Is it possible to prescribe in the employment contract of a health worker that the amount of his compensation payments is established by the legislation of the Russian Federation? In the event that the legislator has established the minimum amount of compensation payments for medical workers, the employer must indicate in the employment contract of the employee in a specific amount or as a percentage of the official salary. Compensation payments to medical workers can be provided for various reasons: for medical experience, for irregular working hours, for work in rural areas, for the presence of a professional category, etc. Labor legislation, as a rule, establishes only the minimum amount of such payments. The employer must establish the specific amounts of compensatory allowances for medical workers by prescribing such sections in the regulation on the remuneration of the hospital. Additional guarantees for employees who work in conditions that deviate from normal must be specified in the employee's employment contract, in accordance with Art. 57 of the Labor Code of the Russian Federation. In addition, the recommendations approved by the order of the Ministry of Health of the Russian Federation No. 167-n dated April 26, 2013, indicate that specific factors and conditions for receiving all compensation payments should be prescribed in the salary regulation, as well as in the employee’s employment contract.

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

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

However, the employer must cancel the previously provided guarantees if the employee's workplace provides safe working conditions, which is confirmed by the conclusion of the state examination or SUT. In connection with the adoption of the new law No. 426 "On SOUT", there is a transition period to new system job evaluations. So, if the hospital carried out certification of workplaces before 07/13/2015, then it will continue to be valid for 5 years. SOUT during this period is not necessary. The medical institution has the right, but is not obliged, to initiate the conduct of the SOUT before the expiration of the certification results.

If the preservation of the working conditions that gave the employer the right to establish compensation payments to its employees is confirmed, then the amount of these additional guarantees cannot be changed in comparison with those payments. which were valid at the beginning of 2014. In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 15, 2014 regarding the application of the new rules of the SOUT, the improvement of working conditions is the reduction of the final class or subclass of working conditions at a particular place of work of an employee. So, if the working conditions of the health worker have improved, which was confirmed in the conclusion of the SOUT, the hospital management may review the amount of compensation that is provided to the employee in harmful working conditions. At the same time, it is necessary to remember the rules for changing the terms of the employment contract between the hospital and the employee, which are detailed in Art. 74 of the Labor Code of the Russian Federation.

Replacing additional leave for harmfulness with monetary compensation

Many employees have a desire to replace part of their annual leave with monetary compensation. Is it possible, from the point of view of the law, to replace the leave provided to an employee for working in harmful working conditions with monetary compensation?

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

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

Accounting for compensation payments when on duty at home

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

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

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

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

Compensation payments: control of establishment

The following government agencies and officials can check the correctness of the establishment of compensation payments to medical workers:

territorial bodies of the labor and employment service, in the course of the state examination of working conditions. It is during such an audit that the inspectors assess the correctness of providing medical workers with the necessary amount of compensation for working with harmful or dangerous working conditions;

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

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

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

Stimulus payments to medical workers

Using the scoring

Medical institutions of the municipal or state system health care providers are not required to use a work performance score to evaluate the performance of their employees. Incentive payment to medical workers should be established in local acts of the hospital, in a collective agreement, industry agreement or other regulations that contain labor standards.

By order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013, guidelines, which states that there are different mechanisms for distributing the incentive fund between employees of a particular institution. Including the introduction of a scoring system, bonuses is acceptable. This means that a particular medical institution can develop and implement its own mechanisms for accruing incentive payments to medical workers, including the right to introduce a points system for distributing payments. To do this, it is necessary to develop appropriate criteria and indicators.

PNP "Health" payments

Payments to medical workers under national project"Health" is established in the regions in accordance with tariff agreements and the terms of the territorial program. Recall that one of the objectives of the program is the financial incentives for medical workers. Should the management of a medical institution keep payments to district doctors and paramedical staff that were previously provided to them under this program? Labor legislation in Art. 135 of the Labor Code of the Russian Federation identifies sources in which additional incentive payments to employees can be established, including the conditions for paying bonuses.

In accordance with the program of state guarantees for 2016, which was approved by Decree of the Government of the Russian Federation No. 1382 dated December 19, 2015, the structure of the tariff provided for paying for the assistance provided to the population in the compulsory medical insurance system includes incentive payments for district doctors, nurses, employees of feldsher and obstetric points, ambulance workers, etc.

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

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

In this regard, we believe that a medical institution should provide that all such payments should be made in the amount that is already included in the tariff for the provision of medical care under the territorial compulsory medical insurance program approved at the regional level.

Conditions under which incentive payments are not made

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

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

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

Reimbursement of medical workers

The issue of applying to medical workers such a sanction as deprecation of bonuses is controversial. It should be noted that according to departmental recommendations, as well as the provisions of the Labor Code of the Russian Federation, in medical institutions it is recommended to provide conditions for the use of incentive bonuses, but not conditions for depriving the employee of the bonus due. In accordance with Government Decree No. 2190-r, measures to improve the system of incentive payments to medical workers are carried out in order to correlate the salary of doctors with the specific results of their work. First of all, the quality of the medical services provided is taken into account, based on what certain incentive payments are applied. The bonus itself is one of the types of incentive payments for medical workers, therefore, the medical institution must establish specific conditions for receiving it. A specific list of disciplinary punishments is contained in Art. 192 of the Labor Code of the Russian Federation, however, such a measure as deprivation of bonuses (deprivation of bonuses) is not contained in the current version of the code. Judicial practice also speaks of this. The courts unequivocally interpret the application of bonus deductions in relation to any employee of the employer as an unreasonable and unenforceable sanction, which is recognized as illegal by the current legislation. In this regard, we recommend that the chief physicians of hospitals avoid the application of such sanctions in relation to medical workers; the local acts of the hospital, all the more, should not contain any conditions for depriving them of bonuses.

Labor standards for incentive payments

When establishing incentive payments to health workers, certain labor standards are used, however, not all of them should be used as criteria for additional payments. In particular, labor standards are inapplicable, which are not directly provided for the purpose of assigning incentive payments and in no way reflect the results of the professional activity of a medical worker and the quality of the medical services provided to him. This is due to the provisions of the Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, which states that all incentive bonuses for employees depend on the quality of their work and professional results achieved, and specific indicators and criteria for their performance should be reflected in the employee’s employment contract on the basis of the developed system of remuneration. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, the specific labor standards of the institution are established by the labor rationing system in the organization. At the same time, different norms and standards can be established in a medical institution: by the number of personnel, by time, by volume, output, etc.

It is inappropriate to use the following norms to determine incentive payments:

1. The norm of the number of health workers. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, this norm is needed, first of all, to determine the number of employees of certain positions that are necessary to perform a certain amount of work or production and other functions. For example, such a norm can be expressed in one medical position per site in accordance with the number of attached population.

2. Standards of time. In accordance with the order of the Ministry of Labor No. 504, they express the specific time spent by a health worker that is necessary for him to provide one service (performance of work). This indicator is primarily used to calculate the norms of the number of employees.

Service standards, in accordance with the order of the Ministry of Labor of the Russian Federation No. 504, are indicators of the number of jobs, equipment, production areas, etc., with which an employee works during a certain unit of working time. Such an indicator can be used to assess the performance of an employee when calculating incentive payments.

An approximate list of indicators for assigning incentive payments for the intensity and effectiveness of work, as well as bonus payments for certain categories of employees, was recommended by the expert group of the information center "ICFER-Medicine".

Medical workers' payroll

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

• cash from budgets of different levels;
• funds from extrabudgetary sources (from CHI funds);
• cash received from income-generating activities.

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

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

The accrual incentive payments depends on the quality and volume of work performed by the hospital, as well as on other conditions described in the regulation on remuneration. It is from these components that the modern differentiated system of remuneration is formed. Thus, the final salary of a doctor directly depends on the quality, complexity and volume of his work, i.e. on the quality of medical services provided to the population.

In order to calculate the incentive part of earnings according to such a system, it is necessary to follow the following order:

• determine how many points each doctor earned during the reporting period;
• sum up all the points earned by the employees of the department;
• determine the part of the wage fund that accounts for incentive payments to employees of the department;
• calculate the cost of one point;
• calculate the incentive part of the employee's salary based on the cost and the amount of points earned.

Based on this, the wage fund of a medical worker is the sum of all payments due to the employee for the month worked, including incentive payments, bonuses, and other regular payments. The salary of a doctor is calculated based on the tariff lists of the hospital, as well as its approved staffing table.

*) includes doctors and employees of medical organizations with a higher medical (pharmaceutical) or other higher education, providing medical services (ensuring the provision of medical services) in educational, scientific, cultural, healthcare, social service institutions.