Scientific Justification of the System for Providing Medical Personnel for Regional Healthcare under Contemporary Socio-Economic Conditions (on the Example of Khabarovsk Krai)

The dissertation is devoted to the problem of providing medical personnel for regional healthcare under conditions of socio-economic transformation. The research was conducted on the example of Khabarovsk Krai — a subject of the Far Eastern Federal District with a vast territory and low population density, where the issue of geographical disparity in the distribution of medical personnel between urban and rural territories is acute.

The work covers the analysis of personnel policy in healthcare, the dynamics of medical personnel provision during the period of reforms, demographic and migration processes in the region, the state of the network of healthcare institutions, as well as the results of sociological research of physicians and graduates of a medical university. On the basis of a comprehensive analysis, the author developed an organizational and managerial model for medical personnel provision, including predictive models of the number of personnel and a system of measures for attracting and retaining specialists in remote areas.

Relevance of the research. The concept of the development of healthcare and medical science in the Russian Federation envisages the adaptation of the healthcare sector to the conditions of market relations, the reorganization of the economic base, and the rational use of all types of resources in order to achieve the goals of population health protection (Shchepin O.P., 1999, 2001; Shevchenko Yu.M., 2000; Denisov I.N., 2000; Kucherenko V.Z., 2001 et al.).

Medical personnel constitutes the most significant part of healthcare resources and ultimately ensures the productivity and effectiveness of the sector's activities; therefore, the most important condition for improving the system of population health protection and enhancing the quality of medical care is the scientifically grounded resolution of issues and problems related to medical personnel (Kuzmenko M.M., 1996).

The excessive concentration of medical workers in cities and their shortage in remote areas and rural localities (Shchepin O.P., Filatov V.B., 1998) is one of the most pressing problems of the healthcare system. This problem is particularly acute for the Far Eastern region and, in particular, Khabarovsk Krai, with their vast territory and low population density. Work in remote areas and rural localities is unattractive to physicians due to the underdeveloped service sector, poor social and living conditions, inadequate communications, and isolation from the medical environment. Therefore, when planning personnel provision for the healthcare system of the subjects of the Far Eastern Federal District, greater attention must be given to the issue of eliminating the geographical disparity in the distribution of medical personnel.

The shortage of personnel providing primary healthcare and the surplus of narrow-specialist physicians (Shchepin O.P. et al., 1998) is a problem characteristic of the healthcare systems of many countries of the world. Such an imbalance leads to low accessibility of primary healthcare, although up to 80% of patients receive medical care at this stage.

Another problem of contemporary healthcare is the imbalance in the ratio of physicians to mid-level medical workers (Shchepin O.P., 1999, 2000; Vyalkov A.I., 2000; Perfilyeva G.M., 2000). In major cities of the Far East, krai and oblast centers such as Khabarovsk, a situation has emerged in which an increase in the number of physicians is accompanied by a negative growth rate in the number of mid-level medical workers. In remote areas and rural localities, the opposite picture is observed: the number of physicians is declining, as there is no influx of young specialists, and against this background the situation with nursing personnel appears more stable.

In recent years, migration of medical workers out of the sector has intensified in Russian healthcare, and the share of older age groups in the workforce has increased (Eremina Z.I., 1997). According to the literature, the main reasons for the departure of specialists, predominantly of young age, from the sector are: seeking higher wages, better social and living conditions, and a decline in the prestige of the medical profession in society (Shchepin O.P., Filatov V.B., 1998).

At the same time, the share of physicians of retirement age who continue to work due to the low level of pension provision is high. In remote areas and rural localities, they constitute the main workforce of the sector. If this trend persists, in the coming 10–15 years, healthcare in these territories will face an acute shortage of personnel, and possibly even their complete absence.

Problems of medical personnel characteristic of the Russian healthcare system also include low efficiency of their utilization, deficiencies in the system of advanced training and control, low wages, and, as a consequence, an unsatisfactory socio-economic position of medical workers, a low level of motivation, and a number of other problems.

The implementation of healthcare reform required the adoption of effective measures to form and implement a personnel policy that, taking into account the ongoing transformations in the country and the sector, would make it possible not only to preserve the existing personnel potential but also to qualitatively transform and adapt it to new conditions. Healthcare personnel accounts for approximately 60–70% of all operating expenses of the sector; therefore, the management of workforce development is recognized worldwide as a priority task in healthcare management.

This problem acquires special significance at the regional level, since a unified conceptual approach to the formation of a system for providing medical personnel and personnel policy in healthcare cannot account for the existing differences in economic development, social, medical-demographic, and climate-geographic conditions that have been established in the remote territories of Russia, such as the Far East.

It appears relevant to conduct a comprehensive study of the system for providing medical personnel at the regional level under contemporary socio-economic conditions, and this determined the topic of this work.

The goal of the research was to develop and scientifically justify measures aimed at ensuring the healthcare of the region with medical personnel under contemporary socio-economic conditions, attracting and retaining specialists in healthcare institutions of remote northern districts and rural localities (on the example of Khabarovsk Krai).

The tasks of the research included:

- justifying the regional features and determining the main trends in healthcare personnel provision in the region during socio-economic reforms;

- studying the opinions of physicians on the state of the healthcare system in the region, the main directions of sector reform, the personnel situation, and determining the social well-being and motivation of specialists;

- determining the prospects for personnel provision of the regional healthcare system taking into account the professional intentions of graduates of Far Eastern State Medical University (based on sociological survey data of students); developing and scientifically justifying the necessary structural-functional and organizational measures aimed at attracting and retaining medical personnel in healthcare institutions of remote northern and rural districts of the krai; forming a prospective organizational and managerial model for healthcare personnel provision in the regional healthcare system.

The scientific novelty of the research lies in the fact that: for the first time, on the example of a separate subject of the Far Eastern Federal District, a comprehensive scientific analysis was conducted of the state of medical personnel provision in healthcare institutions in interrelation with the ongoing structural transformations in the sector, socio-economic development of the territory, and the demographic situation; a forecast of the situation's development up to 2012 was modeled; the comprehensive sociological survey of physicians and graduates of Far Eastern State Medical University made it possible to study the attitude of specialists to the reforms being carried out, to questions of personnel policy, to evaluate the quality of the working environment, the satisfaction of physicians with their work, and to determine the professional motivations of students; and on the basis of the material obtained, a number of recommendations were developed for the leaders of healthcare management bodies at the regional and municipal levels, aimed at improving medical personnel provision in subordinate institutions; an organizational model was developed for providing the region with medical personnel, aimed at more effective management of personnel resources taking into account the specifics of the healthcare system of the territory.

The practical significance is determined by the results of the comprehensive research, the program and methodology of which made it possible to study the situation with medical personnel, determine the forecast for the development of the situation, form an organizational and managerial model, and develop practical recommendations aimed at improving the situation with medical personnel provision in the healthcare institutions of the region. The results of the research and the recommendations developed on their basis were used by the Department for Coordination of Organizational and Methodological Interaction in the Far Eastern Federal District on Healthcare Issues in preparing the Coordination Council on Healthcare and the Coordination Council on Postgraduate and Additional Professional Education of Healthcare Specialists in the Far Eastern Federal District, as well as in the annual report to the President of the Russian Federation "State of Health of the Population and Healthcare Resources of the Far Eastern Federal District."

The materials of the dissertation research are included in the program of practical classes for listeners of advanced training and professional development cycles at the Department of Public Health and Healthcare of Far Eastern State Medical University.

The main provisions put forward for defense are: the specifics of medical personnel provision are formed under the influence of socio-economic and demographic characteristics of the administrative-territorial entities of the region; dissatisfaction of physicians with working conditions, the level of wages, and the decline in the prestige of the medical profession in society lead to the outflow of qualified specialists, predominantly of young age, from the sector; the career plans of medical university graduates regarding their professional future do not correspond to the needs of the regional healthcare system; the existing measures aimed at attracting and retaining medical personnel in healthcare institutions of remote northern and rural districts of the region are carried out without taking into account the needs and motivations of specialists and do not achieve the stated goal; the implementation of an organizational and managerial model for medical personnel provision in the regional healthcare system under contemporary socio-economic conditions will improve the situation with physicians in the region's healthcare institutions.

Verification of the work and publications: The materials of the research were reported and discussed at: the regional educational-methodological conference dedicated to the 50th anniversary of the preparatory department and the 70th anniversary of Far Eastern State Medical University (Khabarovsk, 2000); the IX Congress of Pediatricians of Russia (Moscow, 2001); the 58th final scientific conference of students and young scientists "Current Issues of Modern Medicine" (Khabarovsk, 2001); the interregional scientific-practical conference dedicated to the 100th anniversary of the completion of the construction of the Trans-Siberian Railway "Governmental Healthcare: Problems and Prospects" (Khabarovsk, 2001), the scientific-practical conference "Population Health, Policy, and Technologies of Healthcare Development" (Moscow, 2003), the joint meeting of the Department of Public Health and Healthcare and the Department of Hygiene of Far Eastern State Medical University with the participation of leaders of regional healthcare institutions. Based on the results of the research, 8 printed works have been published.

Scope and structure of the work. The dissertation consists of an introduction, 6 chapters, a conclusion, findings, recommendations, a list of references including 269 sources, of which 194 are domestic and 75 are foreign, and appendices. The work is presented in 136 pages of the main text, contains 13 tables, 14 figures, and 55 appendices.