Medical Overwork as a Systemic Problem

A Shortage Filled by Current Staff

Russia's healthcare system continues to face a shortage of medical personnel, despite the annual graduation of new specialists from universities and colleges. The main burden falls not only on doctors, but also on nurses, paramedics, midwives, and laboratory technicians—specialists without whom clinics simply cannot function properly.

Director of Professional Development at the Russian Nurses Association Yulia Agapova notes that the country continues to experience a shortage of medical workers: the system lacks approximately 23,000 doctors and around 63,000 mid-level specialists.

This situation means that formal staffing levels don't always reflect the actual number of specialists working with patients. Some employees hold multiple positions simultaneously, take on extra shifts, or work at several medical facilities at once.

Medical workers have become leaders in overtime hours. Overtime work by doctors and mid-level medical personnel can account for about 40% of the monthly standard working time. Additionally, 39% of nurses and 38% of doctors work at multiple clinics simultaneously.

This model allows the system to maintain access to medical care, but it also creates additional risks: increased professional burnout, reduced quality of rest for specialists, and a higher likelihood of errors due to fatigue.

According to the chairman of the Healthcare Workers Union of the Russian Federation Anatoly Domnikov, overtime becomes a systemic problem when several factors begin operating simultaneously.

"Medical overtime shifts from a personal choice to a systemic norm when staff shortages, financial pressure, and social expectations all converge at once. An acute shortage of personnel forces management to plug gaps in the schedule using remaining staff, while tying bonuses to overtime hours makes excessive work the only way to earn a higher salary."

The expert points out that the problem is not just about the number of staff, but about the organization of work itself.

"The situation is made worse by a myth deeply rooted in society and the professional community that doctors must 'sacrifice' themselves and their time for patients. As a result, overwork becomes a rigid requirement of the environment itself, turning into a vicious cycle that inevitably leads to mass burnout among specialists and a decline in the quality of all medical care."

Where the line between responsibility and overload lies

In medicine, overwork has a special nature. For many specialists, extra time at work is connected not only with financial motivation, but also with professional responsibility to patients.

President of the All-Russian Public Organization "Society of Doctors of Russia," Academician of the Russian Academy of Sciences Oleg Yanushevich believes that a doctor's willingness to work more is not inherently a negative phenomenon.

"Overwork is always a doctor's choice, and it is never the system's choice. Yes, doctors are empathetic, and those doctors who understand they can help a person never monitor how much time they work—they simply help people," he said.

However, the expert emphasizes that it is the system that must account for the human factor and prevent professional commitment from turning into constant exploitation of specialists' resources.

"On the contrary, the system should limit this empathy, because a doctor's health and time are irreplaceable resources that the system must monitor."

Yulia Agapova notes a similar problem:

"Overwork never ceases to be a personal choice. Legislation protects the interests of workers. No one can force someone to work more than they are willing to. It's another matter that people who come to work in medicine and the healthcare system possess a high level of responsibility to society, which can serve as an additional motivating factor to work beyond a single position."

At the same time, she says, it is precisely the sense of responsibility among medical workers that is gradually becoming a way to compensate for staff shortages.

"Unfortunately, the sense of duty to society and the high level of empathy among nurses, paramedics, midwives, and laboratory technicians is becoming a systemic tool for plugging 'holes' in staffing schedules due to chronic personnel shortages," notes Yulia Agapova.

One reason for the high workload remains the level of pay. For some mid-level medical personnel, extra shifts and moonlighting have become a way to increase income.

According to Rosstat, the average accrued wages for healthcare workers in Russia remain below the level of many industries with comparable qualifications. In 2025, the average accrued wages for workers in healthcare and social services exceeded 81,000 rubles per month.

The result is what's known as a hidden deficit: specialists are registered in the system, but in reality their working time is spread across multiple positions.

"A hidden deficit is a situation where a medical organization's website shows no vacancies and the staffing schedule is fully filled, but there are fewer actual people than occupied positions. For example, when a specialist works one and a half positions to cover staff shortages or ensure an acceptable salary."

Private clinics as competitors for staff: money is no longer the only factor

The staffing situation in healthcare is developing not only within the state system. Private clinics are increasingly competing for medical specialists, offering a different work format: narrower specialization, less administrative burden, and a different approach to organizing patient appointments.

However, experts note that the choice of workplace for medical professionals has long ceased to be determined exclusively by income level. According to Oleg Yanushevich, the difference in salaries between the public and private sectors is often not the deciding factor.

"Today private clinics are a system, exactly the same as the state system. If we conduct an analysis, salary levels will be comparable. Yes, there will be a 10-15% difference, which can easily be offset through other forms of motivation."

According to him, specialists are increasingly paying attention to the conditions in which they will work. At the same time, the state system retains advantages related to the scale of work and professional experience. In state medical organizations, specialists gain access to a larger patient flow, complex clinical cases, and broad practice.

Yulia Agapova believes that it is the professional environment that remains one of the strong arguments in favor of working in state institutions.

"If we're talking in positive terms, the main advantage is experience. Private clinics cannot provide the same clinical exposure, the same clinical diversity as medical organizations working primarily within the compulsory health insurance system."

According to her, social guarantees also play an important role.

"We shouldn't forget about stability, guaranteed social benefits, and pension privileges. Targeted support programs are also actively developing: for example, payments under the 'Zemsky Doctor' and 'Zemsky Paramedic' programs."

Support programs for young specialists and workers in rural areas remain one of the main tools for attracting personnel. Under the federal "Zemsky Doctor/Zemsky Paramedic" program, physicians and mid-level specialists can receive lump-sum payments when relocating to work in small settlements.

However, financial measures alone are not enough. Experts agree that retaining specialists requires changing the work environment itself.

Salary matters, but doctors choose attitude and prospects

The issue of staffing shortages in healthcare is gradually shifting from a simple lack of people to the problem of retaining specialists. Even with an increase in the number of medical school and college graduates, the system faces the fact that some workers change their field of activity, move to the private sector, or reduce their workload.

According to data from Russia's Ministry of Health, the number of graduates from medical educational institutions increases annually. In 2025, Russian medical universities graduated nearly 78,000 young specialists, while medical and pharmaceutical colleges produced nearly 128,000 graduates. However, training a new specialist takes years, and the effect of educational programs does not manifest immediately.

Health Minister Mikhail Murashko previously stated that the ministry plans to close the doctor shortage by 95% by 2030. To achieve this, authorities are betting not only on increasing admissions to medical universities, but also on developing a targeted training system, supporting young specialists, and increasing the attractiveness of the profession.

At the same time, representatives of the professional community believe that keeping people in the profession is impossible through financial instruments alone.

"Doctors can only be retained in the healthcare system through one thing: the awareness that they are needed by this system. And when a doctor feels that they are being cared for, that they are a vital part of a serious professional team, that they are changing people's lives for the better, they are ready to dedicate themselves to both patients and their work," believes Oleg Yanushevich.

According to him, professional motivation remains one of the key factors in choosing a medical career.

"This is far more valuable than any salary. Money is certainly important, because we all live in a world where money doesn't determine everything, of course, but it determines a great deal. But for a doctor, understanding that people need them is critically important," the academician says.

However, experts emphasize that the idea of vocation cannot be used as a substitute for normal working conditions. The medical system needs to change processes that create additional burdens on staff.

One such area is reducing bureaucracy. Medical professionals are forced to spend a significant portion of their working time not on treating patients, but on filling out paperwork and completing administrative procedures. According to Anatoly Domnikov, it's precisely organizational changes that could significantly reduce the burden.

"Doctors need modern equipment and technological support: implementing artificial intelligence to analyze tests can speed up diagnosis and protect against errors. Combined with a decisive reduction in paper bureaucracy, this allows medical professionals to focus entirely on treating patients," the union chairman notes.

Yulia Agapova takes a similar position, speaking about the need to change working conditions for mid-level medical personnel.

"Second, reducing the bureaucratic burden—simplifying documentation, implementing convenient digital tools," she notes.

According to her, specialists need not only financial motivation, but also clear professional prospects.

Hidden shortage: when positions are filled but there's no one to see patients

One of the most complex problems in Russian healthcare remains the gap between formal statistics and the actual availability of medical care. In some institutions, there may be no vacancies, the staffing table may appear completely filled, but the workload on individual employees remains excessive.

Experts call this gap a hidden shortage. According to Anatoly Domnikov, the problem is that having a position on paper doesn't yet mean having available capacity for patients.

"A hidden shortage in healthcare arises when a medical institution's staffing table is filled, but patients' actual access to specialists is reduced to a minimum."

One cause is the administrative overload of doctors.

"Medical professionals are forced to spend a significant portion of their working hours on reporting, filling out paperwork, and complying with organizational regulations. This reduces appointment hours and minimizes the time allocated for direct patient care."

Another factor is the shortage of mid-level specialists.

"The deficit of nurses and laboratory technicians forces doctors to take on their functions—from preparing examination rooms to performing technical procedures. As a result, qualified specialists spend their resources on tasks outside their core competencies," says Anatoly Domnikov.

In Moscow, authorities claim the workload situation is under control. The capital's health department notes that the city's system is working to create comfortable conditions for specialists, including developing educational programs, professional development, and implementing digital solutions.

The department also emphasizes that additional workload on employees is compensated and carried out within the framework of legislation.

"Furthermore, it's important to note that thanks to the 'My Administrator' project, which is being implemented in municipal medical organizations, all non-medical issues (administrative, logistical, informational, etc.) are handled by special administrators. This allows doctors to be relieved of non-core duties and frees up more time for direct patient care," the press service reported of the Moscow Department of Health.

Digitalization as a way to reduce workload, not replace specialists

Authorities and market participants cite the development of digital technologies as one solution to the personnel problem in healthcare. This primarily involves tools that can take over some routine operations: processing medical documentation, analyzing research data, assisting with patient routing, and preparing information for physicians.

At the same time, experts emphasize that technology is not a replacement for medical workers. Its purpose is to free up specialists' time for direct patient care.

In recent years, the state has been actively developing digital healthcare infrastructure. Under the federal project "Creating a Unified Digital Framework in Healthcare Based on the Unified State Information System in Healthcare" (EGISZ), medical organizations are transitioning to electronic document management, developing electronic medical records, and data exchange services.

Yet digitalization by itself doesn't solve the problem if staff shortages and high work intensity persist. 

The union believes that technology should be part of a broader reform of work organization.

"Actually retaining doctors in the system requires a fundamental restructuring of the work environment, starting with modernizing working conditions," says Anatoly Domnikov.

According to him, an important direction is not only implementing new tools, but also redistributing responsibilities within medical teams.

"Reducing psycho-emotional pressure is helped by optimizing schedules, regulating patient flow, and developing teamwork. Creating multidisciplinary teams, where specialists from different fields manage a patient together, effectively distributes the workload, ensures knowledge sharing, and lifts from the doctor the burden of sole responsibility for complex clinical decisions," notes the union chairman.

This approach is gradually becoming one of the key directions in healthcare development: instead of a model where one specialist is responsible for the broadest possible range of tasks, the system is trying to shift toward a more team-based organization of care.

Burnout as a consequence of more than just workload

The problem of overwork is directly linked to the issue of professional burnout among medical workers. However, experts assess the causes of this phenomenon differently. Oleg Yanushevich believes that the very concept of burnout cannot be viewed solely through the lens of working hours.

"Emotional burnout, in my view, is a somewhat mystified topic. Let me explain. Obviously, any person in any profession gets tired. From monotony, routine, and so on."

In the academician's opinion, a specialist's sense of being needed is of great importance.

"My formula over the years is this: the greater a doctor's demand, the less emotional burnout. When a doctor isn't busy or when he feels, for whatever reason, a careless, disrespectful attitude toward himself, that causes more burnout than the work itself."

At the same time, union representatives believe that constantly working under increased workload creates systemic risks.

"Overwork is becoming a harsh requirement of the environment itself, turning into a vicious cycle that inevitably leads to mass burnout among specialists and a decline in the quality of all medical care," says Anatoly Domnikov.

For mid-level medical personnel, the problem is especially acute. Nurses, paramedics, and midwives are often on the front lines of patient interaction while simultaneously handling a large number of practical and organizational tasks.

Yulia Agapova notes that retaining these specialists requires a comprehensive approach. According to her, not only salaries matter, but also opportunities for professional development.

"Investment in professional development: access to current training programs that allow them to acquire necessary competencies. And not just a certificate of course completion," says the Director of Professional Development at the Russian Nurses Association.

Another factor is the quality of the work environment.

"Creating a comfortable work environment: prevention of professional and emotional burnout, modern equipment, adequate resources, support from colleagues and administration, development of corporate culture," the expert notes.

What needs to change to close the staffing gap

The staffing issue in healthcare cannot be solved with a single tool. Increasing the number of medical school and college graduates takes time, while specialists already working in the system need conditions that will allow them to stay in the profession.

Russia's Ministry of Health is betting on a set of measures: increasing targeted training, developing support programs for young specialists, modernizing primary care, and making work in the regions more attractive.

Ministry head Mikhail Murashko has stated that by 2030, the plan is to close the physician deficit by 95%.

However, experts believe that in parallel, the operating model of medical organizations itself needs to change.

One direction is reducing the administrative burden, which takes up a significant portion of specialists' working time. The second is creating clear career paths. The third is developing an employee support system.

Yulia Agapova points out that it's especially important to change attitudes toward mid-level specialists, who have long remained a less visible part of personnel policy.

"There must be a clear and understandable correlation: level of education-level of responsibility-position-salary level," she notes.

According to her, nurses, paramedics, and other specialists need to understand that professional advancement within their field is possible.

Anatoly Domnikov also speaks about the importance of professional prospects.

"A predictable professional future is also becoming an important incentive. The system needs clear career advancement trajectories, opportunities for professional development, and participation in conferences," he notes.

Beyond professional development, social guarantees matter as well.

"Housing rental compensation, utility payment coverage, as well as reliable support mechanisms in case of illness or injury give medical workers a basic sense of security," says the union head.