Medical experts discussed the pros and cons of private medical practice

Now many doctors, for example, having retired, continue to help their patients, remaining in the shadows. Active young doctors maintain medical blogs, while offering medical assistance and recruiting patients from among subscribers. That is, in fact, there is a private medical practice in Russia. Such specialists do not have the status of an individual entrepreneur, it is impossible to obtain a license, to organize a private office for receiving patients, too, Marina Bludyan, public ombudsman for protecting the rights of entrepreneurs using special tax regimes, said at the round table.

As a result, doctors take a serious risk: medical activity without a license falls under a criminal article punishable by a fine (up to 120,000 rubles) and even imprisonment for up to three years.

At the same time, the legalization of private medical practice would be beneficial for both the doctors themselves and their patients. "What's the difference between an injection given by a sole proprietor or self-employed, assuming the same education, skills and benefits? Why can't an individual get a license, work "in the white" and pay taxes?" - Natalya Ryabova, deputy head of the commissioner's legal expert service, said during the discussion. The head of the tax policy department of the Russian Ministry of Finance, Danil Volkov, in turn, noted that his department “conceptually does not object” to the possibility of issuing licenses to the self-employed, but only if the relevant departments, primarily the Ministry of Health, give the go-ahead.

“The issuance of licenses to the self-employed is, to some extent, the return of old traditions. The state form of medicine appeared only in the 20th century. So all these are evolutionary processes that have the right to life,” the co-chairman of the All-Russian Union of Patients, Doctor of Medical Sciences, told RG Yan Vlasov - Our doctor is an assistant to the state in realizing the right of a citizen to receive medical services, but his salary is insufficient for a normal life: more than half of the doctors are forced to work for 1.5 wages, and every third - for more than two wages. that many go into private medicine. But if we allow this type of activity, it is necessary to think about the observance of the principles of continuing medical education by private practitioners and how to confirm their qualifications.

Approximately the same point of view was expressed by "RG" and a member of the Public Council for the Protection of Patients' Rights under Roszdravnadzor, Doctor of Medical Sciences Alexei Starchenko. In his opinion, doctors working in a medical institution are always in a subordinate position and are forced to follow all the orders of their superiors.

Some people are happy with this, but many, especially when it comes to high-level professionals, would like to get more independence. Independent practice (provided that a clear and transparent licensing procedure is adopted) will give them this opportunity.

This is true, the private doctor confirmed to RG. “I worked in several state medical institutions and changed several private clinics. In the polyclinic, most of the working time is spent working with documents, patients go in a stream, so that the patient himself, if you follow the appointment schedule, could not pay as much attention as needed. When left state medicine, this problem has disappeared - in private clinics, the reception network is much more spacious. But there are other difficulties. In almost all the clinics where I worked, we were required to prescribe as many studies to patients as possible, of course, for an additional fee - even those , which could be perfectly dispensed with. The words "revenue plan" were pronounced at every planning meeting. and they didn’t fire me just because I fulfilled the revenue plan without unnecessary appointments - simply because patients came to me and I always had a full record. Now I'm retired. But many of my patients are still being treated by me - I consult by phone, if necessary, I come to the house, ”the general practitioner, a cardiologist, told RG on condition of anonymity.

Many patients dream of "their" doctor. There is a demand. This is indirectly evidenced by the fact that network medical laboratories are also opening rooms in their offices where patients are received by doctors of various specialties. But how to ensure control over the work of "private traders"?

“There are always risks in medical activity, regardless of the organizational form of the doctor’s work,” said the head physician of Invitro-Moscow, Doctor of Medical Sciences Sergey Khomyakov. “A doctor who has a license not for an office, but for himself, bears much greater responsibility, consumers will make higher demands on it, which is a plus, in my opinion."

If medical private practice becomes legal, it could create competition for commercial medical institutions. Will the patient benefit as a result? According to Olga Shuppo, scientific director of the network of immunorehabilitation and preventive medicine clinics Grand Clinic, such a decision may result in a decrease in the quality of medical care.

“I am categorically against the decision to issue a license to the self-employed to carry out medical activities,” Olga Shuppo told RG. “It is clear that the state aims to replenish the budget with taxes from the income of the self-employed. But as far as medicine is concerned, such a decision is likely to of the services provided.If you wish, you can buy licenses, now there are all possibilities for organizing work privately.You can’t buy only the level of professionalism and responsibility that exists in private and public medical institutions, the training of doctors, the drugs used, as well as the quality of patient routing, control of appointments, processing feedback".

Nevertheless, it is no secret to anyone that doctors of many specialties earn extra money privately. Many cosmetologists, masseurs 1-2 days a week conduct an appointment at the clinic, and on other days - at home. “Some even buy equipment for hardware cosmetology for such work. In this case, it is not necessary to talk about the quality of the service, as well as protecting the rights of patients,” says Olga Shuppo.

“Doctors of far from all specialties need to switch to self-employment and complete freedom,” said Ekaterina Kuzina, medical director of “MK Doctor Nearby”, Ekaterina Kuzina, in a conversation with RG. “Working in a clinic, a doctor understands that his responsibility is protected. And this is not Considering other advantages of working in a large medical institution - improving education, access to new knowledge and technologies, social protection. It is no less important now to move towards providing greater freedom for doctors in providing consulting services in the telemedicine format. This will increase the availability of medical services, consultations of highly specialized doctors for remote areas - will help solve key health problems".

According to Sergei Khomyakov, everything will depend on the changes that will be made to the legislation. “Today, the district principle of providing medical care is working, within the framework of which home visits by a doctor are possible. A general practitioner and a pediatrician may well combine work in the office and at home. Doctors in many narrow specialties simply cannot provide assistance at home, because for medical manipulations require special conditions of sterility, complex equipment, etc.," the expert noted.

Nevertheless, today there is a basis for high-quality medical work even outside the walls of a medical institution - most of the necessary analyzes and instrumental studies can be performed using the services of network medical laboratories and private diagnostic centers.

At the same time, the key question is: how to control the quality of work of a private practitioner and his professional growth?

“Abroad, a doctor receives permission to open a private practice after several years of work in a state clinic. To do this, he undergoes advanced training, a commission that determines his readiness for private practice,” notes Yan Vlasov.

Perhaps, the expert believes, we should follow the same path: to provide continuous medical education, to develop the institution of SROs (self-regulatory organizations) in medicine, when a competent commission evaluates the qualifications of a doctor and the possibility of opening a private practice.

"A doctor studies all his life, this should be his personal responsibility. The more qualified a doctor, the more patients he has, the more his income, respectively. Abroad, there is already a good practice of monitoring the activities of a doctor through associations of specialists. received due development, but with changes in legislation and licensing not of the premises, but of the doctor, an increase in the activity of medical associations is quite likely," Sergei Khomyakov concluded.