Future doctors divided over new mandatory service rules
Starting March 1, medical university graduates will be required to work for one to three years in a state hospital under the supervision of an experienced mentor. These amendments to the legislation were approved by Vladimir Putin. Future medics from Arkhangelsk have spoken out about the new system. Their opinions are divided: some believe the mandatory service will scare off young specialists, while others call the changes a formality.
«Everyone is already cutting their teeth in state hospitals»
Vladislav, a student at the Northern State Medical University (name changed), believes that almost nothing will change for young medics.
«No one is waiting for students in private clinics right after university. Most often, those who go there are already known and will bring their own patients. 90% of young doctors go to state hospitals anyway to gain experience, learn something real, and only then, with experience and a reputation, do they go to private practice. In theory, only doctors from, say, Krasnodar or Dagestan suffer from the new rules, where state clinics are in trouble and everyone works in private practice right away.»
According to Vladislav, the law does not deprive specialists in the Arkhangelsk region of the opportunity to work in private clinics.
«Medics are not being forcibly sent to work in villages. No, it«s simply within the Compulsory Medical Insurance (CMI) system. And, by the way, some private clinics work with the CMI system, and you can also complete your service there.»
The future doctor believes the new rules sound scary but shouldn«t cause major inconvenience.
«The mandatory service can be interrupted. It needs to be completed within four years after graduating from university. If you want to have a baby—go ahead calmly. At the same time, no one sets the rate of the position. The law says: «This must be the main place of work,» but the number of positions is not set. That means you can go for a 0.5 rate and not stress about it.»
The service term, the student says, is not long.
«Almost everyone will serve two years in a city or one year in a village. There are few specialties that require three mandatory years in a state institution—only 5 or 6. But in Kuban and the Caucasus, there will be more doctors in the CMI system, which is great for the region… but not great for the doctors in that region.»
Vladislav is doubtful about the new mentorship system.
«I have a feeling this is a way to launder money through «mentors.» Right now, it looks like an ephemeral position without real, clearly defined duties, but with a bonus. It«s funny that they can mentor young doctors online… I don»t understand how you can teach practical skills online. I, for one, plan to squeeze every last drop out of my «mentor» with the words «you»re being paid for me«.»
«Fewer people will want to work in medicine»
Alexey, a first-year student at the Northern State Medical University (name changed), believes that mandatory service was already obligatory for most young medics.
«Voluntary-compulsory service has existed for about 10 years, they just compelled it differently. Medical education consists of a specialist degree and residency (6 years + 2 years), and absolutely everyone wants to get into residency because without it, a medical education is pointless: you can only work as a therapist, and with a lower salary than a resident. It«s in residency that you get specialties: »surgeon,« »cardiologist,« »psychiatrist«.»
Universities have a system of points for individual achievements. The number of points influences whether a student is accepted into residency or not.
«And for signing a «targeted» agreement, that is, an obligation to work in a state institution, they now give a bunch of points for residency, and this is essentially the only normal way to get in. Getting into residency without a targeted agreement is only possible if you graduate with a red diploma (honors), and that«s unrealistically difficult. You can study on a paid basis, but there are very few spots, and tuition costs from half a million rubles (approx. $5,500 at current rates) a year.»
According to the student, it is still possible to enter residency without a targeted agreement or an honors diploma, but to do so, after the specialist degree, you need to work in a state hospital for three years. However, the salary for a specialist will be lower than a resident«s salary.
Alexey believes the new rules will significantly change the established points system. Academic achievements will become the main criterion for admission to residency, and this could deter young specialists.
«It seems to me this innovation will reduce the number of people who want to work in medicine. If everyone becomes, essentially, state-sponsored trainees, there«s no guarantee you»ll get into residency. You«ll have to apply based on achievements and studies as before, and such points are much harder to get.»
«Studying medicine is very hard, and if there«s no targeted program, there will be far fewer people who want to become doctors.»
«The level of medicine will fall»
Yevgenia (name changed) completed her residency last year. She also believes the new rules will make life harder for young specialists.
«This law doesn«t affect me anymore, but there»s still been a lot of news about it. It«s very upsetting that another tightening specifically targets medics. People far from medicine mostly think it»s right to force doctors to work in the public sector, since their education is paid for by taxes. But the fact that other professions—lawyers, journalists, economists, and others—are paid from exactly the same budget, unfortunately, doesn«t concern anyone.»
«It would be great if the staff shortage issue were solved in other ways: equip hospitals with modern equipment, ensure legal order between medical staff and patients (doctors don«t feel safe due to cases of patient attacks), raise salaries.»
The doctor believes that mandatory service may increase the number of doctors in state hospitals, but only for a short time.
«I think that for the next 5–10 years, the number of medical staff in hospitals will increase, and then there will be a decline along with a drop in the level of medicine.»
«There are people who by their 6th year understand this job isn«t for them, there are those planning to go into related professions, there are specialists whom private clinics are ready to hire immediately on good terms. Now they won»t have the opportunity to leave, and the system is set up so that during these three years it will make a person hate their job, and the salary isn«t good enough to make them stay.»
Yevgenia believes the new conditions could also deter applicants from the profession.
«Perhaps some truly smart kids will reconsider applying to medical universities: eight years of study, and then two or three years of service with not the highest salary. Their spots will either be taken by less capable students, or they will remain empty altogether.»
What exactly does the new law change?
We previously reported on what exactly the new law changes. It has many nuances, and the service conditions are still being clarified. For example, it will be possible to work in a private clinic that provides some services under the CMI system. And you don«t have to serve the entire term in one hospital. A graduate from a paid or state-funded program will be able to choose a medical institution themselves, but only from the list provided by the Ministry of Health. Students in targeted training programs will not be able to choose their workplace independently, but they will not need to undergo mentorship, as they will already be working in state medicine.
Also among the innovations: residency programs will now effectively have no state-funded spots; they will all be targeted. Residency is needed for a doctor to obtain a narrow specialization, such as surgeon, otolaryngologist, or urologist. The changes will take effect starting March 1, 2026. The State Duma explained these amendments by a staff shortage in state clinics and hospitals.
There is still no specifics regarding self-funded students, but so far, no one has relieved them of the obligation to undergo mentorship. Sergey Leonov, Chairman of the Health Protection Committee, stated that the mentorship mechanism in practice is neither distribution nor mandatory service.
