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Cite as: Archiv EuroMedica. 2022. 12; 4: e1. DOI 10.35630/2199-885X/2022/12/4.1
, Tatiana Sorokovikova , 
, Lydia Pototskaya , , Sergey Zhukov , RELEVANCE: The human resources policy is one of the leading social and economic sectors of society. There is a vast shortage in health professionals on a global scale. This problem is aggravated every year. That’s why it is so relevant now. Public health facilities are affected most of all. They have to compete with private clinics, which provide more favorable working conditions for specialists. The health system needs qualified personnel. The global shortage of doctors due also to “optimisation” processes that have been recognized as ineffective.
The human resources policy of health care is aimed primarily to increase the number of medical personnel. The state population's health depends on it. In this regard, the problem of staffing in health care is an important area of analysis.
PURPOSE: To analyze employment data in public health facilities in the city of Tver and to evaluate the trends in staff turnover rates.
MATERIALS. The data from official reports of polyclinics No. 1, No. 2, No. 3 of City Clinical Hospital No. 7 in Tver (Russia) was analyzed. The assessment was carried out for the period from 2011 to 2020 by comparing three time periods: 2011-2014, 2015-2017, 2018-2020. In the course of its work, mathematical calculations on the validity of the investigated data were made.
RESULTS. The analysis of data from polyclinic No. 1 shows a decrease in the percentage of employment among doctors by 38% (p=0.197) and among nurses by 17.5% (p=0.559). The employment of paramedical staff did not change and remained below 50% throughout the decade. There is a clear shortage of outpatient personnel.
The indicators of polyclinic No. 2 indicate a stable positive dynamics of staff employment in the field. However, nursing and paramedical personnel require an increase in involvement in the specialty, because there are a large number of free positions.
The indicators of polyclinic No. 3 have not changed for 10 years. This polyclinic has a minimum number of rates for the work of medical personnel. It may be due to the peculiarities of the territorial location of this medical institution.
CONCLUSION: A decrease in the percentage of staff employment was noted in the polyclinics of the City Clinical Hospital No. 7 for the period 2011-2020 for various reasons. In general, the decrease in indicators was observed among doctors. The grounds for termination of employment may be: the remoteness of the workplace, low wages, high professional loads, including the additional work. It is necessary to develop the right strategy to compensate for the vacant positions of specialists. One of the main reference points can be monitoring the employment of hospital staff. This issue remains relevant in the regions of the Russian Federation.
KEYWORDS: doctors, medical staff, outpatient clinic, shortage of staff
The human resources policy is one of the leading social and economic sectors of society. There is a vast shortage in health professionals. This problem grows every year. That’s why it is so relevant now. Public health facilities are affected most of all. They have to compete with private clinics, which provide more favourable working conditions for specialists. The health system needs qualified personnel. The global shortage of doctors due also to “optimization” processes that have been recognised as ineffective [1].
At present, there are some relevant problems in the management of human resources for health. They are the discrepancy between the size and structure of personnel and the volume of activities, tasks and areas of health reform; the inadequate legal and regulatory framework; the inadequacy between the training of professionals and the needs of practical health care and the tasks of restructuring industry; lack of evidence-based medical workforce planning; imbalance in the composition of medical staff between general practitioners and narrow specialists, doctors and paramedical workers; insufficient social protection of health workers and low wages, which do not contribute to attracting and retaining specialists in the industry, increasing the trend of outflow of young professionals; low level of participation in personnel matters of professional public organisations. The solution of these problems is the main key to the health of the country as a whole [1,5].
The human resources policy of health care is aimed primarily to increase the number of medical personnel. The state population's health depends on it. In this regard, the problem of staffing in health care is an important area of analysis.
Purpose. Analysing employment data in public health facilities (Tver, Russia) and assessing the trends in staff turnover rates.
Materials. The data from official reports of polyclinics No. 1, No. 2, No. 3 of City Clinical Hospital No. 7" in Tver (Russia) was analysed. The assessment was carried out for the period from 2011 to 2020 by comparing three time periods: 2011-2014, 2015-2017, 2018-2020. In the course of its work, mathematical calculations on the validity of the investigated data were made.
Results. The outpatient department of the City Clinical Hospital No. 7" serves the population of the Zavolzhsky district of Tver with a total adult population of 108,586 people. The city's largest enterprise is located on the premises of the polyclinic. It is the Tver Freight Car Building Plant with about 12,000 employees. There are also large enterprises such as a building materials plant, a house-building plant, glass factories and others. The total number of the working population is 62,800 people. Polyclinic No. 1 serves 447 patients per shift, Polyclinic No. 2 serves 165 patients, Polyclinic No. 3 serves 265 patients. The total number of patients per shift is 877.
The surgical outpatient department of the state budgetary institution "City Clinical Hospital No. 7" is represented by surgical rooms for seeing patients in polyclinic No. 1, 2 and 3. All surgical rooms are located on the first floors of typical old buildings near the reception, X-ray room, ultrasound room, clinical and biochemical laboratory. There is a set of necessary premises for surgical reception in every room. There are clean and purulent dressing rooms, a room for seeing patients with surgical pathology. The surgical room of polyclinic No. 1 has a separate room for waiting for patients. All surgical rooms are equipped with the necessary communications (heating, water supply, sewerage) connected to city networks. There are operating tables in clean dressing rooms, ceiling lamps, dressing tables in purulent dressing rooms, ultraviolet containers for storing instruments, and dry heat containers for sterilising. There is standard furniture: desks, couches for examining patients, cabinets for storing documents.
It can be noted that the working conditions, equipment in polyclinics and the location of institutions meet the standard requirements for receiving patients and providing them with highly qualified medical care.
According to the analysis of the data of polyclinic No. 1 for the period 2011-2014 the total number of surgeons’ rates is 4.5, of which 4 are employed. The employment percentage is 88%. One surgeon has the highest qualification category, one specialist has the first category, two do not have any categories. The total number of nurses’ rates is 5.5, of which 4 are employed. The employment percentage is 72%. Two people have the highest qualification category. Two are not certified, due to the lack of the necessary work experience. Among paramedical staff the total number of rates is 2.5, of which 1 is employed. The employment percentage is 40%.
For the period 2015-2017, the statistics for this polyclinic changed slightly. The total number of surgeons’ rates is 4.5, of which 1,75 are free. The employment percentage is 61%. Among the working doctors, only one has the highest qualification category. The statistics nurses and paramedical personnel have not changed.
For the period 2018-2020, the total number of surgeons’ rates is 4.5, of which 2.25 are employed. The employment percentage is 50%. One specialist has the highest qualification category, and one has the second category. The total number of nurses’ rates is 5.5, of which 3 are employed. The employment percentage is 54.5%. Two people have the highest qualification category, one is not certified due to the lack of the necessary work experience. Among paramedical staff the total number of rates is 2.5, of which 1 is employed. The employment percentage is 40%.
The analysis of data from polyclinic No. 1 shows a decrease in the percentage of employment among doctors by 38% (p=0.197) and among nurses by 17.5% (p=0.559). The employment of paramedical staff did not change and remained below 50% throughout the decade. There is a clear shortage of outpatient personnel. The polyclinic No. 1 is the furthest from the city centre of all institutions studied. This causes some difficulties in travelling to work for specialists.
According to the analysis of the data of polyclinic No. 2 for the period 2011-2014 the total number of surgeons’ rates is 2, of which 2 are employed. The employment percentage is 100%.Surgeons are not certified due to their refusal to be certified. The total number of nurses’ rates is 3.5, of which 2 are employed. The employment percentage is 57%. One person has the highest qualification category, one has the first category. Among paramedical staff the total number of rates is 1.5, of which 1 is employed. The employment percentage is 66%.
For the periods 2015-2017 and 2018-2020, the values have not changed. They are completely similar to those for the first period of the decade. This indicates a stable positive dynamics of staff employment in the field. However, nursing and paramedical personnel require an increase in involvement in the specialty, because there are a large number of free positions.
According to the analysis of the data of polyclinic No. 3 for the period 2011-2014 the total number of surgeons’ rates is 1.75, of which 1 is employed. The employment percentage is 57%. The total number of nurses’ rates is 2.5, of which 2 are employed. The employment percentage is 80%. One person has the highest qualification category. One is not certified, due to the lack of the necessary work experience. Among paramedical staff the total number of rates is 1, of which 1 is employed. The employment percentage is 100%. For the second and third periods of the decade, the employment rates of medical personnel did not change.
The indicators of polyclinic No. 3 have not changed for 10 years. This polyclinic has a minimum number of rates for the work of medical personnel. It is worth noting that the clinic is located in the private sector. The majority of potential patients consists of residents of this city area. This may be one of the reasons why the hospital does not need to expand its staff.
Comparing the indicators of all three institutions we can notice an incomplete percentage of employment and its decline from the beginning to the end of the decade. The reasons for the shortage of staff can be many. According to a survey of doctors and nurses in all constituent entities of the Russian Federation (November-December 2019), the main reasons for the lack of medical workers in the outpatient department are: low wages (69% of respondents who noted the shortage of personnel agree with this), a high level of professional workload (59 %), optimisation measures in 2013–2019 (51%) and creating a negative image of medical workers in the media (45%). 80% of medical workers of the highest and middle levels are forced to carry an additional load due to the shortage of personnel. The shortage of medical personnel leads to a significant decrease in the quality of care for patients [2,5].
There are some ways to solve the problems of staff turnover. But it is worth touching on all aspects: the level of wages, working conditions, advanced training, the level of research bases, etc. Particular attention should be paid to the conditions of a specialist's workplace. The absence of modern diagnostic methods can be a problem in making a diagnosis, which leads to a decrease in the employee's confidence in their professional qualities and then to a rapid emotional burnout. Introduction of not the most expensive diagnostic methods allows the active research of various processes and diseases for preventive and therapeutic purposes, and also for scientific research. It also gives some advantages to a medical institution when a new specialist chooses a place of work [3,4].
A decrease in the percentage of staff employment was noted in the polyclinics of the City Clinical Hospital No. 7 for the period 2011-2020 for various reasons. In general, the decrease in indicators was observed among doctors. The grounds for termination of employment may be: the remoteness of the workplace, low wages, high professional loads, including the additional work. It is necessary to develop the right strategy to compensate for the vacant positions of specialists. One of the main reference points can be monitoring the employment of hospital staff. This issue remains relevant in the regions of the Russian Federation.
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