The largest medical universities this year did not get more than a thousand students to the target places, and at least 500 budget places remained empty after the start of studies, the BBC Russian Service calculated. Even the additional enrollment at the end of August did not help universities. The reason is the new law: starting from this year, young doctors cannot freely choose their place of work if they studied for free - they are sent for work, often to other regions where there are not enough doctors. The BBC spoke to students and doctors about how the new regulation will affect their future.
This summer, medical universities in Russia held their first admissions campaign since the law on labor, as it is called in the medical community, came into force.
The law limits the further employment of students who studied on a budget. When entering university at state expense, the future doctor agrees to work for three to five years wherever he is sent - this is reminiscent of the Soviet “distribution”.
Most of the budget places in medical universities this year actually became “targeted”, that is, their graduates will be “distributed”.
“No one wants to go to the target, because there are so many fools to be found,” comments Alexey (name changed), a young doctor who entered residency this year, commenting on the shortage. He was specially preparing to enter the paid department, just so as not to be obliged to work, he told the BBC.
“I adore medicine,” explains Alexey. “I can’t imagine my life without medicine.” But I love myself too, and I want to do medicine, not healthcare.”
At the beginning of August, at least 1,500 targeted places were not filled in medical universities in Moscow and St. Petersburg, the BBC calculated. The specialized resource Ordinatura.org obtained a similar figure. For example, in the First Moscow State Medical University named after. THEM. Sechenov, 198 places were vacant, and at the Russian National Research Medical University named after. N.I. Pirogov - 289 places.
The shortage primarily affected residency training - this is the next stage of medical education, when a doctor, after studying for six years at a university, receives a more specialized qualification, for example, a surgeon or gynecologist.
This year it was planned to accept 20 thousand future residents using the budget, Health Minister Mikhail Murashko said at the end of June. Almost 80% of them had to study under a target agreement, and only 20% were “pure” budget places.
But due to the fact that universities had to announce additional enrollment, some of the targeted places moved to budget places, that is, those where the contract for work is not immediately concluded.
For example, in one of the leading medical centers in Russia, Russian National Research Medical University named after. N.I. Pirogov’s plan for admission under the target quota was 704 people (total budget 974), but the BBC was able to find orders for the enrollment of only 250 people.
The university announced additional recruitment: in the end they managed to recruit 592 people, but 132 places remained empty. Some of the “target” places eventually became budget ones. The website of the Russian University of Medicine of the Ministry of Health of Russia (RosUniMed) directly states that unfilled “target” ones have been added to budget places, but it is impossible to isolate them in the order on budget recruitment.
A “clean” budget does not mean free education without further distribution: “target students” sign a distribution agreement right at the beginning of their studies, and the few “pure” state employees will either have to sign it later or transfer to a paid department. Without a targeted agreement, public sector employees will no longer be able to pass accreditation, that is, they will not receive the right to work in their specialty.
The advantage of a “clean” budget is that it will be cheaper to terminate the target contract: you will only need to pay the cost of training, as if the state employee studied on a paid basis. Those who signed the target immediately will be fined three times for termination.
In November 2025, Professor of the Department of Pathophysiology of the First Moscow State Medical University named after. I.M. Sechenov, Doctor of Medical Sciences Anton Ershov, spoke out in the media against the law on labor. Soon after, he was forced to resign from the university.
Ershov continues to publicly speak out against the law on social networks. He criticizes “enslaving target contracts and huge fines for terminating them,” as well as ridiculous salaries at the start of a career. All this turns young people away from medical professions, he emphasizes, and does not at all help provide all corners of the country with the required number of doctors.
“Instead of solving the problem, management prefers to shut their mouths,” he adds, recalling his own dismissal.
With the help of training, the authorities are trying to solve an understandable problem - the lack of doctors in the outback, where the standard of living is low and there are few prospects, but someone still has to treat the local residents.
“In the 21st century, it turned out that there was a shortage of doctors in all countries. Firstly, because the population is growing, secondly, because it is aging, thirdly, because everyone wants to be healthy and want to live long, but there is not enough money for this,” explains Vasily Vlasov, professor of the Department of Health Economics at the Higher School of Economics, Doctor of Medical Sciences.
This is a problem all over the world, and different countries are looking for different approaches to solving it. In the United States, private healthcare uses market mechanisms: higher salaries for doctors. “In countries like Great Britain, they invite foreign doctors, complete their training, bring them to an acceptable level for practice, and thus feed their medical profession,” says Vlasov. However, in both cases the problem has not been fully resolved: residents lack access to medical care.
In Russia, they took the path of introducing restrictions for specialists. Training with doctors is not a new idea; they have existed before.
“Since the end of the 90s, they began to come up with different ways to not only force those who study at a medical institute to study to the end, but to send them wherever the party orders. Where will the party order it? Where it’s bad, where it’s difficult, there’s a swamp, mosquitoes,” explains Vlasov. “But at the same time, I was sorry for the money.” In principle, you can send people to very difficult places if they are paid well: like shift workers, oil producers travel and are absolutely happy, because the salary is good. But the doctors didn’t want that.”
Vlasov considers the system of training for targeted education to be unfair and even illegal, because it violates the right to choose a job at will: “Graduates of conservatories have no restrictions on working after receiving their education, graduates of the Agricultural Institute also have no restrictions, neither do teachers and engineers. But the doctors have it!”
The additional enrollment did not solve the problem of the shortage of students in government-funded places: the largest Russian universities, according to BBC estimates, lacked about 550 students this year.
Regional medical institutes, unlike the capital ones, have almost completely filled the target places, Vladislav Ledovsky, editor-in-chief of the Ordinatura.org website, told the BBC. He explains that in the regions, as a rule, there are only one or two medical universities, that is, young doctors simply have no choice, and going to Moscow to study is too expensive for them. In addition, they are usually offered work placements in their own region - it is easier for local students to agree to this than for a Muscovite to go to a distant province.
Even in those universities where the required number of target students was recruited, the “quality” of these students could fall, since the deficit could be filled at the expense of “weaker graduates,” emphasizes Vasily Vlasov.
The law on working hours, which caused the shortage, was adopted last fall. Doctors' work-offs themselves existed before this, it was just easier to refuse them. The law introduced work for all state employees: even those who did not initially enroll in the “target” program will have to enter into an agreement during the course of their studies.
The second part of the law introduces the concept of mentoring, and behind it is also training in the compulsory medical insurance system. Now graduates in a number of medical specialties (no matter whether they studied on a budget or paid) must work for one to three years as a seemingly full-fledged doctor, but “under a mentor” in a state clinic or hospital—they cannot immediately go into private medicine.
But in this case, the graduate can at least choose his own place of work: there is a chance of getting into a good hospital in a big city. This applies to everyone who graduated after the law came into force, even if students were not told about it upon admission.
Even State Duma deputies from the Communist Party of the Russian Federation opposed the bill - they believed that this was a violation of the constitutional right to choose a place of work. Opponents of the law even tried to challenge it in the Constitutional Court, but did not gather enough votes from deputies to do so.
The law was adopted and signed by President Vladimir Putin. Social networks responded to this with a stream of videos from future doctors: students said they were leaving medical school. Doctors have a longer education period than most professions. Now, according to the calculations of dissatisfied students, they will have to study and work for 10-11 years for a small salary before starting to freely build a career.
Indeed, tens of thousands of graduates of medical universities and colleges do not work in their profession and do not continue their studies. About a third of young doctors “simply disappear” from the healthcare system - most likely, they go to alternative labor markets, Alexander Miroshnichenko, director of the All-Russian Educational, Scientific and Methodological Center for Continuing Education of the Russian Ministry of Health, said in June.
At least, before it was easier to avoid detention: simply return to the university the money it spent on training this specialist. That's exactly what Alexey did.
“When I entered the specialty, I also signed a target agreement, because I thought: but I am 100% accepted,” he recalls. “I didn’t understand what that meant.” And only in my fourth year did I realize how terrible it was. Then I realized that it was easier for me to pay a fine of half a million and be free.” Under the new law, fines are now higher.
“You will be sent to a place where there are not enough doctors,” Alexey describes the disadvantages of practicing targeted training. “And there aren’t enough doctors there for a reason.” Plus the most annoying thing is that during our training we still have classes in hospitals with doctors, managers, and patients. And some hospital might like you madly, and the director will want to take you, and here you go, your dream job. But it won’t work out: you have a target, they won’t let you go to this hospital, and you, for example, from St. Petersburg, Tomsk, Moscow or Irkutsk, where there are powerful universities, will go to Chukotka.”
To repay the half a million rubles that the state budget spent on his education, Alexey took out a loan. I needed income to give it away, plus for residency I needed additional points that are given for practice. Therefore, Alexey went to Kamchatka to work as a doctor under the Zemsky Doctor program.
This program to attract young doctors to the outback started in 2012, and it is voluntary: specialists who agree to move to the provinces are given a high salary and 2 million allowances. Authorities report its success. For example, in 2025, Deputy Prime Minister Tatyana Golikova said that only 17% of participants terminated the contract before the end of its five-year term.
Alexey has completely different impressions: “It’s not worth it: not two million, not a salary three times more than what I receive now. There is no personal development for the doctor there, only degradation.”
Alexey remembers his work in the provinces with horror: “Any doctor, if he does not use his knowledge, if there is no normal clinical work, degrades. Imagine: a surgeon in some regional hospital, where the population is 15 thousand at most. At best, he will operate once a month, whereas in a normal hospital a surgeon will operate five to six times a day. What skills can a surgeon who operates once a month have?”
Doctors who work for 40 years in one place and do not follow innovations in the profession cannot teach him anything, he believes. Alexey had no one to ask for advice: “It’s very difficult to find a doctor there who is truly competent by modern standards. Every time I had to argue and swear that this cannot be treated, this is not how they do it. And the doctors who have worked there all their lives answered me: “This is not Moscow, this is Kamchatka, this is how they work here.”
After a year and a half, Alexey decided that enough was enough. He did not spend the two million that were given for participation in the program, but put it in the bank at interest. When I quit, I simply returned the money: “In the end, I was even in the black,” he says. The loan was also gradually closed.
Alexey dreams of being a therapist: but not a local physician, in a regular clinic, but getting into a good hospital, where he can make diagnoses and work with complex clinical cases. This is exactly what residency is needed for.
“Those who want to complete residency at any cost are precisely those rare people who want to become [narrow] specialists. Well, for example, they dream of becoming heart surgeons. They will fight to get into such a residency, save money, take out loans and study. Then, of course, they will have to somehow fight it off. There will be a need to charge more from patients,” explains Vlasov. That is, the Soviet tradition of gifts to doctors from patients will not go away, and maybe it will become stronger.
The law hits people from poor families, Vlasov continues, because the law does not apply to “payers.” “Those who cannot pay for residency will go to work in a clinic because they need to feed their family. In residency, as you know, we don’t pay a salary, but they pay an insignificant, ridiculous stipend. This is the perpetuation of wealth inequality through such unequal access to further education,” he explains.
“As a matter of principle, I am not going to sign a target agreement,” the young doctor insists. “No, this is a complete taboo for me.”
Marina (name changed) is a sixth-year student at a medical university in Tver. She enrolled even before the new law, so she is finishing her studies on a “clean” budget. After graduating from the specialty, he also plans to go to residency, but getting there will not be easy. “Those people who have now concluded the target agreement are given plus 200 points upon admission [to residency]. Since I studied on a budget, I won’t have such points, and my chances of admission are decreasing,” she explains.
Marina has no money for paid training. This means that when studying for a residency, she will in any case have a target agreement.
