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Cablegate: How Much Do Russian Doctors Really Make?

DE RUEHMO #3540/01 2001327
R 191327Z JUL 07





E.O. 12958: N/A

REF: Moscow 1811

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1. (SBU) Summary: Although government doctors in Russia officially
earn $205-$900 per month as a base salary, they frequently earn much
more in reality. Physicians often supplement their base government
salaries for clinical work with income from private patients,
teaching positions in universities and medical schools, and extra
payments from insurers and local and regional governments. Russian
doctors are generally viewed as hard-working and enterprising, and
they manage to make a decent living despite low official wages by
wearing many hats and developing private practices. There are also
numerous reports of unofficial extra payments to give certain
patients preferential treatment at public facilities, but our
contacts disagree about whether to call these bribes or simply
"gratuities." End Summary.

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Public Health Care Salaries

2. (U) With the launch of the National Priority Health Project in
2006, the salaries of primary care medical professionals
significantly improved, but official salaries are still low
(reftel). The monthly salary for primary care doctors and
pediatricians working in the public sector is now $542-$890 per

3. (SBU) With the National Priority Health Project raising base
salaries in primary care, there has been a definite shift of some
specialists and an influx of young doctors into primary care
(reftel). The head of a health NGO that works with health clinics
in various regions of Russia told us this is at least partly
explained by the greater salaries that primary care doctors can now
receive compared to those who work in a more specialized area.
According to the NGO's informal polling at public health clinics, a
doctor working at the HIV/AIDS center in Saint Petersburg can expect
to earn $271-$310 a month as a base salary, and a doctor in an
HIV/AIDS center in Saratov earns $209 per month. The infectious
disease specialist in a public health care clinic in Saint
Petersburg can earn $310-$349 per month; while, the same specialist
in Saratov earns $122. These salaries pale in comparison to a
general practitioner in primary care practicing in Saint Petersburg,
who can earn more than $969 per month at a public clinic; while a
primary care physician in Saratov can earn more than $581 per month.

4. (SBU) Medical salaries vary widely by region and are
significantly lower outside of Moscow and St. Petersburg. In 2005
in the city of Angarsk, the average salary of all health care
workers was $240 per month, and physicians earned about $360 per
month. In 2006, medical salaries in Angarsk increased to an overall
average of $446 per month, while doctors' salaries increased to
$760. In Yakutia (Siberia), a doctor can expect to earn about $300
a month. (NOTE: A good pair of winter boots in Yakutia can cost
almost $400. END NOTE)

5. (SBU) According to one consultant at a health NGO, an average
physician in Moscow can expect to earn $200-$1000 per month in
official income. Primary care doctors in Moscow's public medical
clinics make more, about $1,000-$1,350 per month. However, given
the high cost of living in Moscow today, many Moscow physicians must
juggle multiple jobs to make a livable wage, and some resort to
unofficial means to enhance their base salaries.

Base Salaries Are Just the Tip of the Iceberg

6. (SBU) The base salaries of doctors are enhanced in a number of
ways. Insurers and local and regional governments frequently
provide payments to clinics and hospitals, which in turn are
distributed to doctors in the form of monthly bonuses which
supplement their base incomes. Doctors also receive bonuses for
outstanding service and for occupying more than one position within
a given health care institution or at other clinics. According to a
senior Moscow cardiologist, the base salary only makes up about 18
percent of a heart specialist's total compensation. Payments from
public and private insurers and from the Moscow city government make
up about 64 percent of income. An experienced cardiologist in his
hospital makes about $791 per month in official salary, including
extra payments from insurers and the government, while a department
head makes about $1,542 per month. The highest paid specialties in
Russia are dentists, anesthesiologists, radiologists, intensive care
doctors, and infectious disease specialists, according to the senior
cardiologist. (NOTE: Infectious disease specialists have always
received higher pay to compensate for the extra risks associated

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with their job. An infectious disease physician's monthly salary at
a clinic includes an additional 15 percent for the risks of treating
acutely infectious patients. A doctor at an HIV/AIDS center
receives an additional 60 percent for infection risks. Even so, the
number of infectious disease doctors is decreasing. END NOTE.)

7. (SBU) On top of official salaries, doctors routinely maintain
private practices at public facilities and schedule private clients
in between their public patients in order to utilize state-owned
equipment, though this practice is technically illegal. Many
specialists are able to cultivate an active clientele of patients
who need long-term care or periodic monitoring of chronic
conditions. These patients will pay the doctor directly for
consultations and visits, and will pay the hospital and clinic for
tests, just as in the United States. A doctor at a health NGO told
us dentists, neurosurgeons, and obstetricians and gynecologists are
among the highest-paid specialties and have plenty of opportunity to
develop lucrative private practices on the side.

8. (SBU) Russian doctors also sometimes receive monetary benefits
from pharmaceutical companies for prescribing certain drugs, though
these payments make up a fairly small share of doctors' overall
income, according to our contacts. One doctor told us that Indian
drug companies are well-known for paying the most to doctors for
prescribing certain drugs.

9. (SBU) Many doctors find ways to supplement their salaries through
entirely legal channels. Many physicians maintain multiple
positions within the health care sector. For example, a doctor
might work in a clinic during the day and teach night classes at a

Private Health Care Salaries Much Higher

10. (SBU) Private health care in Russia has become increasingly
popular, especially in Moscow, because of rising incomes and a lack
of patience with the public health care system. A Moscow private
diagnostic laboratory told us their physician salaries are in the
range of $1,000-$2,000 per month. A private Russian-Swiss company
quoted salaries for medical advisors at $3,500 per month. According
to one contact, a Dentist at the European Medical Center in Moscow
can expect to earn $3,000 per month, a general practitioner would
earn $4,000-$5,000 per month, and a plastic surgeon would earn
$5,000-$7,000 per month.

Bribes, Tips, Cognac and Chocolates

11. (SBU) Our contacts disagree about whether to characterize extra
payments to doctors to receive better medical services through the
state system as a bribe or simply as a "gratuity." As one doctor
contended, small gifts to doctors are traditional in the Russian
culture. Due to the close relationships which grow over time
between doctors and patients, many patients feel it necessary to
present their doctor with "gifts of gratitude," as one doctor told
us, especially for obstetricians and gynecologists, dentists, and
surgeons. It is understood that by bringing gifts or making extra
monetary payments, patients can expect better care in the future.
As one doctor explained, "Someone willing to pay extra is a more
attractive client."

12. (SBU) According to one recent study conducted by the Russian
branch of Transparency International, a patient can expect to pay an
extra $90 a day in bribes or "tips" for medical care in Moscow.
Contacts tell us that it is common to pay relatively small amounts
of extra cash ($40-$100) both in clinics and in hospitals, but
patients normally don't receive anything more than normal treatment
and care in exchange for these unofficial payments.

13. (U) According to a survey in June by the Levada polling center,
the Ministry of Health and Social Development was considered by 19
percent of respondents to be the most corrupt, the highest response
rate of any Russian ministry. (NOTE: The Ministry of Internal
Affairs was the next highest with 15 percent of respondents
considering it the most corrupt). Of those surveyed, 51 percent
acknowledged paying bribes for medical care. Georgiy Satarov, the
head of the anti-corruption NGO INDEM Foundation, claimed at a
corruption conference in April that as many as 20 million Russians
do not seek medical care, because they can no longer afford the
routine extra payments needed to obtain medical services. Problems
with health care were also identified as one of the chief sources of
complaints from citizens in the annual report released at the
beginning of April by Vladimir Lukin, Russia's Human Rights

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14. (SBU) Russia's doctors and nurses have long been underpaid based
on their official salaries, and there is a long history of making
informal extra payments to doctors. One doctor told us a well-known
anecdote about one of the Stalinist era Soviet Commissars, who said
that doctors and teachers do not need a salary, "because the people
will feed them." During the Soviet era, a barter system of bribes
was used in villages and medium-sized towns. The butcher, for
example, would ensure the doctor received the choicest cuts of meat,
and the doctor would make sure the butcher and his family didn't
have to wait in line when they went to the local clinic or hospital.
In larger cities, it was not uncommon for patients to bring a box
of chocolates or bottle of cognac to the clinic as a gift for the
doctor. Today's Russia appears to be maintaining these traditions
of privilege.


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