Ludmila Kozlova: “The quality of healthcare cannot exceed the quality of the education received”

Ludmila Kozlova: “The quality of healthcare cannot exceed the quality of the education received”

Tribuna’s guest is the Deputy Chairwoman of the Federation Council on Social Policy, the Smolensk region, Honored Doctor of Russia, Honored Worker of Science, Ludmila Kozlova. She discussed with Vladimir Nesterov problems of medical education.

- What has changed in recent years in medical education? We somehow got used to the fact that the Soviet Union had a strong school, had strong institutions; in 1990, everywhere and for sure, medicine was no exception, there was some kind of failure, lack of specialists, lack of teachers. What do we have now?

- A lot has changed. And as in any thing, there are changes in a positive direction, but a lot of negatives. In the overall quality of medical education, today we are talking about medical education having decreased compared to what it was before. The prestige of teachers in higher education, in general, has declined. It was very prestigious to stay at the university and become a teacher. Now the situation is different. There is a low social status; the level of salaries is poor for professors and teaching staff. Previously, it was between 7 and 10 years, you had to work to get an apartment. Well, you did not have to, it was not written down anywhere, it just happened. This issue was resolved.

The level of salaries was higher than in practical healthcare. And it was not higher for nothing, because the level of professionalism when it comes to clinical doctors' departments was, truly, also higher. And there was a motivation to work, a motivation to learn. 

Now what motivation can there be, when salaries are very low, especially in the theoretical departments and especially for beginning teachers? I am remembering my times again – they were just outstanding people, not just people with the names of, say, Professor, Honored Scientists, corresponding members, and so on, even ordinary assistants and lecturers, their level was high. It is necessary to raise the prestige of this profession. If: there is no money for medicine, there is no money for education, what will we have? Sick and uneducated people?

- It seems to me that this is a standard phrase of the Ministry of Finance.

- Precisely in the Ministry of Finance, because both the head of state and the prime minister have said that, despite the difficulties, the social component won't be touched and the bar won't be lowered. And then much depends on the heads of agencies.. Because now, in many universities, in most of them, probably, there is off-budget activity. The number of budget places is adjustable, of course, if we talk about medical universities, the majority is still owned and run by the Ministry of Health. Although there are many in the Ministry of Education. Too many cooks spoil the broth. And if you have to talk about the medical schools, in my opinion, it is, of course, the Ministry of Health. Some universities, about half, have their own clinical bases, hospitals are under the jurisdiction of departments, committees of healthcare, and so on. Professors of the clinical departments are the same doctors (surgeons, internists, pediatricians, ophthalmologists, and so on), they must deal with medical activities, otherwise they lose their qualifications.

If previously there was the Regulations on Clinical Hospitals, which operated until 1993, today members of the departments are deprived of the possibility to just perform clinical work, if the relationships did not find a common language. 

- Why is that?

- Insurance companies, when they check, they are asking: who is the attending physician? The attending physician must be an employee of the hospital. So what is the way out of this situation? There could be two major ways out of it, as I see. Either the assistant works at a 75% rate, because if he works at a bigger rate he will not be able to carry out his main job as efficiently, at a 75% rate. Or have the most professional that they can, as assistants, as associate professors, and professors, to serve as chiefs of departments. He will also be at a high level, and will be on the staff of the hospital.

Members of the clinical department realize that they are losing their professional skills without practice and becoming inferior to doctors who work in the hospital. What does it mean? It means that an ordinary doctor has better professional skills than a teacher. Will this teacher be respected? And what attitude will students have towards such a teacher?

That is why teachers should actively solve these issues themselves, as well as help at every stage. I was the head of a department. Our teachers always spend five minutes on so-called mini-trainings. 

Certainly, the law should be formalized as a statute for those universities that do not have their own scientific base. 

- Many universities were established in the post-Soviet period. Some universities are often closed, or they can be attached to other universities. Is it possible to establish so-called 'medical institutions'? 

- We are doing everything excessively. A new specialist, who is responsible for organizational activities, wants to leave some trace in the history of the university and begins reforms that are not always considered. Now we have come to the conclusion that we have a lot of people with higher education. Now we are closing the vocational training schools and technical schools. As for medical education, we opened additional universities. But please tell me if there any universities which have functioned for a long period of time in this region,they have their own school, why was it decided to establish them? It was explained by the fact that this profession is in demand in other regions. Moreover, it is always easier to study at home because of financial costs. Certainly, it is difficult to keep children who study in other cities. Perhaps this is true. But a university requires several decades in order to become a strong institution.

There is an excess of doctors. On the other hand, we have a lack of skilled personnel everywhere. 

We decided to open new universities. But where can they employ teachers? In other universities there were always good specialists of practical public health in the university at the time of opening. They were good professionals, but without pedagogical skills. Doctors were invited from the capital. But the level of a specialist from the capital, when he arrives in other city, he cannot work so effectively as he worked in Moscow. Now we have what we have.

- Is there a difference between graduators who studied at budgetary and extra-budgetary places?

- So if you haven’t passed a competition on budgetary places, you can receive an extra-budgetary place. In practice, when I noticed that those who study on a fee basis, or on a commercial basis, were sometimes even superior to those who studied on a budgetary basis. 

- How is today's youth motivated, when they intend to receive a medical degree? Do they have an interest in the medical profession in your opinion?

- Yes, the profession is still interesting. The majority I used to work with were motivated. But our theoretical knowledge surpasses our practical skills. Students studied great during the wonderful student years. They had all the spiritual qualities that a doctor should have, i.e. compassionate and respectful attitude towards patients. A few years ago two former students of mine could join their lives with neonatology, but then they went to work in other firms. Why? One of them told me, "Ludmila Vyacheslavovna, my mother is raising me alone, she has taught me for six years, and now I earn five thousand rubles," this was a few years ago, but the base rates have not changed significantly. Their salary, including night nursing, was 10 thousand rubles. They left for companies, because they were offered 35-40 thousand rubles.

- Did they leave for work in private medical companies or unrelated to medicine?

- They chose pharmacologic companies, as there were higher salaries. The companies took them with their hands and feet, because the level of training was really high. 

And I really enjoy working with such students, who that a doctor, especially a beginner, should be a considerate person, and if he realizes that something is outside his purview or he does not know anything, he always asks a colleague. He does not pass by. And there are some honor students who begin work, but they have confidence bordering on arrogance. They have a false sense of confidence. As I say, high self-esteem as a professional is excessive quality. He can miss something, may cause harm to the patient. Teachers must be interested in training a good doctor. It very much depends on the teachers. A doctor has to learn for the whole his life. There should be continuing education. 

- By 'continuing education' we can mean reading magazines or books, or visiting some conferences and retraining, can’t we?

- There are two forms: advanced training and retraining. Retraining means a process when a therapist or pediatrician becomes an ophthalmologist. 

- Recently, they very often speak about this subject in connection with the cuts taking place in the health sector. Of course, we are talking about advanced training. How often must doctors undergo advanced training?

- It should be every five years.  But education should really be continuous. Previously doctors used to earn a little less, but it was enough for them to buy professional journals and newspapers. And all institutions bought several professional journals and newspapers. And it was available for doctors and nurses. Now the level of salaries is so small that neither the doctors nor the teachers can afford to buy magazines. Even institutions can't. There is the Internet. But sometimes I see such nonsense on the Internet. There is no review. There is now an opportunity to publish medical books, monographs, etc., without the need for a review. If you have money, you have found a sponsor, you can release some publication. 

- Are there reliable periodicals which are carrying repsonsibilty?

- Of course. There are magazines and websites and so on. It can also be found on the Internet. But usually when a person starts to study, he not only reads magazines, he immediately begins to study the issue. You can watch scientific conferences and seminars online in your spare time between sessions. To attend these conferences, not everyone can do it. But if the head of an educational institution intends his institution to work well, he will find a chance to send people for study training.

Peter Glybochko, rector of the Sechenov Medical Academy, impressed me with his intention to educate teachers. Some have such an opportunity, but they still don’t use it, considering that people can become well-educated without it. It is a wrong attitude.

Not all departments of a university has the opportunity to send someone for long-term study training, as it leads to increasing the teaching load on others.

Doctors have always had a desire for learning. When not only a doctor, but also a teacher in particular knows a new technique, it increases his level and his respect. And I am very pleased that I visited Smolensk in my spare time, for example, and implemented such research methods as electroencephalography, rheoencephalography of newborns and ultrasound examination of the hearts and brains of newborns. Firstly, it needed to be done. Secondly, it was interesting for me. I wanted my teachers to also master it and have an extra professional quality. Much training has been paid for by the department, including teachers’ stays at trainings. 

- Is there any way of improving the prestige of the profession, increasing people's interest in the profession without a significant increase of wages?

- There is the presidential program, according to which by 2018 or 2020 the salaries of teachers and medical workers in particular should significantly increase. I asked the Minister of Education a question about the plans of the ministry to increase prestige and improve personnel. He promised to meet with me and answer this and other questions. I'm looking forward to this meeting.

We can also resolve the issue with housing certificates.It will be cheaper than a decline in the quality of healthcare. The quality of healthcare cannot exceed the quality of the education received.

In the message to the Federal Assembly, President said that we should take care of the personnel, and protect the personnel. A head of any institution should always stand above his attitude to people.

There should be certain documents that must come from federal sources. And you cannot give too much to the local government. That is what I'm talking about: the position on the selection of a rector, the position on the selection of the head of a department, they should be same in all the universities. Today there is one rector, tomorrow - another. And another comes and starts to change something to his liking. This shouldn’t be done.