He noted that official statistics on surgery are very scarce: in 2018 there were 19,919 general surgeons, in 2016 – 20,683. The National Medical Research Center carried out analytical work: the data received in 2019 from 83 constituent entities of the Russian Federation will be included in collection “Surgical care in the Russian Federation”.
Among the existing problems in the organization of surgical care, he named the insufficient provision of medical organizations with modern equipment and the discrepancy between the tariffs for the DRG and the actual costs. Difficult patients (with pancreatic necrosis, intestinal fistulas, postoperative complications) turn out to be the least profitable for a medical organization. Due to the high cost of consumables, it is difficult to implement endovideosurgical technologies during operations on the stomach, pancreas, colon, and hernias.
The specialist complained that with a rational distribution of tasks for compulsory medical insurance at the existing DRG tariffs, centralization of patients in a third-level medical organization is possible only in case of gastrointestinal bleeding, obstructive jaundice, chronic pancreatitis, when surgical treatment is required. “Clinical recommendations for routing patients with severe surgical pathology to third-level medical organizations and interdistrict centers will not be implemented without the appropriate state assignment and tariff,” he said.
The chief surgeon also noted the need to change the federal state educational standard for the residency program in the specialty of surgery: “After the first year, a surgeon can work in a clinic. The second stage is not spelled out absolutely. We believe that in addition to two years, a resident needs 2 years of clinical internship. You can be admitted to the second stage of residency only after 2 years of work. For targeted training – admission on a competitive basis and on the basis of contracts.”