The main thing - to find your way
– Dear Muharram Muharemovic, revisionthe newspaper "sight" thank You for the opportunity to ask questions and congratulate You and the staff of the Ufa research Institute of eye diseases with a significant date – the 85th anniversary of education. As one of the largest national centers, SBD "Ufa research Institute of eye diseases" provides high-tech care to patients, makes a great contribution to training. We wish You and Your team success and all the best!
– I am very pleased to give an interview for your publication, as today the newspaper "sight" is, in my opinion, the most informative media for ophthalmologists. It provides and overview and analytical articles on various areas of ophthalmology. I enjoy reading your newspaper. From ophthalmology journals rather narrow circle of readers, and most ophthalmologists information still comes a little. Therefore, the question of issue is absolutely affordable for the majority of doctors in our specialty publications is long overdue, and it's about time you released your newspaper.
Thank You for the kind words addressed to the newspaper. In the jubilee year to draw some conclusions. Despite the fact that the "Field of view" No. 2, an article was published about the activities UFRII GB, please list the achievements of recent years, which illustrate the success of Your institution?
– Before speaking about the achievements of Ufa research Institute of eye diseases in recent years, can not remember its founding members: Professor Victor Petrovich Odintsov, Professor Vladimir I. Spassky, Professor Gabdulla Kudoyarov of Chabarovice. Thanks to their heroic efforts and the efforts of their colleagues had been performed the most important task is eliminated trachoma in the country. Victory over this terrible disease have been gained in the difficult years of the almost universal illiteracy among the population, the extremely low standard of living. We are proud of our great predecessors!
If we talk about past 5 years (that's five years I am responsible for the work of the Institute), the most difficult problemwas to change the psychology of people – both patients and doctors. I'll explain what I mean. First of all, before our task was to transform the Institute into the institution for the provision of surgical care. We have concentrated the most modern equipment, staffed by the most skilled surgeons. When we arrived, the proportion of surgical activity at the Institute was only 50%, and the other half of the patients had received conservative treatment. And it was quite difficult to prove to doctors and patients, with partial atrophy of the optic nerve or, for example, the retinal degeneration is no need to be treated in the high-tech Institute. In any other medical facility the patient may undergo a course of treatment. However, we often hear: "How can you refuse a patient treatment?" It was necessary to change the psychology of eye doctors in district clinics and to convince them that cataract patients should be directed to operations at an early stage of the disease, with visual acuity of 0.2-0.3, not waiting until the cataract is ripe. So, let's say "educational" work was quite long but gave positive results. The percentage of surgical activity with a 50% increased to 85% and before 2005 at the Institute in the year there were 10-12 thousand operations, this year we are reaching the level of 30 thousand. It is, indeed, quite significant changes. In addition, so that the surgeons could operate, we have reduced the Institute the number of beds and the number of specialists remained unchanged. The result – productivity increased by at least 3 times, which led to a significant increase in the salaries of doctors. Another serious problem we had to face – a high percentage of paid services. Moreover, the question is: will continue to develop the Institute as a scientific institution or moved to a status of Regional hospital. We took, I think, a reasonable decision to completely abandon paid services. It was necessary to work only on the MHI and the MHI to increase the number of operations, thereby stimulating our doctors. The Ministry of health of the Republic health insurance Fund has met us, and we were among the first in Russia to receive minimally invasive medical economic standards (MES). This means that we get paid by the number of bed-days, andthe finished case. That is, if we do surgery on an outpatient basis, we obtain for it as much as if the patient was here for 14-15 days. With the support of the Ministry of health and the Republican health insurance Fund, we have begun to create incentives for doctors. As a result, we managed to get a slim, well-functioning system in which doctors and health workers at all levels – from clinics to functional diagnostics departments know that any they carried out a surgery or procedure give a boost to wages. And this is all done not for money patients, not at the expense of paid services, namely budget money. The doctors have a real incentive to do more operations. We are not cutting the number of patients during the holiday period. Now one doctor can remain on the whole Department, to lead 60 people to operate and earn substantial money. That is, the system has fully justified itself and works fine.
– You have a second degree is not economic? A very sound approach.
I have no economic education. But within a few years, before becoming a Director, having already obtained a doctoral degree, I worked as a Deputy Director for Economics. I try to approach many issues from an economic, from a financial point of view, and that's the main thing. In medicine, in particular ophthalmology people have to work not only with the clinical thinking, but also economically. Although, of course, the transition to economic track – the procedure is quite painful, associated with a major change in psychology. Translate all our medicine on a paid basis — this is not an economic approach, here is a great mind is not necessary. And when you work only on budget money, virtually no paid services, you have a really good understanding of the economy. After all, we are obliged to provide the patient all that he put on mediko-economic standards: high-quality surgery on the most advanced techniques of modern IOLs and medications. We are required to provide a doctor with a decent wage, which allows him to be a free man.
align="justify" style="text-align: justify; ">so You had to thoroughly rebuild the system?
– There was a complete reorganization of the clinic, science. We have a research Institute and not all work to build on the clinic, otherwise it is not scientific research Institute and the hospital. We are in charge of the Academy of Sciences of the Republic of Bashkortostan. As with any academic system, Academy of science gives a little money, and scientific staff are not eligible to receive salary from the health insurance Fund. In this case, there may be a difference in wages between doctors and researchers, even if they work in the same Department and doing the same operation. We decided to translate the science to commercialization – established scientific research and production departments. Their task is not only pure science, but also the introduction of research results into practice, the creation of finished products, medicines. For example, we have created machines "Uplink" ultraviolet irradiation of the cornea, the drug "Extralink" (Riboflavin with dextran), guide for conducting intravitreal injection. That is, our scientists (we have a lot of young people) are charged to commercialize their research results, to earn money. Not to say that this will yield very large dividends, but the main thing is done – we started moving in this direction.
– What issues can be addressed at the level of head of the institution? All depends on the authorities?
– In the existing health system without the assistance of the chiefs to do is impossible. However, their assistance should be to give the "green light" ideas, which you can really rely on which to build its economic base. It's not the fact that the Ministry gave us a minimally invasive MEAs cataract, and last year we got a MES for minimally invasive intravitreal the introduction of lucentisa. This means that all patients, we do an injection of Lucentis free, and you know how much is one vial. You canto ask how we did it? We went to the Ministry of health of Belarus, the mandatory medical insurance Fund and proved that having such a MES, we will bring the Republic significant economic benefits, although it would seem that the treatment of one patient costs a considerable sum. Now we are bidding for the procurement of a large number of vials of Lucentis and begin to implement this program. As part of the governing bodies in the system of health care, in my opinion, should be to maintain a reasonable, cost-effective initiative and not to interfere with the CE implementation. I believe that in the case of our Institute, many questions are solved that way and. The main thing that satisfied both patients and staff.
– With Your permission I want to return to the issue of financing health care, rather, to the problem of underfunding. You spoke about how the Institute is coping with the problem. And yet, what do You think, to what level is necessary to raise the financing of medical institutions in Russia? You are an experienced person.
Is a very complicated issue, and it needs to be decided in each particular case and not only in each region separately, but in each medical institution. Within the region, even in one Ufa, the situation differs significantly depending on the medical institution. For example, under the leadership of academician-Secretary of the Department of medical Sciences the Academy of Sciences of Belarus, corresponding member of Academy of medical Sciences V. M. Timerbulatov, an analysis was conducted of the economic efficiency of medical institutions of the Republic, which revealed that the Institute has the highest efficiency according to the number of treated patients on the ruble of budget funds. I think the funding level should be sufficient to ensure that any hospital can safely provide free care to patients in the volume of the given assignment. For example, you have the opportunity to take 100 people, and the state task you have to take a day 60. The state provides funding for these patients (the majority of these poor citizens) and the remaining 40 people have to pay their own treatment. Of course, the government will always seek to lower this threshold, while the medical institution will tryCE to raise. It in our case is about the state medical institutions. I believe that these proportions (±5% depending on the region) must always be maintained.
– What percentage of paid services has UFRII GB?
– From 2006 to 2011, we almost had no paid services. Gradually they began to introduce, starting from the second half of 2011. Today it is no more than 5%.
However, until 2005, as I said, the percentage of paid services in the Institute were quite significant, which caused discontent among the citizens. According to statistics, 80-90% of cases, eye care services are provided to socially vulnerable layers of the population – pensioners or children.
The middle layer is mainly refractive surgery can afford to pay for the surgery. The region is home to 4 million people and if 5 years ago the country had 750 beds, now only 600. a little less than 300 at the Institute of eye diseases, that is, the main burden of the Republic carries our Institute. Therefore, in terms of financing, we should not cross the line of the existing percentage of paid services.
– As I understand it, You are faced with the problem of shortage of personnel. To You, probably people are happy because the work is interesting and the salary is decent. However, the personnel problem is quite acute in the country. In interviews, the main ophthalmologist of the regions put in the first place is the personnel problem. At the time, Leonid Roshal proposed the idea to return to the system of distribution of graduates, while to create all the necessary conditions: decent salary, housing, etc How do You feel about this idea?
– To the distribution system, like any other form of coercion, I am extremely negative. As for the salary question, I entirely agree with Dr. Roshal – she must be worthy. Andshortage of personnel in the Institute just yet. We employ the competition, the folder of applications to work full. But in the whole country and even in the city of Ufa is a rather serious problem. The urban district clinics we have a huge shortage of doctors. The problem is not resolved by "Soviet-style" enforcement. I believe that the system of incentives needs to be sufficiently differentiated. And if the person agrees to go to the area, the level of wages should be different from the earnings of a doctor in the city. Moreover, this difference should be very serious. If the Institute, for example, one before lunch can work here, and in the second half of the day in a private clinic, the village has no such opportunities, and the level of wages is the same. Let the doctor who went to the rural area to 3-4 times higher salary than in the city, and then the youth will think twice before making the decision where to work – at the Institute of eye diseases or in a rural hospital.
– You have, I noticed a lot of young people.
You are right, young people are very much, the children have a very different, contemporary, way of thinking, many graduates even too "focused" on the money, and we have to hold them back. We often hear; "Give me the surgical table, give me a chance to operate and earn". So guys we say, "No, wait, first, learn, get experience and professionalism. And the money you will not go anywhere if you efficiently carry out its work." In our Institute a very strict system. The surgeon just gets the money for the operation, we evaluated the quality of the operations. If a patient is discharged the day after surgery, so all went without complications, and the doctor receives a high rating, on the second day – plank is reduced by half, and if on the 3-4th day, falls to almost zero. Moreover, each discharged patient is checked by an independent expert.
– You spoke of a laboratory for the production of medical devices, pharmaceuticals, IOLs. As I understand it, it is possibleregarded as a practical extension of scientific activities of the Institute, As You think it is profitable to buy products of the Russian manufacture or manufacturers?
– To be honest, the question of production in Russia is a big headache. To release any product on the market, it is necessary to pass seven circles of hell. In our conditions it is difficult to engage in the production, implementation. The control system output is very complicated. Who had not previously encountered with the production, and should not start, even if this involved manufacturers. To compete with foreign manufacturers, we can, but it is very difficult. There is not only the production but also the marketing system, product promotion worked out to perfection. We are still at the initial stage of this path, the ability to sell. Not so much to produce, how much to sell is the most difficult science.
– Another statement of a famous doctor: "I share two things: if a patient comes and tells him that he was cured, you have to pay is the Prosecutor's office, no questions asked. If the person being treated and he was cured, it is the feeling of gratitude. The doctors in the whole country – the poor, without the help of the people couldn't exist... could you Comment on the last statement of Leonid Roshal.
– About the fact that doctors in the country are poor, I would not give such a categorical assessment. Of course, there is a category of doctors who have the level of wages very low, and to feed the family, they are forced to work day and night, sometimes at the expense of their own health. It is necessary to raise wages, and it is necessary to talk constantly. However, now the health system is gradually gaining momentum of economic incentives, giving doctors the opportunity to earn decent money. Unfortunately, this happens not everywhere and not as fast as would like.
– Tell me, is it prestigious to be a doctor in our country, is it so long to learn?
align="justify" style="text-align: justify; ">– I have this question answer is absolutely clear – of course, Yes. All my life I have devoted to treatment of people. I started with a simple doctor in a clinic in a remote region of our Republic.
In those years I had a rate of 110 rubles minus income minus childlessness on hand received 90 rubles. In the winter he worked in the clinic and in the summer on old connections went to the construction crew, to build houses, but never regretted that I became a doctor. In my footsteps went both my daughters. If you wish, if you have the vocation, the difficulties of the initial stage of formation of the doctor pass almost unnoticed. This profession sooner or later will pay off in the form of gratitude of the people. When you come to cured you and in times bows, you feel an incomparable sense of satisfaction. I'm not saying this to be witty.
– Your daughter ophthalmologists. You affected their choice?
When my older daughter was graduated from the medical University, she had no desire to go into ophthalmology. She explained that didn't want to be a "daughter Bikbov:". To which I replied that in ophthalmology is still a lot of uncharted roads and that it your way will find. And when the youngest daughter entered the medical University and the secondary courses began to think, what specialty to choose, her mentor has made the older, inspiring in her confidence that she will find their way in the profession. The eldest daughter is already established specialist, working on his doctoral thesis under the guidance of renowned Japanese Professor. She is the only Russian ophthalmologist who received a grant from the government of Japan. The grant provides full tuition, accommodation, a decent scholarship. Of course, I would have preferred that she was there, but it turned out the way it did. It deals with vitreoretinal pathologies. See, she found her way though with me doing cornea...
Editor – in-chief of magazine "the Spark" Victor Loshak said: "the New Russian government is a "government of hope".How did You react to the appointment of Veronika Skvortsova Minister of health of Russia and Olga are Hungry, who will head the social block? In Your opinion, the new appointments will the situation change in health care?
– I have great respect for T. A. Golikova, although, of course, many doctors don't like her. But thanks to the former Minister in medicine earned economic levers, which I'm sure will lift healthcare to a new level. Experience medical institutions, including our Institute, shows that a reasonable combination of clinical and economic thinking gives you the best result. And it seems to me that V. Skvortsova both of these qualities are perfectly combined, which is encouraging and gives hope for further progressive development of Russian medicine.
– I thank You for the interesting interview.