Russian doctors have taken to the streets in a rare protest as thousands are set to lose their jobs and dozens of hospitals are due to shut in Moscow in controversial moves to modernise the creaking health system.
With white coats slung over their winter clothing, more than 6,000 doctors and nurses braved the November cold on Sunday to protest against the reforms to be enforced by Moscow's city government.
According to documents leaked to Russian media, more than 7,000 doctors are to be dismissed and 28 hospitals and clinics are to close down in the city in the next few months.
"We do need reform, but not conducted in such a disastrous way," said Pyotr, a 29-year-old doctor taking part in the protests who withheld his surname for fear of being fired.
"Originally this reform was intended by President Vladimir Putin to calm down doctors and the middle class who protested against his reelection. But he has failed to do this," he said.
The reforms to the health sector were among the first decrees that Putin signed after his reelection in May 2012 after Moscow was rocked by mass protests by those opposed to his return to the Kremlin.
The reforms call for the salaries of medical personnel to be doubled. Currently, medics earn far less than their European counterparts -- 45,000 rubles ($969) a month for a doctor and 26,000 rubles ($560) for an orderly.
But the money to fund hospitals and medical staff is supposed to come out of a fund of compulsory health insurance payments that will see its budget fall by 15 percent by 2015, the RBK business daily wrote. Its budget for health spending in Moscow will fall even more sharply, by 18 percent.
The reforms to the medical sector are due to enter force on January 1.
"They are not giving the financial means for the reforms: suddenly it becomes necessary to reduce the number of medics," said Yuly Nisnevich of the Higher School of Economics in Moscow.
Making Health Care Profitable
The reform aims to make hospitals and clinics autonomous, meaning that each institution can spend only what it earns. The state is responsible only for purchasing medical equipment that costs more than 100,000 rubles ($2,100).
"The aim of the reform is to make the work of the medical personnel as profitable as possible," the RBK daily wrote. Maria S., a paediatrician at one of Moscow's largest hospitals, said this puts "very high pressure on doctors".
"The head of our clinic asked each of us to treat not 20 patients a day as before, but 50. Even if I work crazy hours, this is a surreal target," Maria said.
She said she did not take part in the street protest because of "threats against me," but warned that the reforms would have "grave consequences for the quality of health care".
Her concern is shared by the head of the lower house of parliament's health committee, Sergei Kalashnikov. "The accessibility of health care in Moscow has fallen sharply in recent years," he told TASS news agency.
But Moscow's deputy mayor responsible for social questions, Leonid Pechatnikov, argued that the reforms were "necessary and vital".
In an interview with Echo of Moscow radio station, Pechatnikov sought to reassure doctors, saying that the reforms would make it possible for hospitals to merge into centres with multiple specialisations, offering patients a better deal.
Some Moscow hospitals currently have no operating theatres, and patients who need urgent surgery must be rushed by ambulance to other hospitals, he said.
Olga Demicheva, a Moscow doctor who became an Internet sensation with a protest video addressing Putin, also conceded that "reform is now more necessary than ever."
"But the president (and legislators) are giving you fake numbers and shaky measures," she warned. "I understand that the (2014 Sochi Winter) Olympic Games and (Russia's annexation of) Crimea cost a lot but you can't make up the difference by economising on human lives," she said.
Nisnevich said he believed that the health reforms could lead to larger-scale protests if medics' concerns are not addressed.
"Sooner or later, if this goes on, the protests will become massive. This is a grave threat to the state, and it isn't possible to appease it by handing out money, because there isn't any more money."