By Ekaterina Janashia | 2025-12-29

Despite protests from doctors and warnings of a looming collapse, Russian President Vladimir Putin has signed a law requiring graduates of medical universities and colleges to work up to three years in state clinics.

The measure, which takes effect March 1, 2026, revives a Soviet-era practice and threatens stiff penalties for those who refuse, including repayment of double the cost of their education.

In the medical community, the mood is bleak. Many see less a public-health reform than state-imposed "serfdom."

The law sailed through the State Duma in November: 339 lawmakers voted in favor, 69 abstained, and none opposed.

Sergey Kabyshev, head of the Duma Committee on Science and Higher Education, framed the vote as a moral obligation.

"A medical diploma is paid for, first and foremost, by the hopes of future patients," he said. "This debt must be conscientiously repaid."

Officials avoided calling the program mandatory labor, branding it "mentorship."

Under the system, each graduate receives a mentor at a state institution funded by compulsory medical insurance. The assignment begins as soon as a student passes primary accreditation -- the credential required to legally practice.

Healthcare in crisis

Supporters argue the law addresses an emergency.

Russia entered 2025 short 23,300 doctors and 63,600 mid-level staff, according to Duma Chairman Vyacheslav Volodin.

In 54 regions, the supply of specialists lags far behind national averages. Volodin acknowledged that "two-thirds of doctors are working more than one full-time shift," and faulted the Health Ministry for acting too late.

Doctors counter that the shortages stem from chronic underfunding, outdated equipment and a budget that favors the war over social spending. Forced placements, they warn, will only hasten an exodus.

"The problems in Russian healthcare cannot be solved by plugging holes with young specialists," anesthesiologist and intensivist Alexander Polupan told Current Time. "If you move money from killing people to saving them, these issues could be resolved quickly without resorting to forced labor."

The plan also offers few guarantees. Graduates do not receive promises of housing, fair pay or even safety. Many expect to be dispatched to the most remote, and most understaffed, regions.

"I assume people will be sent to the places with the most acute shortages -- places where no one wants to work," said Alexander Vanyukov, a former Moscow vascular surgery chief who emigrated to Latvia. "They will use defenseless people to plug the gaps," he told Current Time.

The law does not exclude assignments to the occupied territories of Ukraine, which the Kremlin formally claims as Russian land. Young medics fear they could become "cannon fodder" for a system stretched by war and starved of modern equipment.

High cost of opting out

The financial stakes are steep. The final bill preserved 30% of university places as free "budget" seats exempt from compulsory service. The remaining 70% are now "target" seats tied to state assignments.

For graduates who want private-sector jobs or plan to leave the country, the exit price can be crushing.

Rehabilitologist Said-Salakh Atkayev noted that six years of specialized study can cost as much as 7 million RUB (about $77,000).

"To then be told I must work for three years in a state clinic or pay double that back? It is total absurdity," he wrote on Instagram.

Online reactions reflect deep resentment.

A sports physician recalled life inside the system: "In 2010, working 1.5 shifts in the Moscow region, my starting salary was 14,000 RUB ($145). Welcome to serfdom."

The government softens the mandate with rhetoric about mentorship and public duty, but critics say the message ignores the reality of exhausted staff and eroding trust.

Even United Russia lawmaker Alexander Mazhuga, who argued the measure enjoyed public support among students and teachers, faced a torrent of criticism on the government's own draft-law portal, where more than a thousand negative comments piled up.

Experts predict the policy will backfire by accelerating brain drain. Instead of filling rural and regional gaps, they say, the rule will push ambitious students abroad or out of medicine altogether.

"I feel sorry that Russia will be left without qualified personnel," Vanyukov said. He urged students to seek programs that let them "choose their own workplace."

For ordinary Russians, the stakes are immediate.

Saint Petersburg endocrinologist Maksim Kuznetsov warned his 1.7 million social media followers to prepare for scarcity.

"My advice to everyone: take care of your health right now," Kuznetsov said. "In five years, finding adequate medical treatment may be nearly impossible."