Effective Contract and Motivation: Can Reforms Improve the Work of Russian Doctors?

Abstract

Since 2012 the reform of the salary system of workers in the budgetary sphere, called the introduction of an effective contract, has been implemented in Russia. The paper presents the results of a study of the reform impact on the labor motivation of physicians. Empirical data are obtained by conducting in-depth interviews with physicians and heads of state medical institutions in Moscow and one of the regions in the European part of the country in 2016. The study revealed multidirectional impact for physicians’ readiness to work more and better by effective contract. There are three groups of doctors. The first and largest group: physicians who feels a positive impact of motivation incentives for physicians’ motivation at work. The second group: physicians who are convinced that an effective contract does not affect their motivation. The third group: physicians who believe that effective contract has led to a weakening of physicians’ motivation. The article gives an explanation of the results of the study. Results of the study also clearly show that the changes in the physician’s remuneration system aimed exclusively on the growth of salary of doctors are necessary, but not sufficient. The impact of an effective contract on the achievement motivation (the desire to improve their professional capabilities and results) was different for experienced and young doctors. The most pronounced increase in the achievement motivation was observed for the majority of young doctors. A special part of the research paper is devoted to informal payments which influence physicians’ motivation. The research has shown that these payments may smooth motivational effect caused by the new rules of remuneration. This fact is typical for Moscow, while in the region, this effect is not clearly expressed.