Ukraine’s modern healthcare system has found itself in a state of deep structural imbalance due to the massive outflow of middle medical personnel. Against the backdrop of war challenges and the constant threat of shelling, nurses and doctors perform their professional duties in conditions of resource shortages and systemic underpayment of labor. Public organizations and representatives of independent medical movements record a critical reduction in staffing in state and communal institutions, which puts the system’s ability to provide full-fledged patient care at risk.
Hidden Mechanisms of Artificial Reduction of Staff Income
The decentralization reform has turned Ukrainian hospitals into communal non-profit enterprises, giving the heads of institutions broad financial autonomy. The expected increase in basic salaries declared by the Ministry of Health and the National Health Service of Ukraine is neutralized in practice by management decisions on the ground. Hospital administrations use the practice of mass transfer of employees to fictitious part-time jobs, in particular to two-thirds or a quarter of the official salary, while demanding the performance of the full amount of functional duties.
A financial audit of internal processes shows that the surcharges for night work, professional categories, or work in hazardous conditions provided for by law have lost their stimulating role. These surcharges are automatically absorbed by the structure of the minimum wage, so the real income of a specialist remains at the basic level, regardless of qualifications. The relevant ministry and controlling bodies have actually withdrawn from regulating the internal distribution of budgets, justifying this by the status of autonomy of medical institutions.
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Risks of the Paramedical Model in Emergency Medical Care
The restructuring of emergency medical care teams has led to the introduction of the so-called optimized model, where one medical worker and a driver go on calls. This approach makes it impossible to follow protocols during complex resuscitation procedures directly in the car while driving. The physical limitations of one person do not allow for simultaneous cardiopulmonary resuscitation, ensuring venous access, preparing medicinal solutions, and fixing the patient.
The combination of strict requirements for operability and a critical shortage of personnel creates conditions for the systemic burnout of emergency service workers. The workload on the existing specialists increases in proportion to the number of layoffs, while the level of financial support does not compensate for the risks and high stress levels. The absence of paired teams reduces the overall effectiveness of providing emergency care in critical situations.
Psycho-Emotional Pressure and Specifics of Work in the Field of Mental Health
Regional specialized institutions, in particular of a psychiatric profile, record a sharp increase in the number of patients with severe forms of post-traumatic stress disorder, acute barotrauma, and acute grief. The specifics of caring for such a category of patients require not only the performance of standard manipulations from middle medical personnel but also continuous psychological support. Nurses become direct participants in the process of social rehabilitation, subject to secondary traumatization and professional burnout.
Despite the significant complication of the patient contingent, the level of pay in the psychiatric sector remains at a critically low level, which does not take into account the specific factors of danger and emotional tension. Personnel are forced to work on the verge of psychophysical capabilities in conditions of chronic shortage of colleagues in the departments. The lack of targeted state subsidies to support the mental health of medical workers themselves deepens the personnel crisis in this sub-industry.
Perspectives of Institutional Changes and Calls for Solidarity
Further ignoring the personnel crisis may lead to the complete loss of institutional capacity of Ukraine’s medical system, as migration processes among qualified specialists become irreversible. Solving the problem requires a review of the National Health Service of Ukraine’s policy in terms of forming service packages, where requirements for the number of middle medical personnel must be clearly detailed and financially supported. Nursing care should receive the status of an independent medical service with an economically justified tariff.
Existing administrative verticals in hospitals are focused solely on fulfilling the orders of the institution’s owners, rather than protecting the interests of labor collectives. Overcoming the financial depression of the industry is possible only if there is active solidarity of the medical community and open coverage of labor law violations. The readiness of personnel to defend their rights is a key factor in the transformation of the healthcare system.
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