Training of doctors in the Russian Federation
A cardiologist’s training consists of several stages. Firstly, you need to finish the medical university and then undergo your training in the residency for 2 years. After that, you can work as a cardiologist in a hospital or an outpatient department. Doctors with such training can consult cardiac patients and provide emergency cardiology care. They don’t carry out Holter ECG monitoring, stress tests, echocardiography, or invasive methods of examination on their own. There are doctors of a narrow profile for such purpose - specialists in functional diagnostics, ultrasound examination and endovascular surgery. Additional training is required for these specializations and can take between 4 months (for doctors of functional and ultrasound diagnostics) to 2 years (for endovascular surgeons). Since 2016 the education of doctors in our country has changed. Now it is called Continuous Medical Education. Each doctor, including a cardiologist, must receive 50 points per year, which consists of 36 hours of training in the university at the Department of Cardiology and 14 hours of conference attendance. Doctors need to accumulate 250 points over 5 years. In addition, the doctor must receive training in his specialty for a duration of 144 hours over 5 years.
The self-education of cardiologists has great importance. Doctors read the European guidelines which are translated and posted on the site of the Russian Society of Cardiology (RSC). Doctors also take part in webinars. The popular site www.Internist.ru has a huge audience of doctors. Some doctors are regular readers of the E-Journal for Cardiology Practice. The main obstacle to reading the E-Journal is a poor knowledge of the English language.
Outpatient cardiac care
More than 10,000 cardiologists work in Russia. About 90% of cardiologists are women. Most of them work in hospitals. A very small number of cardiologists are involved in private cardiology practice depending on the region. There are more private cardiologists in Moscow but there are no more than 1% of them in other regions of Russia. Thereby the main cardiac outpatient burden lies on the general practitioners.
There is no special association for private cardiologists. Those who wish can enter the Russian Society of Cardiology, membership is not obligatory. The RSC is one of the largest medical associations in Russia and has more than 6,000 members.
A special feature of the healthcare system in Russia is the administrative method of management. It is implemented by the Ministry of Health of Russia and regional ministries. Appropriate decrees are issued for the diagnosis and treatment of patients and doctors should be working according to such orders. Nowadays the decrees of the Ministry of Health are based on the Russian recommendations on cardiology that are prepared on the basis of European guidelines.
Russia is a large country both in terms of area and population. It has significant regional differences in the organisation of medical care. As an example, here is the organisation of outpatient cardiology care in my city - Kazan. There are 1.2 million people in Kazan. Doctors’ training is carried out by the Medical University and the medical faculty of the Kazan University. Postgraduate training of doctors is conducted by the Medical University and the Medical Academy according to the principles outlined above.
Outpatient cardiac care for most patients is provided by general practitioners in outpatient clinics according to the district principle. Cardiologists in Kazan are concentrated at a large center - the (Interregional Clinico-Diagnostic Center). 14 cardiologists according to the direction of general practitioners from the attached district outpatient clinics consult complicated cardiac patients - after myocardial infarction, with severe heart failure symptoms, resistant hypertension, and patients with unclear diagnosis. A total of more than 20 000 patients are consulted annually in this out-patient department. Some quick diagnostics are also carried out in this department - ECG, Holter ECG monitoring, stress tests, echocardiography, ultrasound and artery examination. If necessary, the patient is sent to the cardiology in-patient hospital in the same building for hospitalisation.
Nowadays, measures are being taken for strengthening outpatient care for the population, including cardiac care. Outpatient clinics are continuously being equipped with modern equipment, and extra cardiologists are receiving extra training.