The work activity of healthcare workers is associated with great physical and emotional stress, the need in some cases to work in difficult and dangerous conditions for life and health. This determines some of the features of the legal regulation of labor relations in this field of activity: additional requirements when concluding an employment contract, preferential working hours and rest periods, special rules for part-time work, etc. In addition to the general provisions of the Labor Code of the Russian Federation, medical workers are subject to the provisions of the Federal Law dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, as well as a number of other by-laws and regulatory legal documents. The main document regulating the work of a medical worker is an employment contract concluded with the employer.

Working hours

The legislator has enshrined special legal regulation of the work of medical workers, including by establishing reduced working hours for them (Part 5 of Article 92 and Part 1 of Article 350 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code of the Russian Federation)), taking into account the provisions Art. 251 and 252 of the Labor Code of the Russian Federation, providing for the possibility of establishing the specifics of legal regulation for certain categories of workers in connection with the nature and working conditions. These measures are aimed at compensating for this category of workers the adverse effects of various types of factors, increased psychophysical stress due to the specifics and nature of medical and other activities to protect public health, and, therefore, cannot be considered as violating the constitutional rights of citizens and the principle of equality enshrined in Art. 19 (parts 1 and 2) of the Constitution of the Russian Federation.

The stress of the labor process inherent in medical work has always been compensated for by medical workers by reduced working hours and the provision of annual additional paid leave. Therefore, for all medical workers, Art. 350 of the Labor Code of the Russian Federation establishes a reduced working time - no more than 39 hours per week. For certain categories of medical workers, depending on their position and (or) specialty, by Decree of the Government of the Russian Federation of February 14, 2003 No. 101 “On the working hours of medical workers depending on their position and (or) specialty” (hereinafter referred to as Resolution No. 101) in accordance with the Lists of Positions, the duration of working hours is established - 36, 33, 30 or 24 hours per week. For those job titles of medical workers that are not included in the specified Lists, the duration of working hours is regulated by Art. 350 Labor Code of the Russian Federation.

FYI

It should be noted that not all employees in a medical organization belong to the category of medical workers. For example, these are administrative and economic personnel, for whom the normal working hours are set at 40 hours. At the same time, it should be taken into account that the working hours of a particular employee are established in the employment contract on the basis of an industry agreement and a collective agreement based on the results of a special assessment of working conditions.

To determine those who belong to the category of “medical worker”, it is necessary to be guided by the norms of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Law No. 323-FZ). According to Art. 2 of the law “a medical worker is an individual who has a medical or similar education, works in a medical organization and whose labor (official) responsibilities include the implementation of medical activities, or an individual who is an individual entrepreneur who directly carries out medical activities.”

Next, the question arises: what is medical activity? The answer also contains Art. 2 of Law No. 323-FZ: “medical activity is professional activity in providing medical care, conducting medical examinations, medical examinations and medical examinations, sanitary and anti-epidemic (preventive) measures and professional activity related to transplantation of organs and (or) tissues, circulation of donor blood and (or) its components for medical purposes.”

Order of the Ministry of Health of Russia dated July 25, 2011 No. 801n approved the Nomenclature of positions for medical and pharmaceutical personnel and specialists with higher and secondary vocational education in healthcare institutions, which contains both positions of employees to be filled by persons with higher (secondary) medical education, and positions of employees subject to replacement by persons with other higher (secondary) professional education. Thus, if an employee with a higher (secondary) non-medical professional education, in accordance with his labor (job) responsibilities established in the employment contract and job description, carries out medical activities in the sense given to this concept by Art. 2 of Law No. 323-FZ, he can be classified as a medical worker.

As for the heads of medical organizations and the heads of their structural divisions, if, in accordance with their labor (job) responsibilities established in the employment contract and job description, they carry out medical activities, they can also be classified as medical workers.

In accordance with clause 1 of Appendix 2 to Resolution No. 101, doctors of treatment and preventive organizations, institutions: clinics, outpatient clinics, dispensaries, medical stations, stations, departments, offices, when conducting exclusively outpatient treatment of patients, have the right to a shortened 33-hour work week.

According to Art. 33 of Law No. 323-FZ, primary health care includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, promoting a healthy lifestyle and sanitary and hygienic education of the population. Primary medical and specialized health care is provided by general practitioners, local physicians, pediatricians, local pediatricians and general practitioners (family doctors), medical specialists, including medical specialists from medical organizations providing specialized, including high-tech medical care. This type of medical care is provided on an outpatient basis and in a day hospital.

Thus, as part of the provision of primary health care, local physicians, surgeons, neurologists, otorhinolaryngologists, ophthalmologists and others, in addition to outpatient visits to patients, carry out preventive examinations, medical examinations, home care, sanitary education and other preventive work, therefore, they do not may only provide outpatient care and are not entitled to a reduced 33-hour work week.

In this regard, part of the working time of doctors within the framework of providing primary health care to the population, evenly by day of the week, is allocated to the specified types of work, based on the 39-hour duration of their working week.

A doctor-dental surgeon, a doctor-maxillofacial surgeon of medical and preventive organizations and institutions may have a 33-hour work week, if their job responsibilities do not provide for other work, namely: conducting classes to improve the qualifications of medical personnel, participating in medical examination, performing other sanitary and preventive work, organizing treatment at home. Dental surgeons and maxillofacial surgeons working in hospitals are required to work a 39-hour work week.

Summarized working time recording

In accordance with the current labor legislation, in organizations where, due to working conditions, the daily or weekly working hours established for this category of employees cannot be observed, it is possible to introduce summarized recording of working hours. The procedure for introducing summarized recording of working time is established by the internal labor regulations of the organization.

Medical organizations with hospitals provide medical care to the population regardless of the time of day or day of the week, therefore, the internal labor regulations establish for medical workers a summarized accounting of working hours or a shift work schedule for them to be on duty in the evening and at night, on Sundays and holidays days in accordance with the approved work schedule.

With accumulated working hours, the duration of working hours should not exceed the normal number of working hours for a specific accounting period of time. The normal number of working hours for the accounting period is determined based on the weekly working hours established for this category of medical workers. For employees working part-time (shift) or part-time, the normal number of working hours during the accounting period is reduced accordingly.

The use of summarized working time is based on the fact that the duration of the working week established by current legislation is provided by the schedule on average for the accounting period. The daily and weekly working hours established by the schedule may deviate to a certain extent from the established standard working hours. In this case, any deficiencies (overwork) that appear must be corrected within the established accounting period (month, quarter, etc.). The number of working hours according to the schedule must be equal to the number of working hours according to the established norm for this period. The accounting period cannot exceed one year, and for the working time of workers engaged in work with harmful and (or) dangerous working conditions - three months (Part 1 of Article 104 of the Labor Code of the Russian Federation).

Organization of shift work

Article 91 of the Labor Code of the Russian Federation obliges the employer to keep records of the time actually worked by each employee. In relation to medical organizations, the employer (chief physician) or a person authorized by him is obliged to maintain work schedules for medical workers.

In medical organizations with hospitals, workers alternate shifts evenly and, as a rule, the transition from one shift to another is carried out every week at the hours determined by the shift schedule. As for workers in outpatient medical organizations, they move from shift to shift every other day.

The rational organization of outpatient care to the population largely depends on correctly drawn up schedules, which are an integral part of the work plan of the clinic and its structural divisions. They regulate the start and end times of daily work, the number and duration of work shifts, their rotation and the calendar of days off for medical personnel. Schedules are drawn up for a certain accounting period for structural units, groups of personnel (medical, nursing, junior, etc.) and for each occupied position (main, part-time and substitute, part-time) separately.

The duration of the shift (duration of work during the day) on different days of the week may deviate from the established duration of the working day, but the sum of the duration of all shifts for the month must necessarily correspond to the monthly balance of working hours. The duration of one shift should not exceed 12 hours. The duration of the break between shifts cannot be less than double the duration of the work shift. The number of days off per month for each employee must correspond to the number of days off provided by the calendar. The schedules must reflect the recorded types of work performed by the doctor: appointments at the clinic, including dispensary visits, home visits, and other preventive work.

Shift schedules are brought to the attention of the employee. As a rule, no later than one month before it comes into force.

The time for changing clothes before and after the end of the working day (shift) is not included in the recording of working time.

Breaks for rest and food

In accordance with Art. 108 of the Labor Code of the Russian Federation, during the working day (shift), a medical worker must be given a break for rest and food lasting no more than two hours and no less than 30 minutes, which is not included in working hours. However, in those jobs where, due to working conditions, it is impossible to provide a break for rest and food, the employer is obliged to provide the employee with the opportunity to rest and eat during working hours. The list of such work, as well as places for rest and meals, are established by the internal labor regulations. This standard also applies to medical workers who have a 6.5-hour or shorter working day.

Example

For medical workers working at emergency medical care stations (departments), where it is impossible to establish an exact time for meals and rest, the internal labor regulations establish an approximate time, for example, from 13.00 to 16.00. A similar approach is used in the internal labor regulations for ambulance drivers.

Duration of work on the eve of non-working holidays

According to Art. 95 of the Labor Code of the Russian Federation, the duration of the working day or shift immediately preceding a non-working holiday is reduced by one hour both for workers with normal working hours and for those who work under reduced working hours (including this applies to medical workers ), regardless of the basis of its abbreviation. However, it should be remembered that the duration of work at night (including for medical workers who have reduced working hours) is equal to the duration of work during the day (i.e., the duration of work (shift) at night by one hour is not reduced) in cases where this is necessary due to working conditions, as well as during shift work with a six-day work week with one day off. The list of these works may be determined by a collective agreement or local regulations.

If a non-working holiday follows a day off, then the working day preceding this day off is not subject to reduction. If a week falls on a holiday, the working hours for that week are adjusted accordingly. This rule applies to both a five-day and a six-day workweek.

The main form of compensation for overtime on a pre-holiday day in continuously operating organizations and in certain types of work where it is impossible to reduce the duration of work (shift) is to provide the employee with additional rest time. Compensation for such overtime should be provided for in the shift schedule. If in an organization this issue is not regulated by a shift schedule or a collective agreement, then additional rest time is provided by agreement of the parties. Replacing overtime with payment according to the standards established for overtime work is allowed only with the consent of the employee.

Duty of medical workers, including at home

The labor function of being on duty for medical workers, performed outside of normal working hours, is similar to the labor function of being on duty for medical workers, performed according to a schedule.

In accordance with the norms of the Labor Code of the Russian Federation, the employee’s labor function must be defined in the employment contract. Any work that is in addition to it must also be reflected in the employment contract. Based on this principle, we can come to the conclusion that additional types of work specified, in particular, in subparagraph “g” of paragraph 2 of Resolution of the Ministry of Labor of Russia dated August 30, 2003 No. 41, can be formalized either as a combination of professions (positions), or as part-time work, for example, internal, if there are positions in the staffing table of a medical organization.

As mentioned above, the duty of medical workers is specific work and, of course, must be formalized within the framework of an employment contract. In this case, wages for duty should also be included in the average earnings of medical workers.

However, it must be borne in mind that in accordance with the Labor Code of the Russian Federation, any additional work or type of work is carried out only with the consent of the employee himself. For example, the question is often asked about the eligibility of attracting doctors from outpatient departments of hospitals, dispensaries, maternity hospitals, etc. to duty in hospitals. Such duties are possible only with the personal consent of the employee himself and if such functions are written down in the proper responsibilities of the medical worker.

As for the involvement of medical workers working in hospitals on hospital duty, such functions must also be taken into account in the employee’s job responsibilities.

The head of a medical organization can, within the limits of his authority, approve the workload for an employee.

In 2013 in Art. 350 of the Labor Code of the Russian Federation, changes were made that establish that in order to implement the program of state guarantees of free provision of medical care to citizens in an emergency or emergency form, medical workers of medical organizations, with their consent, can be assigned to duty at home.

Medical workers were involved in this type of activity before, but the corresponding norm was abolished in 2008, since it contradicted the current labor legislation, and until 2013, there was no legal definition of the concept of home duty in the legislation.

But no one canceled the specifics of the activities of medical workers, and the medical organization was obliged to provide emergency medical care to citizens and ensure the uninterrupted operation of the organization on weekends and non-working holidays, at night, including emergency response, etc. Therefore, in 2011, the order of the Chairman of the Government of the Russian Federation to the Ministry of Health and Social Development of the Russian Federation to develop a draft federal law on amendments to the Labor Code of the Russian Federation, which establishes the specifics of the work of doctors and nursing staff when they are on duty at home.

In Art. 350 of the Labor Code of the Russian Federation defines duty at home - this is the stay of a medical worker of a medical organization at home awaiting a call to work (to provide medical care in an emergency or emergency form).

In addition, it is established that when taking into account the time actually worked by a medical worker of a medical organization, the time spent on duty at home is taken into account in the amount of 1/2 hour of working time for each hour of duty at home. The total working time of a medical worker of a medical organization, taking into account the time on duty at home, should not exceed the standard working time of a medical worker of a medical organization for the corresponding period. Particular attention should be paid to the fact that duty duties are introduced only with the consent of the employee.

The peculiarities of the working time regime and recording of working time when medical workers of medical organizations carry out duty at home are established by the order of the Ministry of Health of Russia dated 04/02/2014 No. 148n “On approval of the Regulations on the peculiarities of the working time regime and recording of working time when medical workers of medical organizations carry out duty at home” .

For medical workers on duty at home, the internal labor regulations establish a summarized recording of working time.

The start and end times of duty at home are determined by the work schedule approved by the employer, taking into account the opinion of the representative body of employees.

In the case of a call to work for a medical worker on duty at home, the time spent on providing medical care and the time the medical worker travels from home to the place of work (place of emergency medical care) and back is taken into account in the amount of an hour of working time for each hour of medical care and travel of a medical worker from home to the place of work (place of emergency medical care) and back. In this case, the time of duty at home in the accounting period is adjusted so that the total working time of a medical worker of a medical organization, taking into account the time of duty at home, taken into account in the amount of one second hour of working time for each hour of duty at home, does not exceed the standard working time of a medical employee of a medical organization for the corresponding period.

The procedure for recording the travel time of a medical worker from home to the place of work (place of emergency medical care) and back is established by local regulations in agreement with the representative body of workers.

The employer is obliged to keep records of the time an employee stays at home while waiting for a call to work, the time spent providing medical care, and the time a medical worker travels from home to the place of work (place of emergency medical care) and back in the event of a call. to work while on duty at home.

Example

The doctor has a reduced working time of 39 hours per week. The medical organization has established a work schedule for him, providing for the provision of medical care at the workplace for 29 hours a week and duty at home (the doctor must be ready to be called to the workplace) for 20 hours a week. In total, working hours will be 49 hours per week. In this case, 20 hours of time spent on duty at home is taken into account by the doctor as half an hour for each hour of duty (including duty at night), i.e. the duration of the recorded working time in total will be the same 39 hours as during normal operation. If, while on duty at home, the doctor is called to work for 3 hours, then the remaining time on duty at home is reduced by 6 hours, so that the total is 39 hours.

For six months, the Trade Union of Healthcare Workers of the Russian Federation took an active part in the working group of the State Duma Committees on Labor, Social Policy and Disabled Persons, and Health Protection in the preparation of the draft law. The trade union proposed that medical workers, with their consent, be on duty at home beyond the working hours established for a particular employee, and the duration of this duty should not exceed the monthly standard of working time for the accounting period established for the employee. In addition, the Trade Union proposed, in the event that a medical worker on duty at home is called to work, the time spent on providing medical care and the travel time from home to the place of work and back, be paid in the amount of at least double the salary (official salary) , calculated per hour of work, taking into account all established monthly allowances and surcharges. However, the Trade Union's proposals did not find support among the deputy corps and representatives of the ministries of health and finance of the Russian Federation.

After amendments were made to Art. 350 of the Labor Code of the Russian Federation, medical workers, with their consent, may be assigned to duty at home in the form of staying at home while awaiting a call to work (to provide medical care in an emergency or emergency) within the normal working hours.

When taking into account the time actually worked by a medical worker, the time spent on duty at home is taken into account in the amount of 1/2 hour of working time for each hour of duty at home. As a result, medical workers in this situation actually work extended working hours, which is contrary to labor legislation regarding compliance with working hours.

These circumstances entail the reluctance of workers to be on duty, thereby increasing the tension of the psychological climate in teams; medical workers refuse to be on duty within normal working hours.

In order to generalize the current practice of implementing Art. 350 of the Labor Code of the Russian Federation regarding the implementation of duty at home by medical workers, the Central Committee of the Trade Union monitored the registration and payment of these duties.

The monitoring results showed that due to insufficient medical personnel (as well as a lack of staff positions), it is quite problematic to carry out duty at home within the established working hours, as provided for by law, and in some cases it is impossible (this was indicated by 20 regional organizations of the Trade Union). At the same time, the practice of registering and paying for duty at home is not uniform.

The existing system of duty at home within the normal working hours is actually voluntary-compulsory in nature, and if there are only one or two specialists, it turns into round-the-clock duty. In most cases, home duty is carried out outside normal working hours, and payment is made either as overtime, or as part-time work, or in the form of compensation payments. At the same time, the heads of medical organizations are placed within the strict framework of Art. 99 of the Labor Code of the Russian Federation, which provides for restrictions on attracting workers to overtime work - 120 hours. In practice, the time of work carried out in the form of duty at home significantly exceeds this norm.

In this regard, the Central Committee of the Trade Union again addressed the Committee on Health Protection of the State Duma of the Federal Assembly of the Russian Federation with a proposal to return to the discussion of the issue of implementing Art. 350 of the Labor Code of the Russian Federation regarding the implementation by medical workers of duty at home.

In accordance with part three of Art. 92, art. 350 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code of the Russian Federation), a reduced working time is established for medical workers - no more than 39 hours per week. Depending on the position and (or) specialty, the working hours of medical workers are determined by the Government of the Russian Federation.

Resolution of the Government of the Russian Federation dated February 14, 2003 N 101 (hereinafter referred to as Resolution N 101) approved lists of positions and (or) specialties of medical workers, organizations, as well as departments, wards, offices and working conditions, work in which gives the right to a shortened working week . In accordance with this resolution, a 36-hour, 33-hour, 30-hour or 24-hour working week is established for medical workers, depending on their position and (or) specialty, nature and working conditions. In dental treatment and preventive organizations, institutions (departments, offices), the working week is set at 33 hours (Section III of Appendix No. 2 to Resolution No. 101) for the following positions: dentist, orthopedic dentist, orthodontist , pediatric dentist, dental therapist, dentist, dental technician (except for dental surgeon, maxillofacial surgeon). Thus, the positions of chief physician of a dental clinic and his deputy are not provided for by Resolution No. 101.

In accordance with Art. 423 of the Labor Code of the Russian Federation for medical workers whose positions and (or) specialties are not provided for by the said resolution, a reduced working day can be established in accordance with the laws and other regulatory legal acts of the Russian Federation, as well as legislative and other regulatory legal acts of the former USSR in force on the territory of the Russian Federation within the limits and in the manner provided for by the Constitution of the Russian Federation, Resolution of the Supreme Council of the RSFSR dated December 12, 1991 N 2014-I “On the ratification of the Agreement on the creation of the Commonwealth of Independent States”, since these regulatory legal acts do not contradict the Labor Code of the Russian Federation.

At present, the resolution of the Council of People's Commissars of the USSR dated December 11, 1940 N 2499 (hereinafter referred to as Resolution N 2499) and the order of the People's Commissariat of Health of the USSR dated December 12, 1940 N 584 adopted in accordance with it (hereinafter referred to as Order N 584), establishing the duration of the working day, have not been cancelled. for certain categories of medical workers, equal to 6.5 and 5.5 hours. These regulatory legal acts can be applied to the extent that they do not contradict Resolution No. 101*(1). Their provisions affect the positions of doctors and nursing staff in individual medical institutions. However, given that the positions of the chief physician and his deputy relate to the positions of heads of healthcare institutions, and not to the positions of doctors and nursing staff * (2), the norms of Resolution No. 2499 and Order No. 584 do not apply to the workers specified in the question. Thus, the provisions on reduced working hours provided for by Resolution No. 101, Resolution No. 2499 and Order No. 584 do not apply to employees holding the positions of chief physician and deputy chief physician of the clinic.

At the same time, the nomenclature of positions for medical workers and pharmaceutical workers, approved by order of the Ministry of Health of the Russian Federation dated December 20, 2012 N 1183n, still classifies these positions as medical workers. Therefore, employees holding the positions of chief physician and his deputy, in accordance with Art. 350 of the Labor Code of the Russian Federation, a weekly working time should be established not exceeding 39 hours. Moreover, since part one of Art. 350 of the Labor Code of the Russian Federation does not oblige them to establish a reduced working day; the work schedule of these employees may, as a general rule, provide for an 8-hour working day with a five-day working week. However, in this case, the working hours on one of the working days must be reduced by one hour. When establishing a six-day working week, it is necessary to take into account the requirement of part three of Art. 95 of the Labor Code of the Russian Federation, according to which on the eve of weekends the duration of work in a six-day working week cannot exceed 5 hours. Within the meaning of this norm, it applies in all cases, that is, for any weekly working time.

The Labor Code establishes the obligation to keep records of the time actually worked by each employee. This is an important point in respecting their rights - after all, overtime work, work at night or on weekends, and non-working holidays must be compensated. Doctors are a special category of workers: their overwork can affect the quality of services provided to the population. Therefore, the employer must strictly comply with the requirements of labor legislation regarding the duration of work for doctors. Today we will tell you what types of working hours are possible for medical workers, how many hours a week they should work, and what forms of documents should be used to record the actual time worked.

General information about working hours

Working time is the time during which an employee, in accordance with the internal labor regulations and the terms of the employment contract, must perform labor duties, as well as other periods of time that, in accordance with the Labor Code of the Russian Federation, other federal laws and other regulatory legal acts of the Russian Federation, relate to working hours time (special breaks for heating and rest - Article 109 of the Labor Code of the Russian Federation, additional breaks for feeding the child - Article 258 of the Labor Code of the Russian Federation, etc.). The normal duration of such time cannot exceed 40 hours per week.

For medical workers Art. 350 of the Labor Code of the Russian Federation establishes a reduced working time, which is normal for them - 39 hours a week. Also, depending on the position or specialty, the working hours of doctors are changed by the Government of the Russian Federation.

FYI. Article 92 of the Labor Code of the Russian Federation establishes a reduced working time for workers under 16 years of age - no more than 24 hours per week, from 16 to 18 - no more than 35 hours per week, workers who are disabled people of group I or II - no more than 35 hours , and for persons employed in work with harmful and (or) dangerous working conditions - no more than 36 hours.

In particular, on the basis of Decree of the Government of the Russian Federation dated February 14, 2003 N 101, the following working hours are established:

1. 36 hours per week - for doctors, paramedical and junior medical personnel:

— infectious diseases hospitals;

— skin and venereal disease clinics, leper colonies, health care facilities for the prevention and control of AIDS;

— laboratories that diagnose HIV infection;

— psychiatric (psychoneurological), neurosurgical, drug treatment facilities designed to serve citizens suffering from mental illness;

— children's psychiatric (psychoneurological) healthcare facilities, educational institutions for mentally retarded children;

— physiotherapeutic health care facilities;

— the state service of medical and social examination, which carries out examinations of citizens suffering from mental illness;

— ambulance and emergency medical care stations (departments), regional, regional and republican hospitals.

2. 33 hours per week:

— for doctors of medical institutions (outpatient clinics, dispensaries, medical centers, stations, departments, offices) to conduct only outpatient visits to patients;

— doctors and paramedical staff of physiotherapeutic hospitals and offices working full time on medical generators "UHF" with a power of over 200 W;

— dentists, orthopedic dentists, dental therapists, dentists and technicians (except for dental surgeons) of dental health care facilities and offices.

3. 30 hours per week for doctors, paramedical and junior medical personnel:

— tuberculosis and anti-tuberculosis organizations (their structural divisions), social service institutions intended to serve tuberculosis patients;

— forensic medical examination bureaus, pathological-anatomical departments, laboratories, morgues directly working with corpses and cadaveric material;

— institutions of the state service of medical and social examination that examine citizens with tuberculosis;

— healthcare organizations when working on the procurement and preservation of cadaveric blood;

— when working with gamma therapy and experimental gamma radiation in wards for patients with radioactive drugs applied, work related to gamma installations;

— when working with X-ray diagnostics, fluorography, on a rotational X-ray therapeutic unit with visual control.

Note. Nurses in X-ray, fluorography rooms and installations must work 30 hours a week, assisting the doctor with X-ray diagnostics and fluorography for at least half of the working day.

4. 24 hours a week - for medical workers directly performing gamma therapy and experimental gamma irradiation with gamma drugs in radiomanipulation rooms and laboratories.

Working hours

Medical workers can work in various modes - a 5-day work week with two days off, irregular working hours, shift work, part-time work, etc.

Establishing a work schedule is important from the point of view of distributing the norm of working time throughout the accounting period - week, month, quarter or year. For example, with a 40-hour week, the duration of daily work (shift) should not exceed 8 hours per day. How to determine the duration of daily work (shift) with reduced working hours? Order of the Ministry of Health and Social Development of the Russian Federation dated August 13, 2009 N 588n will help us with this. In particular, to determine the duration of a shift (daily work), you need to divide the established length of the working week by 5 days (clause 1). Accordingly, the duration of the shift of health workers will be:

— with a 39-hour work week — 7.8 hours;

— at 36 hours — 7.2 hours;

— at 33 hours — 6.6 hours;

— at 30 hours — 6 hours;

- at 24-hour - 4.8 hours.

To calculate the standard working time for an accounting period, for example, a month, you need to divide the length of the working week by 5 (working days in a week) and multiply by the number of working days according to the calendar of the 5-day working week of this month. From the result obtained, it is necessary to subtract the hours by which working hours are reduced on the eve of non-working holidays. For example, the standard working time for December 2013 will be: (39 hours / 5 days) x 22 days. - 1 hour = 170.6. 39 hours is the normal duration of work for a medical worker, 22 is the number of working days in December, 1 hour is the time by which the shift is reduced before January 1 (a public holiday).

In addition to this calculation of the duration of daily work, it is worth taking into account the requirements of the Labor Code, the norms of which have already determined the maximum duration of work for:

- workers aged 15 to 16 years - 5 hours, from 16 to 18 years - 7 hours;

- students of general education institutions, educational institutions of primary and secondary vocational education, combining study with work during the academic year, aged 14 to 16 years - 2.5 hours, from 16 to 18 years - 4 hours;

- disabled people - in accordance with a medical report issued in the manner established by federal laws and other regulatory legal acts.

If a physician is engaged in hazardous work or work with hazardous working conditions, where reduced working hours are established, the maximum permissible duration of daily work (shift) cannot exceed:

— with a 36-hour work week — 8 hours;

- with a 30-hour work week or less - 6 hours.

By virtue of Art. 94 of the Labor Code of the Russian Federation, the duration of daily work (shift) in comparison with that established for persons employed in work with harmful and (or) dangerous working conditions can be increased by a collective agreement, subject to compliance with the maximum weekly working hours and hygienic standards for working conditions.

Please note! The duration of the working day or shift immediately preceding a non-working holiday is reduced by 1 hour, and if the employer has a 6-day working week, this duration cannot exceed 5 hours (Article 95 of the Labor Code of the Russian Federation).

Duration of work (shift) at night based on Art. 96 of the Labor Code of the Russian Federation is also subject to reduction. But it can be equal to the duration of work during the daytime in cases where this is necessary due to working conditions, as well as for shift work with a 6-day work week with one day off. The list of specified works may be determined by a collective agreement or local regulations.

Now let's move on to working hours.

In medical institutions, the following working hours are most often established:

1. Shift work - work in 2, 3 or 4 shifts. This regime is introduced in cases where the duration of the production process exceeds the permissible duration of daily work, as well as for the purpose of more efficient use of equipment, increasing the volume of products or services provided (Article 103 of the Labor Code of the Russian Federation). Typically, a shift regime is established at ambulance stations, in emergency departments of medical institutions, and medical institutions providing emergency specialized (sanitary and aviation) medical care. As you know, such units work around the clock. The duration of the shift in this case can be 8 hours in a three-shift mode or 12 hours in a two-shift mode. The main thing is that the standard working hours for the month, quarter or year are observed.

When working in shifts, each group of employees must perform duties during the established working hours in accordance with the shift schedule, which is adopted taking into account the opinion of the representative body of employees and is brought to the attention of the staff no later than 1 month in advance.

The schedule is developed in such a way that the doctor, having worked one shift, goes on vacation, after which he will work on another shift. Sometimes the work schedule is tied to the dates of the month or days of the week: for example, Monday, Wednesday, Friday are the first shift, Tuesday, Thursday, Saturday are the second.

Please note that the number of hours worked in a month may not be the same as the normal number of hours worked in the same period if the schedule is for a quarter, half year or year. For example, if the standard hours for a health worker in the fourth quarter of 2013 are 467 hours, he can work like this:

The table shows: despite the discrepancy between the normal number of working hours in individual months and the number of working hours according to the schedule, in general, during the accounting period, the entire standard time was worked.

Quite often, medical workers work according to a schedule of days every other day, or the first shift on even days of the month, the second on odd days. Is this type of work shiftable? No, this work schedule is not shift work, although schedules are also drawn up for it. It's more of a flexible schedule.

2. Flexible working hours. This mode of operation is discussed in Art. 102 Labor Code of the Russian Federation. In particular, under this regime, the beginning, end or total duration of the working day (shift) is determined by agreement of the parties. In this case, the employer must ensure that the employee works the total number of working hours during the relevant accounting periods (working day, week, month, etc.). Let us remind you that the standard working time for a month, quarter, half-year or year is calculated in accordance with Order of the Ministry of Health and Social Development of the Russian Federation dated August 13, 2009 N 588n.

3. Duty at home - a medical worker of a medical organization stays at home while waiting to be called to work (to provide emergency or emergency medical care).

When taking into account the time actually worked by an employee of a medical organization, the time on duty at home is taken into account in the amount of 1/2 hour of working time for each hour of duty (Article 350 of the Labor Code of the Russian Federation). The total working time of a medical worker, taking into account the time on duty at home, should not exceed the standard working time for the corresponding period.

In addition, for certain categories of medical workers, other work modes may be applied.

Part-time work. Article 93 of the Labor Code of the Russian Federation determines that, by agreement between the employee and the employer, a part-time working day (shift) or a part-time working week can be established both upon hiring and subsequently. That is, the employee will work not 5 days a week, but, for example, 3, or the length of his working day will not be 7.2 hours, but 5.

Please note that the employer will not be able to refuse to establish such a work schedule for a pregnant employee, as well as for an employee if he:

- one of the parents (guardians, trustees) with a child under the age of 14 years (a disabled child under the age of 18);

- a person caring for a sick family member in accordance with a medical report.

Payment for an employee working part-time is made in proportion to the time he works or depending on the amount of work he performs. Moreover, such work does not entail for employees any restrictions on the duration of the annual basic paid leave, calculation of length of service and other labor rights.

Irregular working hours. This is a special mode of work, according to which individual employees may, by order of the employer, if necessary, be occasionally involved in the performance of their labor functions outside the working hours established for them. But this mode of operation cannot be established for every health worker. The list of positions of workers with irregular working hours is established by a collective agreement, agreements or local regulations adopted taking into account the opinion of the representative body of workers, and usually includes the heads of medical institutions - chief doctors and their deputies, as well as senior nurses.

Please also note that under any regime, a medical employee may have to work overtime - overtime.

Time tracking

Since the calculation of wages (for example, for overtime or night work) and the provision of certain guarantees and compensations (for example, milk is issued only on days of actual employment in jobs with hazardous working conditions) depend on the actual time worked, it is important to keep records of it.

Order of the Ministry of Finance of the Russian Federation dated December 15, 2010 N 173n approved the forms of timesheets that medical institutions should use to record working hours:

— form 0301008 — time sheet;

— form 0504421 — time sheet for recording the use of working time and payroll.

The report card in form 0504421 is maintained by persons appointed by order for the institution, monthly for the medical institution as a whole or in the context of structural units (divisions, departments, faculties, laboratories, etc.), separate units (branches). The timesheet opens monthly 2-3 days before the start of the billing period based on the timesheet for the previous month.

Please note! The report card form 0504421 records only cases of deviations from the normal use of working time established by the internal labor regulations. In the upper half of the line, for each employee who had deviations from the normal use of working time, hours of deviations are recorded, and in the lower half - symbols of deviations. Hours of operation at night are also recorded at the bottom of the line.

If one employee of a medical institution has two types of deviations in one day (period), the lower part of the line is written in the form of a fraction, the numerator of which is a symbol of the type of deviation, and the denominator is the hours of work. If there are more than two deviations on one day, the employee’s name is repeated in the report card.

Let us remind you that notes on the report card about the reasons for absence from work, work part-time or outside the normal working hours are made on the basis of documents executed properly (certificate of incapacity for work, certificate of fulfillment of state or public duties, written warning of downtime, written consent of the employee to work overtime in cases established by law, etc.).

At the end of the month, the employee responsible for maintaining the time sheet in form 0504421 determines the total number of days (hours) of absences, as well as the number of hours by type of overtime (substitution, work on holidays, night work, etc.) and recording them in the appropriate columns (35, 42, 43, 45, 47, 49, 51). The completed timesheet is signed by the person entrusted with its maintenance.

FYI. The report card of form 0301008 actually repeats the form of the T-13 report card, approved by Resolution of the State Statistics Committee of the Russian Federation dated January 05, 2004 N 1. Some institutions do not use this form, citing the said resolution, in accordance with clause 2 of which this form is not used by budgetary institutions. However, until the adoption of the new form of timesheet for state (municipal) institutions, timesheet form 0301008 may also be used.

The completed timesheet is submitted to the accounting department for calculations according to the appropriate columns. After approval by the head of the institution, the time sheet is used to draw up a payroll sheet (f. 00504401) or payroll (f. 0301010).

Summarized working time recording

In textbooks and articles in the media, you can read that working time can be recorded daily (the number of days worked per month is subject to recording, since the duration of work is the same, and work beyond this duration is considered overtime), weekly (applied if, depending on the specifics of the work, Only its weekly duration can be observed, and the time of daily work or shift is regulated by the schedule) and summarized. The first two types are not regulated by law, but let’s talk about summarized accounting in a little more detail.

Note. When recording working hours together, the accounting period cannot exceed one year.

Summarized recording of working time is introduced when, due to the conditions of production (work) in the institution as a whole or when performing certain types of work, the daily or weekly working hours determined for a given category of workers cannot be observed (Article 104 of the Labor Code of the Russian Federation). When establishing such an accounting regime, it must be remembered that the duration of working hours during the accounting period (month, quarter and other periods) should not exceed the normal number of working hours. The accounting period cannot exceed 1 year.

The normal number of working hours for the accounting period is determined based on the weekly working hours established for this category of workers. For persons working part-time (shift) and (or) part-time week, the normal number of working hours during the accounting period is reduced accordingly.

The procedure for introducing summarized recording of working time is established by internal labor regulations and is mainly relevant where there is shift work or flexible working hours.

2. The Ministry of Health of the Russian Federation, together with the Ministry of Labor and Social Protection of the Russian Federation, must provide clarifications on the application of this Resolution.

Judicial practice and legislation - Decree of the Government of the Russian Federation of February 14, 2003 N 101 (as amended on December 24, 2014) “On the working hours of medical workers depending on their position and (or) specialty”

3.1. For medical workers, in accordance with Article 350 of the Labor Code of the Russian Federation, a reduced working time of no more than 39 hours per week is established. Depending on the position and (or) specialty, the working hours of medical workers are determined in accordance with Decree of the Government of the Russian Federation of February 14, 2003 N 101 “On the working hours of medical workers depending on their position and (or) specialty,” other regulatory legal acts in force to the extent that they do not contradict the labor legislation of the Russian Federation.

Hello, dear friends. Today we will look at the working hours of medical workers according to the law. The main document establishing the length of time all doctors work is Decree of the Government of the Russian Federation No. 101 of February 14, 2003.

The number of hours worked per week depends on the group to which the employee belongs. There are 4 groups of health workers, the length of time worked varies depending on the presence of dangerous, harmful conditions in the workplace. Let's look at these groups.

Highlights

I would like to immediately note that the division into these groups was made on the basis of the Labor Code of the Russian Federation. The smallest group is health workers servicing radiomanipulation equipment with gamma radiation: 24 hours per week or 4.8 hours (4 hours 48 minutes) per day in a 5-day week.

They practice gamma therapy and gamma irradiation using special techniques. This is a very dangerous profession for health, therefore this group of doctors also has the right to an increased duration of the next vacation, preferential service upon retirement and additional payment for harmful conditions.

Second group

The next group of doctors should work 30 hours a week or 6 hours a day with a 5-day week. This group includes the following employees:

• Institutions involved in the treatment of tuberculosis diseases, including all workplaces that have contact with patients for this type of disease.
• Mortuaries, autopsy and pathological-anatomical laboratories - all employees who have the opportunity to contact corpses.
• Expert groups that carry out actions to confirm the presence of tuberculosis diseases in patients.
• Forensic medical experts who come into contact with corpses and their parts.
• Services that collect and store cadaveric blood.
• Units that come into contact with X-ray radiation (fluorography), radioactive substances used in gamma examinations.

Third group

In this group of doctors, the reduction in work time is 33 hours per week or 6.6 hours (6 hours 36 minutes) per day with a 5-day week.

All doctors who perform initial and repeated appointments with patients in clinics, employees of physiotherapy departments, servicing devices at ultra-short wave frequencies above 200 W, and all dentists, except those involved in jaw or dental surgery, are related to it.

Everyone else

The fourth group includes the majority of health workers who receive and treat patients. Their working week is 36 hours or 7.2 hours (7 hours 12 minutes) per day. These are doctors, nurses and orderlies (except for those involved in statistics and archivists):

• Organizations treating infectious and dermatovenerological diseases.
• Leprozoriev.
• Organizations providing treatment, maintenance and examination of patients with AIDS and HIV-infected people.
• Laboratories that have contact with the blood of patients with AIDS and HIV-infected people.
• Psychiatric, neurosurgical and drug treatment organizations that examine and treat patients with these diseases, in addition to social organizations to help people left homeless.
• All children's medical organizations that care for disabled children, children with mental and nervous diseases and the mentally retarded.
• Physiotherapeutic services serving hydrogen sulfide and sulfur baths, mud peat and ozokerite hospitals that have contact with hydrogen sulfide and sulfur gas, preparing mud baths and cleaning after them.
• Expert groups having contact with patients with signs of mental illness.
• Ambulance stations and other types of emergency assistance, also involved in the delivery of mental and infectious diseases to special hospitals.
• Sanitary-epidemiological and anti-plague organizations.
• Blood transfusion stations.
• Organizations involved in the rehabilitation of drug addicts and alcoholics.
• Services that come into contact with radioactive liquids and x-rays.

Some exceptions

As you can understand, for health workers in clinics, hospitals and sanatoriums, kindergartens and schools, if they do not fall into the above groups, the working time is within 39 hours per week or 7.8 hours (7 hours 48 minutes) per day with a 5-day week.

When a health worker falls into one of the groups entitled to a reduction in working hours according to the Labor Code of the Russian Federation (disabled people under 18 years of age, etc.), then his working day corresponds to the duration in this group.

For women working in rural areas, the established working week is 36 hours, regardless of the work performed, unless they belong to groups with a shorter working day.

We calculate the graph

Some difficulties arise regarding the payment of part-time jobs and overtime according to the schedule. Health workers are allowed part-time work in the amount of half the monthly salary.

It must be borne in mind that if a doctor is given a standard of, for example, 36 hours a week, then half the rate is 18 hours and no more. If there are unfilled vacancies, it is allowed to combine one more full-time position.

When organizing round-the-clock duty, a schedule is drawn up that takes into account the monthly standard of hours, which can be specified in the production calendar or calculated independently.

For example, with a 36-hour work week, the monthly norm would be 172 hours, and the 24-hour schedule would look like this:

1st employee

2nd employee

3rd employee

4th employee

5th worker (replacement)

1st employee

2nd employee

3rd employee

4th employee

5th worker (replacement)

Where 12 is the day shift, 12 is the night shift. A replacement worker (fifth) is usually needed in the absence of the main employee (regular vacation, sick leave). If all the workers are on site, there is a shortage of normal hours.

All changes within a medical institution regarding working hours are made by order 2 months before the start of its effect, with the simultaneous execution of a corresponding change to the employee’s employment contract.

Compared to the Soviet period, there were no significant changes in the working hours of medical workers; only new positions and professions were added to the lists. The only deterioration was the limitation of payment for night hours (from 22-00 to 6-00) to 20% of the tariff and salary.

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