In 2017, Vladimir Sotnikov graduated from Tomsk Medical University and joined the government's Rural Doctor program, an initiative aimed at encouraging young medical professionals to work in remote rural locations.
Sotnikov was sent to his home village of Aleksandrovskoye in a remote northern corner of Tomsk Oblast, nearly 1,600 kilometers from the provincial capital. The local, 77-bed hospital serves the entire, sparsely populated region.
"My friends and relatives were there," Sotnikov said, recalling his joy at being able to return home. "Everything was familiar to me. I was glad to go back to my home."
Two years later, however, Sotnikov is frustrated and disenchanted.
"In school, they taught us to heal people. But in this hospital, we just forget about being doctors," he said. "All they want is to be able to send positive statistics to their bosses."
He cited a recent "unofficial order" to register all heart-disease patients over the age of 60 as suffering from other illnesses.
"That's how they reduce the mortality from heart disease, and officials can go on television and report that everything is fine here, that people live long and happy lives before dying of old age," Sotnikov said.
Sotnikov described some of the hospital's practices as immoral, and others as outright illegal. Three times, he told RFE/RL, he was ordered to fill out false death certificates; after that, he refused. He said he was given two reprimands after challenging this and other hospital practices, after which he was fired.
The 30-year-old is challenging his dismissal in court. If he loses, he will have to repay the 1 million rubles ($15,200) he was given by the government as a Rural Doctor program incentive. What's worse, Sotnikov said, his medical career will likely be over.
"If they fire me, I won't be able to work as a doctor anymore -- no one will hire me with such a reputation," he told RFE/RL. "It doesn't matter that there's a shortage of qualified personnel in Russian medicine and hospitals are begging for young doctors."
The Russian government created the Rural Doctor program in 2012 to cope with a catastrophic shortage of qualified medical personnel far from big cities. The Health Ministry reported that the number of doctors in rural areas had declined by 4 percent in the five years before the program was created.
Under the plan, young specialists receive a lump payment (worth $30,500 when the program began and $15,200 now) for agreeing to work in a rural health facility for at least five years. Local health departments often provide additional incentives as well.
Although the Health Ministry has not released comprehensive data on the program, it has been considered a success generally and the government says "thousands" of doctors have participated.
In his February 20 state-of-the-nation address, President Vladimir Putin praised it and called for its expansion to include older doctors. He conceded that a shortage of personnel remains a critical issue for rural health care.
But recent months have brought increasing indications, like the Sotnikov case, of problems in the Rural Doctor program. On March 1, a local official in the Karymsky Region of Zabaikalsky Krai, in the Far East, complained that many program participants were giving the government its money back and leaving.
"We had high hopes for the Rural Doctor program," regional deputy chief of staff Valentina Kuznetsova was quoted as saying, "but unfortunately people are giving their million [rubles] back and leaving the region. Generally, this is because of poor working conditions, a lack of modern equipment, and a lack of housing for medical workers. In the past 15 years, the region has given young doctors 11 apartments -- but they do not belong to the region. The doctors privatize them, sell them, and leave."
As a result of personnel shortages, medical facilities in the remote region are being closed down.
"We want to work, but a lack of staff prevents this," local midwife Svetlana Lukyanova told a local television station in late February.
In Tomsk Oblast, where Sotnikov worked, Deputy Governor Ivan Deyev told journalists on February 6 that 700 doctors had been deployed to the region since the Rural Doctor program began in 2012 and 20 percent of them did not complete their contracts.
"There are various reasons," Deyev said. "Some don't like the remoteness; some are not prepared for the conditions. We often get doctors from the European part of Russia who aren't used to temperatures around minus-40 Celsius."
In the town of Susuman in Magadan Oblast, the average age of doctors at Susuman District Hospital is about 75, the hospital's head doctor, Igor Samsonvich, told local media in January. Samsonovich said the main problem is that the Rural Doctor program has not been activated in the region, and young doctors are drawn to other areas instead by the promise of 1 million rubles.
Local residents, Samsonvich said, often travel 100 kilometers to the village of Yagodnoye -- or even further, to Magadan itself -- to see a doctor.
In Nizhny Novgorod Oblast, surgeon Yury Korovin, who works at a hospital in Okulovka, complained to the independent Alliance of Doctors trade union that Putin's orders to support local medicine are being ignored and, instead, facilities are being shuttered.
"We have two doctors who came to us and who were supposed to get 1 million rubles from the Rural Doctor program," Korovin said in an interview that was broadcast on the YouTube channel of opposition politician Aleksei Navalny. "But they haven't received anything."
"We have many cases where participants were not paid anything under the program," Alliance for Doctors Director Anastasia Vasilyeva told RFE/RL. "Bureaucrats are trying to squeeze the money, and so they find reasons."
Vasilyeva said she knew of a similar case in the far western Kaliningrad Oblast.
There, 39-year-old Marina Cheremisina is facing criminal embezzlement charges. Six years ago, she and her family moved from Omsk to the city of Bagrationovsk under the Rural Doctor program. She got her million rubles and used it to buy a plot of land where they planned to build a house. But in June 2017, two months after her fourth child was born, Federal Security Service (FSB) agents showed up at her door. According to prosecutors, Cheremisina defrauded the state by working the first two years of her Rural Doctor stint in Bagrationovsk, which is too large to qualify for the program.
Cheremisina explained that she was originally assigned to work at a village hospital in Dolgorukovo, about nine kilometers from Bagrationovsk. But that hospital was administratively part of the city hospital in Bagrationovsk, and after she had worked in Dolgorukovo for a few months the director of the hospital in Bagrationovsk ordered her to work temporarily for him because of a critical shortage of doctors. Local health officials knew about the assignment and signed off on her documents.
For the last two years of her Rural Doctor stint, she worked a hospital in the village of Nivenskoye, about 25 kilometers from Bagrationovsk. She received a commendation for excellent work and her Rural Doctor contract was extended to make up for the time that she had worked in the city. She was working under the terms of that extension when the FSB came calling.
Now the mother of four faces up to 12 years in prison if convicted on two counts of embezzlement. She is being asked to repay the 1 million rubles plus 790,000 rubles that she earned as salary during the period in question.
"I am 100-percent certain that in the case of this Kaliningrad doctor, the government is trying to get out of its obligations," Vasilyeva told RFE/RL. "I am ready to defend this doctor -- the situation is unprecedented."