In Russia’s Provinces, the Doctor Is in (the Streets)

OKULOVKA, Russia — With his mop of white hair and soft surgeon’s hands, Dr. Yuri I. Korovin hardly fits the image of the typical Russian street protester.

But spurred into action by his tiny and shrinking paycheck, Dr. Korovin recently joined colleagues in a strike organized by a newly formed doctors’ union affiliated with Russia’s main opposition politician, Aleksei A. Navalny.

“It’s not good to make money off the sick,” he said wryly in the hospital in Okulovka, a town of about 12,000 people north of Moscow. But, like many other doctors in Russia, he would like to make more.

The strike and street protests by doctors and ambulance medics here were among dozens of labor actions that broke out this spring in Russia over bread-and-butter issues like garbage disposal, poor roads, corrupt local officials and the quality of medical care.

The medical workers’ union, called the Alliance of Doctors, has opened branches in 20 regions of Russia since it formed last summer and has staged about a dozen protests nationwide since then.

For now, few expect the protests to change much, as President Vladimir V. Putin remains broadly popular. But the brush fires of provincial discontent highlight the disconnect between Russia’s chest-thumping rise abroad and its stagnating economy at home. After five years of declining wages, adjusted for inflation, Russians are taking notice.

Russia ranks 73rd in the world in per capita gross domestic product, between the Seychelles and Greece. In one measure of the hard times for many, Russia’s state statistics agency this year released a survey showing that about a third of Russians could not afford a spare pair of shoes for the winter. An additional 21 percent said they could not afford to buy fresh fruit regularly.

“A very natural thing is happening,” Ekaterina Schulmann, a political scientist at the Russian Presidential Academy of National Economy and Public Administration, said in a phone interview. “The worsening economy, the declining real wages, is souring public opinion.”

Just two hours from Moscow by train, Okulovka might just as well come from a different century. As the town sinks slowly into the swampy ground on which it was built, wooden houses lean at odd angles on their sagging foundations, water pools in the roads, and wind blows through the broken windows of a partly abandoned paper mill.

About a third of those houses have no indoor plumbing, the authorities in the surrounding Novgorod region say. Life expectancy in the region, 64 years for men, is the third-lowest in Russia.

One issue gaining traction in particular is the impoverishment of doctors in rural Russia. After a medical procedure, it is more often the doctor than the patient who winds up with sticker shock — not because the payments are so outrageous, but because they are so small.

Dr. Korovin, who is paid about $8,670 a year and extra for after-hours operations, recently treated a man with a stab wound to his lower abdomen.

“The guys were drinking, they were relaxing somewhere and, well, this happened,” he said with a shrug.

For that hour-and-a-half, after-hours operation, the hospital, which is funded by Russia’s state-run insurance program, paid Dr. Korovin 500 rubles, or $7.70.

In their strike, doctors and nurses demanded that the local authorities fulfill a decree signed by Mr. Putin that doctors be paid twice the average salary of the region where they work. Double the average annual salary in the Novgorod region would be 744,000 rubles, or $11,448, well above Dr. Korovin’s salary.

For a physician in the United States, the average salary last year was $313,000, according to a report by Medscape, a publication for doctors.

“I voted for Putin; we all voted for Putin,” said Dr. Korovin, the only remaining surgeon in town. But his salary, never much to brag about, has gone down, he said. “I never thought I would have to protest.”

Local officials say there is simply no money to comply with the decree. Regional governments compensate hospitals according to fee schedules. In Novgorod, these are tiny: for example, $12 for a consultation with a cardiologist and $8 for a consultation with an urologist, according to a spreadsheet provided by the regional government.

But expressing dissent over this state of affairs is dangerous, even far from the capital.

Just a few stops up the railway line from Okulovka, in the same belt of economically depressed provincial towns in northwestern Russia, a court fined an unemployed man, Yuri D. Kartyzhev, $470 for an online post calling Mr. Putin an obscene form of the Russian word for dimwit, under a new law prohibiting insults to state symbols or officials.

“I’m not the only one upset,” he said in an interview in his kitchen overlooking a tableau of mud and collapsed wooden sheds in his back yard. In the interview, he was careful to avoid most obscenities, now a prosecutable offense, but said he had not changed his views.

“You could put a monkey in the Kremlin and get better results,” he said. “They think I’m a failure, that I didn’t make anything out of myself. But they didn’t make anything out of me, out of us.”

The doctors’ strikes, in contrast, have not provoked a harsh crackdown so far. If they were fired or arrested, the doctors say, who would be willing to take their places for such low pay?

The answer, increasingly, is nobody. Doctors are leaving provincial towns and cities in droves, heading for the higher paying areas in and around major cities, particularly St. Petersburg and Moscow.

In Novgorod region, hospitals already have 229 openings for doctors, according to Anna Cherepanova, a City Council member in the regional capital with the opposition party Yabloko.

In Okulovka, two surgeons quit this year, leaving only Dr. Korovin, a general and colorectal surgeon. Declining to work is out of the question. Under Russian law, Dr. Korovin said, it is illegal for a doctor to refuse care.

The labor action was a work-to-rule strike, sometimes known as a work slowdown, when employees carefully fulfill requirements laid out in their contracts but no more. The strike petered out this month with promises of slightly better wages.

On a recent, drizzly day, Dr. Korovin examined an older man who had broken a rib in a fall. He tended another man’s cut foot.

Within minutes of a reporter’s arrival at the hospital, the police and a local City Council member turned up — but ended up sympathizing with Dr. Korovin.

Dr. Korovin, 61, says he seems to have treated everybody in town at one point or another, including the City Council member, Andrey Karpushenko, whose appendix he removed a few years back. The two reminisced about the event.

“Of course, we need to raise salaries,” Mr. Karpushenko said.