Monetary tips from patients continue to supplement their salaries. Some doctors also supplement their incomes with part-time jobs outside of their profession. Problems also persist regarding the training of doctors. From the time they entered medical school they were trained in separate programs to be pediatric doctors, adult doctors, and public health doctors, rather than generalist doctors. While the training system has now changed to train generalist doctors first, and then specialists, the transition is slow.
Many Russian citizens receive primary care and many specialty services in polyclinics.
Patients may, however, bypass the primary care doctor and see a polyclinic specialist. While women doctors dominate both primary and specialty care in the polyclinics, hospital specialists are mostly men. Russia has more types of specialists than other countries. Since specialists are paid more than primary care doctors, there was an incentive to develop more specialties and also for doctors to become specialists. Russian hospitals tend to be crowded, and do not offer the amenities to which one might be accustomed.