In a Monday TV interview, Moscow Mayor Yury Luzhkov said Russia could reinstate direct elections for governors in the regions as a more democratic method of selecting regional leaders.
Currently, the heads of Russia's 89 regions are nominated by the president and approved by the regional legislature.
"Changing it [the gubernatorial election system] is both unrealistic and unacceptable," Medvedev said. "Should any governor find it inadequate, they should understand they are not private individuals and can offer me their resignation."
However, Medvedev said some leverage should be imposed on governors to make sure their work is efficient.
"This issue can be settled through public, representative bodies, so that a procedure be established for swift and effective dismissal. I think this procedure fully complies with the Constitution and can be put into practice," the president said.
The 2004 decision made by the then-President Vladimir Putin to abolish direct elections for regional leaders in favor of presidential nominations fueled Western criticism that Russia was backsliding from democracy. Putin said the move was needed to ensure stability in the country.
