Head of the Estonian Family Medicine Association Le Vallikivi criticizes the Conservative People's Party's (EKRE) pharmacy reform proposals on ERR's "Otse uudistemajast" webcast and sheds light on fundamental and material aspects of the work of family physicians. Defending family doctors' proposal of allowing people to go on sick leave without a doctor's certificate during the first three days, Vallikivi says that people can easily fool doctors to go on sick leave as things stand.
"It is harebrained – it's as if no public debate has ever taken place," Vallikivi said when asked what she thinks about the idea to give family doctors the right to sell medicines. "We have only just managed to get rid of salesmen advertising drugs. We have said we will not attend biased trainings, accept free pens. We do not know how and don't want to do it. No one asked us," she said.
Vallikivi was also critical of allowing the sale of drugs outside pharmacies. "Everyone could take it up – supermarkets, veterinary shops, soothsayers, movie theaters etc.," she said. The family physician said that pharmacists spend five years in the university, while the profession is seen as just another business with no deeper meaning or value.
"If I'm your doctor and you're my patient, you expect me to make choices that are best for you and not based on what we could sell you. That is at the heart of the matter," she emphasized. In addition, the pharmacy reform is meant to ensure general availability of medicinal products, a solid selection and to avoid a certain drug running out suddenly and for unknown reasons.
"Health information is not equally available to the patient and a medical worker. It is easy to put on a white coat and sell something. It cannot be allowed," she said.
Commenting on host Indrek Kiisler's note that at least over the counter drugs could be sold outside of pharmacies because patients do not ask pharmacists about them, Vallikivi said that it would be wise to consult with pharmacists also when buying such products as their effects could depend on other drugs the person takes or simply to get more information on what's ailing them. "It is quite possible to kill a person or bring about brutal coeffects using conventional drugs," Vallikivi said. "Shops could sell cough drops, not medicinal products," she added.
At the same time, Vallikivi said she is not convinced pharmacists could give people medical advice. "The problem there is that pharmacists have not been trained to look, touch and smell people. They talk to people when they're wearing coats. That situation is a little dangerous from the patient's point of view. Just as we (family doctors) don't want to sell drugs," she said.
Family doctors receive over €10,000 a month from the Health Insurance Fund
Asked about the income of family doctors, Vallikivi said that a family physician receives a little over €5 a month per person on their patient list or a little more for elderly people and children. This means that in a situation where the average list has 2,000 people, a family doctor takes in over €10,000 a month, Kiisler said. Vallikivi agreed but emphasized that the money is used to pay salaries of doctors and nurses, as well as rent and utilities.
"Family doctors make more than the average salary, but they rank low among doctors, alongside rehabilitation doctors and psychologists," Vallikivi said. The minimum salary of doctors is around €2,300 a month, she added. "We are not living large, while we also can't complain," the head of the Estonian Family Medicine Association said.
Vallikivi emphasized that tests have a separate budget, and it's not a sum doctors get to keep if there's anything left over.
To save on costs and work more effectively, around half of family doctors work in family medicine centers. This allows a doctor to maintain reasonable working hours, attend trainings and maintain their mental and physical wellbeing, she said. "It is teamwork that makes it possible to perform tasks successfully while keeping one's mental and physical health."
Patients have become smarter
Talking about how patients have changed over the past 20 years that she has spent working as a family doctor, Vallikivi said that many are better prepared coming in for an appointment thanks to "Doctor Google." "Patients are getting smarter and it is making work easier. That said, there have always been people who search for diseases to have and still are," she admitted.
Vallikivi said that pensioners are diligent patients, while some parents have become a little more helpless. "Perhaps it is because families are smaller and do not exchange as much information anymore," she said.
Vallikivi also talked about family doctors' work organization and how it could be possible to reduce the workload of emergency rooms of hospitals.
Fooling a family physician not rocket science
Commenting on why the association proposed allowing people to stay home for up to three days without a sick leave certificate, Vallikivi explained that such situations could be solved between the employer and the employee. It is also very easy for people who do not want to go to work to fool family doctors if they're willing to lie about their condition, she added.
"Every office has those who would prefer to do something other than work," she said. Vallikivi said that people are generally motivated to work because the current system is effective. "But there are other kinds of people too. Fooling a doctor is not rocket science. It's the same as a child telling their mother they feel ill," she said.
People – both employees and employers – need to look in the mirror to answer the questions of why am I looking to skip work or why do people not want to come in to work in my company," the doctor said.
Editor: Marcus Turovski