Members of Haapsalu city council's social and legal affairs committee Helle Saarsoo, Peeter Vikman and Merle Mäesalu proposed supporting a family physician with their own patient list with €25,000 from the city's 2020 budget, local paper Lääne Elu reports.

Mayor of Haapsalu Urmas Sukles told ERR he feels creative about the proposal and has consulted with family doctors and the Health Board.

"In any case, such an initiative could be a positive thing," he said.

Sukles explained that the money is not the issue and that what the city needs to figure out is how to make the sum work in a way to really attract new family doctors to work in Haapsalu – family physicians are in short supply all over Estonia. The mayor added that while ensuring availability of healthcare is a state-level task, the local government could lend a hand.

"So, I believe the initiative might even work. What also works is that Haapsalu has one of the best living environments in Estonia, and if we could also offer family doctors accommodation, we would have quite a competitive package," the mayor said, adding that the city is also working on the latter possibility.

The family medicine crisis in Haapsalu took a turn for the worse earlier this year when a retired doctor's patients were taken over by the Terviseagentuur family medicine center run by family doctor Madis Tiik. The company offers people family nurse visits or the possibility of consulting with a doctor in Paide via video conferencing. Dr. Tiik visits Haapsalu once a week.

The Health Board has a six-month contract with Terviseagentuur, with Sukles saying that while he has so far only encountered criticism regarding video consultations, the solution is not all bad upon closer inspection and can be used as a temporary option.

Sukles could not say when the motivational package for attracting new doctors could be finalized. The city first wants to work out what the money could buy and how to distribute it.

"Giving family doctors a lump sum of €25,000 would not be the most sensible thing. If we just gave the money to the person, the state would take half of it in taxes. But the initiative is a good one, and I believe we will turn it into something quite nice," Sukles said.

Motivational packages for family doctors not common

Data from the Health Board suggests local governments offering family physicians support are few and the practice is not commonplace.

One municipality where a support scheme is in effect is Tapa. The municipality council decided to offer support for existing and new family doctors last year.

A new family physician is paid €5,000 when they start work, while all family doctors get €1,000 a year for expenses and general physicians coming to Tapa from abroad get up to €1,000 as a one-off measure.

The support is meant to cover costs of language classes and accommodation, while expenses receipts are required. Accommodation is also offered if necessary.

Head of communication for the Health Board Simmo Saar said that local governments are not obligated to offer family doctors motivational packages, while the latter do play a part in attracting doctors and could prove decisive.

"Just as it is with their capacity to find businesses, the attractiveness, resources and motivation of local governments for finding solutions to attract family doctors differ," he found.

University of Tartu training more family doctors than before

Public procurement for family medicine residency positions has increased in recent years, from 25 places in 2015 to 35 places last year.

Ruth Kalda, professor of family medicine and head of family medicine residency at the university, said that admissions should not be increased to a notable degree, and that it is more important to make sure residents graduate.

"Graduation is often postponed due to having children and sometimes as a result of illness, while allowing part-time residency could offer a better chance of marrying work and family life," she said.

Fifteen doctors graduated from family medicine residency last year, 14 the year before. Four students dropped out last year, with six failing to graduate in the two previous years.

Kalda said that the problem in Estonia is not so much shortage of family doctors or that too few are trained but the fact people prefer to work in larger cities and not where there is a shortage of doctors: Valga County, Võru County, Ida-Viru County, Lääne-Viru County and the western Estonian islands.

"It is not a matter of doctor training but regional policy – a question of motivational mechanisms and support networks," Kalda found.

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