'Siin me oleme': Young family doctors not keen on taking over practices

Le Vallikivi, head of the Estonian Family Medicine Association.
Le Vallikivi, head of the Estonian Family Medicine Association. Source: Priit Mürk/ERR

Shortage of family doctors has reached a point where aging doctors are working unto poor health and even death instead of retiring with dignity. Patients need to count on appointments becoming increasingly difficult to get in the future, documentary series "Siin me oleme" revealed.

Family doctor Hilja Priuhka (68) has decided to hand over her practice and its over 2,000 patients in the Valga Municipality of 15,400 residents.

"I'm giving away my practice. I believe I can retire now, since I'm already a pensioner," Priuhka explained. "There is no shortage of work, with more coming every year, and I have begun to think that there is more to life."

But surrendering a practice is not that simple in a situation where no replacement can often be found. A local doctor's decision to retire often ends in attempts to convince them otherwise.

Väike-Maarja family doctor Mall Lepiksoo (74) whose practice comprises over 2,500 people said that she cannot retire knowing her patients would be left without a doctor and that she has been looking for a young replacement for years who would need to work with her for a few years before they could hope to taker over a practice with so many patients. A corresponding initiative, dubbed the Health Insurance Fund's incubation project, has recently been launched.

She proposed having medical students work a year in first-contact care after graduating from medical school. "Some would definitely choose the profession after that."

"Patients look at you with their sad eyes and ask you to stay a while longer," head of the Estonian Family Medicine Association Le Vallikivi said. "People who still have some strength left usually try to hold on."

Vallikivi described the shortage of family doctors a quite critical. "Yes, we have doctors who want to retire but cannot. They work well past the retirement age and with serious medical conditions; they are quite burnt-out, so the situation is not good."

Almost half – 48 percent – of Estonia's 735 family doctors are over 60 years of age, in other words, close to the retirement age or already receiving a pension; 11 percent are over 70, meaning that family doctors are literally working until they die.

The number of family medicine practices has fallen from 805 to 786 in the past ten years, with 20 practices either merged or closed. In around 50 practices, an assistant doctor is doing the work, meaning they lack a dedicated family doctor. Some competitions fail to attract a single applicant, while some practices no longer even bother to hold competitions to find a new doctor.

Heli Paluste, head of the healthcare network at the Ministry of Social Affairs, said that family doctors are in critically short supply everywhere outside Tallinn and Tartu. She added that 28 family doctors graduated last year and 17 the year before that, while both years saw competitions looking for 20 doctors. However, an analysis from a few years ago found that less than half of family medicine graduates took up practices. Running a family medicine practice entails more than medical work, including finding one's own replacement and taking care of the business side of things, Paluste said in terms of why graduates are reluctant.

Young family doctors take jobs in private companies, hospitals, emergency response and as replacement doctors who qualify for additional compensation. This despite the fact that family doctors working in rural areas are entitled to so-called distance pay to compensate for longer commute times that was hiked by several times recently. There is also a starting out benefit for doctors willing to work in more remote areas, as well as a recently introduced possibility for young family doctors to apply for a smaller practice list. Local governments also offer compensation and incentives for new doctors.

Rapla family doctor Andres Lasn, who communicates to and from work from Tallinn, driving 65 kilometers twice a day, said that young doctors and other specialists are more likely to work in rural areas if they are from those same places to suggest that making sure more people from rural areas get a higher education could help remedy the situation in the long run. He also said that a stronger social system, for example, one that could effectively bring patients to and from the doctor from further away could be another solution.

The Ministry of Social Affairs is working on draft legislation to move family doctors from the administrative area of the Health Board to that of the Health Insurance Fund, in other words, to where funding comes from.

Le Vallikivi said that while a lot of positive effort has been made in recent years, it will take time for results to manifest.


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Editor: Marcus Turovski

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