The Health Board has announced nine competitions for family doctors to take over practice lists. Of these, four are repeat competitions, meaning a previous competition failed to attract a family doctor to take them over.
The Health Board is seeking family doctors to take over practice lists in Tallinn, Pärnu, Rakvere, Jõhvi Municipality, Kehtna Municipality, Tõrva Municipality, Mulgi Municipality, Viljandi and Viljandi Municipality as well as a new practice list in Viimsi Municipality. Even without Viimsi, these practice lists include a total of nearly 12,600 people.
As of Tuesday, 54 of Estonia's total of 785 family medicine patient lists are currently being served by a temporary substitute. In other words, no patients are currently going without access to a family doctor. Doctors themselves nonetheless find that the substitution issue remains unresolved, or that the solution isn't having an impact.
Not enough new family doctors
The healthcare worker shortage, particularly in rural regions, has been a pressing issue for years already. According to Health Board figures, the highest number of temporary substitutes serving patient lists are currently in Lääne-Viru, Võru, Pärnu and Valga counties.
Katrin Palover, a family doctor with over 20 years of experience working in Southern Estonia's Valga County, told ERR that the main reason the country isn't seeing an increase in young new family doctors is foreign competition.
"A young person would rather go to Northern Finland and get paid €5,000-6,000 for seven shifts," she said.
Palover said that young people are afraid of the family doctor profession, and added that they have no incentive whatsoever to remain in Estonia.
"A family doctor is typically either a private limited liability company (OÜ) or a self-employed person (FIE), which means that sometimes they have to buy everything from a chair to cleaning clothes themselves," she explained. "You have five jobs: you're a driver, an accountant, a businessperson, a doctor and occasionally a nurse as well. You're shouldering a huge responsibility, and no one is really thanking you for it either."
Palover, who herself has nearly 2,000 people on her patient list, also spoke of patients' dismay when they discover that they're being seen by a substitute doctor as their own doctor is on vacation.
Issues with family doctor training
Ruth Kalda, professor of family medicine and family medicine residency general supervisor at the University of Tartu (TÜ), said that the family doctor shortage has resulted from the fact that at one point, family medicine residencies were very limited, and the system still hasn't managed to catch up with the deficit. Moreover, family doctors over 65 years old are retiring, and young people aren't consistently graduating.
The Ministry of Social Affairs responded recently by increasing the number of residency spots to 40.
According to Kalda, family medicine is their biggest specialty. "While other specialties accept one, two or three [students], some 34-35 join family medicine," she said. Thus, the problem clearly isn't a lack of interest.
TÜ's 360-credit medical degree program is six years long. Of these studies, two courses totaling seven credits focus on family medicine. Two courses likewise worth a total of seven credits also teach patient communications. None of these, however, teach family doctors how to manage themselves.
According to Palover, there are doctors working across Estonia who haven't managed to keep up with their practice list. "That isn't right," she said. "Doctors should be trained from day one — discuss accounting and so on. So many more people would want to work as family doctors, since the pay is actually better than for doctors working under a hospital."
Vivian Alles, who has worked as a family doctor in Tartu for 25 years, said that she delegates her non-medical responsibilities, such as accounting and other administrative work, to others.
"If you don't want to deal with it, then find someone who will," Alles said. She acknowledged that it isn't always easy to find people to do this work, but it's always possible to figure something out.
Med school should include business
Alles believes that prior to choosing family medicine, young people need to be aware of the realities of the job. "Under the current system, the time spent in a family medical center is unbelievably limited," she said.
"In Finland, future family doctors spend nine months at a family medical center," she described. "In that time, a young doctor is able to learn their job and gain a broad medical knowledge base ranging from eye diseases to immunology. This way they see how exciting this specialty really is — always difficult, but so interesting! The more they see the actual work, the more likely they will be to choose this specialty."
Kalda, who herself also works as a family doctor, thinks young doctors may end up bogged down by the business side of things, especially if they are working independently, not at a family medical center, where administrative and financial work are handled by a dedicated staff member. She believes that the university should include more family medicine — and prior to graduating med school already. The question, however, is which courses to expand, and at the expense of what else.
The family medicine professor noted that TÜ's med school intends to start cooperating with the university's own School of Economics in order to introduce skills such as finance and launching a business into the curriculum. The university also wants to involve family doctors already operating as business owners as well.
Living out of their car
According to Palover, patients have the right to criticize their doctors and challenge their decisions. She also noted that patients will often show up at the doctor's office after surgery and start bombarding their family doctor with questions that they were afraid to ask the surgeon directly.
She added that family doctors often don't receive the same recognition as their specialist colleagues. "We're specialists with a broad profile," said Palover, who herself has previously worked as a pediatrician and an ear doctor. "Sometimes your entire life is packed in the trunk of your car. One day you might have to pay a house call with equipment and image a patient's heart there. In order to diagnose at all, a family doctor has to be a combination of all different surgeons — only then can a patient be referred to a specific specialist."
A family doctor's professional responsibilities vary a great deal.
"Family medicine is a bit like emergency medicine," Kalda said. "But what emergency medicine doesn't have is consistent preventive care. A family doctor is responsible for a patient as a whole. For example, people with chronic illnesses require regular monitoring, not just during a specific episode."
Kalda added that as most doctors working in family medicine are women, who often end up at home with children during their residencies, they aren't eager to take up a practice list immediately upon graduating — as doing so demands a great deal of responsibility and a lot of time spent away from home. As a result, family doctors tend to take up practice lists later in their careers.
Editor: Aili Vahtla