The Health Insurance Fund (Haigekeassa) says it is prepared to pay family doctors overtime for evening and weekend work. Doctors, however, say the sums offered are too small, adding that people are not keen on going to the doctor in the evening, while at the same time it would not solve hospital emergency departments overload problems.
There are close to 400 family medicine centers in Estonia, while last year the Health Insurance Fund paid just 23 doctors extra overtime, for seeing patients after 6 p.m. and at weekends, ETV news show "Aktuaalne kaamera" (AK) reported.
The Laagri health center (tervisekeskus) works from 8 a.m to 6 p.m., and its director, Triinu Mari Ots, says she does not consider the extension of the working day to be justified.
Ots told AK that: "At present, if we wanted to widen our reception hours to 7 a.m. to 8 p.m., the Health Insurance Fund could indeed pay for that, but it is not a figure that would attract any doctors."
The meager nature of the overtime on offer and the shortage of family doctors are, however, not the only reasons why Ots does not consider extending working hours to be rational.
"It is completely pointless to duplicate two systems. We are not such a rich country that we can afford staffed care at ER in hospitals, but also in family medical centers," she said.
Le Vallikivi, head of the Society of Family Physicians (Perearstide selts), says longer working hours would not solve the concern with ER overload, as they are most cases present when family doctors are at work as well.
"If you close the lab at four in the afternoon, the X-ray department at three, you end up being somewhat of an old-school doctor … Is there any reason to arrange an out-of-hours appointment [beyond that time at a family doctor[ if you have to tell the patient to come back tomorrow anyway, so we can take X-rays , blood samples etc." Vallikivi said.
There is currently no social agreement on when presenting at ER is accepted and when it is not. Attempts have been made to come up with one, but so far this has remained at leaflet advice level. "Be it a family doctor, or an ER room". What was agreed there did not end up being mandatory, and, according to Vallikivi, patients are still not sent home from ER until they have been thoroughly checked out.
Melita Väljamäe, a family nurse in Pirita, said more should be done to educate patients, so that they know when help is needed and of what kind. According to Väljämäe, there are also those who can't figure out how to reduce a fever on their own.
Väljamäe said: "The primary need for later opening times is to get to see a family nurse instead, because the majority of admissions in the current season concern viral diseases, which are known to be relatively self-repairing," she said.
The creation of on-call clinics in the capital is currently under consideration, however. Marko Tähnas, from the Health Insurance Fund, said that this solution still requires a prior assessment of the patient's concern.
"Simply creating a clinic whose doors are constantly open, where you can walk in whether this is a medical worry or not; maybe that's not the right way to do things. The right way, instead, is to receive pre-triaged patients," he told AK.
Editor: Andrew Whyte, Merili Nael