After going out to watch family doctors work for the first time, the Estonian Health Insurance Fund (Tervisekassa) concludes that some reorganization is needed to leave doctors with more time for treating patients. Estonia is short 100 family physicians today, which could grow to 300 a decade from now.
Laura Johanna Tuisk, head of the family medicine service at the Estonian Health Insurance Fund, said that going to see the work of family medicine centers first hand revealed that family doctors' workdays are longer than believed.
"That some family medicine practices receive patients four hours a day does not mean that is the extent of their patient-centered work. They spend the rest of the day answering emails, returning people's calls and doing e-consultations for specialist doctors. It is all part of a family doctor's work," Tuisk explained.
There is a lot of administrative work involved for which medical education is not needed. That is why the Health Insurance Fund has decided to fund hiring an assistant or receptionist.
"Someone who could call the patient in for tests, relay information from the doctor, communicate with other healthcare providers and care homes," Tuisk said.
Another way to lessen the workload of family medicine centers is to extend the validity of prescriptions for patients with chronic conditions. Le Vallikivi, head of the Estonian Family Medicine Association, said it is something family physicians have been requesting for a long time.
"It is hardly effective to have them call in every 180 days if their condition is stable," Vallikivi said.
The Health Insurance Fund currently pays family doctors for seven hours of work per day, with one hour reserved for paid services, such as issuing health certificates.
"Based on the data we have collected so far, this is not really justified. Services we initially believed could take up to an hour a day aren't that demanding," Tuisk admitted.
The fund will hike the paid hours of family doctors to 7.5 per day. Le Vallikivi said that family doctors will be paid €60 on top of the salary of resident doctors whose training is not finished yet or general practitioners who never got into the residency program.
"We were second from last in the [doctors'] salary rankings last year, while rehabilitation doctors have now overtaken us and we are at the bottom," Vallikivi added.
While family doctors say that the planned changed will help, they will do little to alleviate Estonia's family medicine crisis as the system is short 100 doctors.
"The situation will continue to get worse for the next eight to ten years. If we do the right things at the right time, find the courage to make decisions, allocate resources, know-how and skills to the system, things might start to improve after that," the head of the Estonian Family Medicine Association said.
Editor: Marcus Turovski