Family doctor shortage reaches Tallinn

A family doctor's office.
A family doctor's office. Source: Olev Kenk/ERR

Tallinn is now struggling to find family doctors, a problem previously only experienced by smaller towns and rural areas. One solution could be extending medical students' studies to include a year-long internship.

One family medical center in the capital's Õismäe district has been seeking a new doctor for a long time. The facilities are modern, full or part-time work is available. The center also owns a brand-new apartment close by where the new colleague could live. But the search has failed.

One reason, said Diana Ingerainen, head of the center, suggests is language.

"Õismäe is 60 percent Russian-speaking, young doctors don't speak Russian – there are a lot of conflicts and they don't want to come to such an environment," she said.

Another reason, Ingerainen said, is young people do not want to do low-skilled work and simple or repetitive tasks could be automated. For example, monitoring chronic patients.

The authorities also give doctors tasks that do not fall under their area of expertise.

Diana Ingerainen. Source: Priit Mürk/ERR

"My patient wanted to leave the hospital to go home, and the City of Tallinn has set up a way to cover the transport costs, but only if the family doctor personally calls," she said, highlighting one example. If this call is made by anyone other than the doctor, such as an assistant, Tallinn will not pay the bill.

Family doctor Eero Merilind said not all cities are suffering from a deficit of doctors. Tartu, a university city, does not have this problem.

Merilind said the crisis could be alleviated if trainee doctors were made to do a nine-12 month internship as part of their residency studies.

"Estonia has been in a special situation in the sense that you can become a specialist even if you have never worked in primary care. I think that needs to be changed because if we could get 150 more residents into primary care every year, that would give us a chance to somehow improve primary care," said the family doctor and member of the Riigiikogu. 

Merilind has already approached the University of Tartu with this idea, he said, but the institution is quite conservative. He said it would need to be agreed if this would become part of the curriculum or something extra.

Eero Merilind. Source: Ken Mürk/ERR

Ingerainen supports the idea. She said it would help future doctors to get an overview of the medical system rather than just narrower knowledge of their own chosen specialty.

Dr Margus Lember, dean of the Faculty of Medicine of the University of Tartu, said medical students already understand the system before they finish general training.

"In the sixth year, which is purely a placement year, all students work in a family doctor center for several months. Now, changes to residency are not that easy, residency is a study of your own specialty, with your own programs, your own length of residency, and to fit in forcing somebody to go somewhere seems a bit odd," said Lember.

A similar solution is already used in Finland. "Our residencies are EU-compliant, but much shorter than in Scandinavia," added Lember. While in Finland a residency is between five and seven years, in Estonia it lasts between three and five.

Ingerainen said one of the reasons for the doctor shortage is that residency places have been biased toward surgical specialties.

Dr Margus Lember. Source: ERR

"The General Medical Council has consistently pointed out that residency places are proportionally misassigned. These proposals have been made by external experts, I remember the first one from 2003, that the proportion should be different. We are now in dire need of family doctors and psychiatrists," Ingerainen said.

Lember said the number of residency places is set by the Ministry of Social Affairs and other institutions, including the university, hospitals, and professional associations. 

The share of residency places for family doctors is very large, the dean argued.

"There have been quite a lot of places allocated to family medicine in the last five to 10 years, the question is whether they are always filled," said Lember. There were 40 places allocated this year for family doctors but only 36 were taken up.

Estonia has 782 registered family doctors. More than half are over 50 years old, 283 are over 60. There are


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Editor: Merili Nael, Helen Wright

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