With Estonia's so-called "family doctor crisis" expected to get worse in the near future, solutions are now being put in place in order to prevent people being left without access to treatment. One option being touted would be to treat patients primarily via remote consultations, removing the need for a family doctor's involvement and ensuring that only those requiring critical treatment visit their nearest health care center.
In Estonia, everyone ought to have their own family doctor. While officials say the current system is a good one, with family doctors retiring at a rapid rate and young doctors reluctant to take their place, it may no longer be realistic to persevere without some changes.
Alternative ways to ensure people do not go without necessary medical treatment are now being sought. One option put forward would involve temporarily transferring consultations to the online environment.
"This is something we are very much afraid of, because it could lead to a situation whereby a person who cannot get a nurse's appointment, or cannot get a doctor's appointment, instead gets a digital appointment, and there is only an assistant on the spot," said Elle-Mall Sadrak, head of the Association of Family Doctors (Eesti Perearstide Selts).
According to Sadrak, this approach has been used before in the case of war refugees from Ukraine, with the state paying private clinics a stand-by fee as well as additional funds for each appointment. However, she believes going down that route could cause major problems in five or ten years' time.
"That's where the problems arise, when the private clinics that have got everything under their bellies. At some point, you get a situation where they have the majority and start dictating the price. The Finnish example shows that the Finnish state can no longer afford to pay for primary health care," Sadrak said.
According to the Estonian Health Insurance Fund, solutions need to be found to help navigate the crisis. It is also inevitable that work at the primary care level will need to be redistributed.
"If we know that we have six appointments at the health center, four of the six family doctors want to retire, and only two want to continue working, then there is someone somewhere answering the phone and remote consultations could be done by someone else," said Laura Johanna Tuisk, head of family medical services at the Estonian Health Insurance Fund.
According to Tuisk, international data shows that the proportion of critically ill patients is generally around 15 percent.
The Ministry of Social Affairs says that this would be a temporary solution and is certainly not its first choice. The ministry instead sees the way forward as a situation in which the doctor is no longer personally responsible for the appointment.
"Because the expectations of employees have changed so much, people no longer want to take on a family doctor's appointment and then work at it day in, day out, from morning till night. They want a flexible working life. It is reasonable to expect that if it is the institution, not the individual doctor, who is responsible for this, there will be more interest in helping people as a family doctor or nurse," said Kaily Susi, adviser to the Ministry of Social Affairs.
Almost half the family doctors in Estonia have recently retired or are approaching retirement age.
Editor: Michael Cole