Every fifth family doctor has reached retirement age in Estonia, and with a lack of young people looking to take their places, the Ministry of Social Affairs is preparing for a crisis, "Aktuaalne kaamera" (AK) reported on Sunday.
AK said there has been talk of a crisis among the family doctor system for the last ten years, and officials have admitted that things could get worse in the future. The ministry is now suggesting hospitals could replace the role of family doctors in some areas of the country — an idea which is not popular with hospitals.
There are 171 family doctors over the age of 65 in Estonia, and they are entitled to retire if they want to. Currently, the system requires a family doctor to open their own business and to register as self-employed. Another option includes working for a health center.
Younger people prefer to work as substitute doctors or in a center with others rather than becoming family doctors. They are also not attracted to working in rural areas.
The number of people seeking family doctors in the past few years has also increased, which exacerbates the problem, as longer and longer patient rosters lead to overworked and stressed doctors.
Heli Paluste, head of the Health Care Unit of the Ministry of Social Affairs' Department of Health System Development, told AK: "The real crisis is probably when some rosters are left without a doctor, or no substitute is found."
Speaking about hospitals replacing family doctors, she said: "This is a crisis measure that we are currently planning to regulate as a temporary solution. Of course, it is preferable that we find a family doctor or at least a replacement doctor, but if the situation is that a family doctor cannot be found then we have to help people. We can't leave them in a situation where their only option is to go to the ER for emergency care."
Paluste admitted that neither family doctors nor hospitals are happy with the solution, but the state cannot leave people without help.
One idea is to start giving young doctors a bonus if they are willing to go and work in a smaller regional center. Another is to give a young doctor the opportunity to shadow a part-time practicing family doctor for their first year.
"We would call it an incubation program, where another family doctor could work alongside the family doctor who wants to leave and it would be funded. We can see if this is now increasing the interest of young people," Paluste said.
A third suggestion is that a young doctor can work part time, rather than full time, as family doctors. But a problem with the third option is who would cover the other half of the time, said retired former family doctor Hiie Tiisler to AK.
According to Paluste, today it is difficult to say that 20 years ago something was wrong with the current family doctor model. Reforming the system was essential at the time. The current solution was preferred although it was not the easiest for the state or the patient.
"It probably went wrong when family doctors were made entrepreneurs and young doctors were not ready to be in business. Everybody would just do medical work, but you had to run and supervise the whole company materially, financially and everything," said Tiisler.
Editor: Helen Wright