Over 100,000 in Estonia lack a family doctor, with no single fix in sight
A new National Audit Office analysis found nearly 110,700 people in Estonia are on patient lists without a permanent family doctor. The state, doctors and the medical association disagree on how to respond.
Nearly 110,700 people in Estonia are on patient lists without a permanent family doctor, according to a new analysis by the country's National Audit Office. Four years ago the figure was 72,500. Retirements are expected to outpace new entrants to the profession, and the state, doctors and the medical association do not agree on a solution.
Dispute over the patient-list model
Katrin Rehemaa, head of the Estonian Medical Association, says the patient-list system created in the early 1990s no longer works well. She argues work should be redistributed so that non-medical duties are taken off doctors and handled by nurses, assistants and support staff.
Social Affairs Minister Karmen Joller (Reform Party), herself a family doctor, rejects this view. She says the family doctor system is almost perfect and that all measures recommended by the WHO have been put in place. She cites research indicating that patients with a long-term relationship with their family doctor live longer and are healthier.
Enough doctors, but poorly distributed
Elle-Mall Sadrak, head of the Estonian Society of Family Doctors, says the problem lies in distribution rather than a lack of specialists: nearly 900 qualified family doctors work in the country for around 780 patient lists. Some cover more than one list or work part-time. She points to a bill now before the Riigikogu, Estonia's parliament, which would introduce special measures for at-risk and crisis areas, such as more flexible working weeks and some remote work. Sadrak also calls for a mechanism to remove from patient lists those who are mentally or physically abusive toward their doctors.
Training and an ageing workforce
A record 46 new family medicine residents were admitted this year. Training a family doctor takes four years, so there are no quick solutions, Joller acknowledges. The Health Insurance Fund has raised payments for doctors treating more complex cases, and a project launched this November uses artificial intelligence to help doctors document their work faster.
More than half of those managing patient lists are 60 or older. The National Audit Office says the Ministry of Social Affairs must design a system that accounts for long-term workforce shortages, and that these cannot be solved by training more doctors alone but also by retaining those already working.
