Development plan urges small family doctor offices to form health networks | News

Tõstamaa family doctor Madis Veskimägi told ETV’s “Aktuaalne kaamera” that Estonia’s current family doctor system is unsustainable, as more than half of all family doctors are of retirement age, and dozens of practice lists across the country already lack an assigned family doctor.

In the coming years, as hundreds of family doctors are set to hang up their white coats for good, this crisis will only deepen.

“Even now, there are already many rural areas where, in a sense, the Constitution doesn’t apply, because there is no doctor,” he acknowledged. “A doctor may visit the area only once every week or two.”

Veskimägi himself has established a joint practice model in Pärnu County, including multiple service points in various settlements. Patients with mobility impairments are transported to the doctor by an accessible bus, and simpler procedures are performed at the family health center rather than referring patients to a specialist or sending them to a hospital emergency room (ER).

This setup allows family doctors at the practice to focus solely on practicing medicine, as other specialists handle various additional tasks.

“Our team includes young doctors who are content with working in an organization where they are simply employees,” the practice founder explained. “They don’t have to worry about regulations, internal work rules and dozens and dozens of other such bureaucratic tasks.”

This is precisely the kind of model that the development plan, drawn up under the leadership of the Estonian Association of Family Physicians (EPS), envisions emerging within the next decade. The era of family doctors managing a practice list alone with just one family nurse should become a thing of the past.

“In the future, indeed, no one should be working entirely alone … but there is no need to consolidate and relocate,” noted Minister of Health Riina Sikkut (SDE).

“What we’re talking about at the primary care level is networking, where there is a larger center and smaller centers collaborating,” she explained. “…The greater part of [health] concerns will be addressed close to home, whether at a health center or regional health center, and the range of specialists working there will be broad. This includes mental health specialists and palliative care.”

More family doctors still needed

However, this new system will still require the involvement of family doctors, and currently, fewer of them are entering the profession than those retiring.

“Family doctors are aging,” EPS chair Elle-Mall Sadrak acknowledged. “The average family doctor is over 55 years old. There are a couple hundred family doctors who could retire today. That is a fact.”

Sadrak admitted that fewer new family doctors are entering the field than ideal, adding that this is one problem that the state now has to urgently address.

“We need to consider whether it’s possible to retrain other doctors as family doctors,” the association chair said. “In the past, we had family doctor courses, which led to the emergence of a significant number of family doctors in Estonia.”

“A good family doctor currently in the system can actually be replaced by a team,” said Ruth Kalda, professor of family medicine at the University of Tartu (TÜ). “…If there is a team of other healthcare workers and specialists involved, then a health center or family doctor center can also manage larger practice lists.”

For people living in sparsely populated areas, however, the situation described by Veskimägi — where a family doctor will pay occasional visits or, if the person is capable, they travel to a regional hub for medical care — will continue to be the reality. For example, traveling from Haanja to Võru.

“And that may be 15-16 kilometers further away, but then a solution could be having a local branch, where doctors from Võru Health Center visit once or twice a week,” Kalda explained. “…These health centers will also take over the provision of care for patients from other areas.”

Veskimägi believes that the current capitation-based system of family doctors operating as private companies is a costly one for the Estonian Health Insurance Fund (EHIF). Instead, he envisions a unified state-run system that would save costs by creating economies of scale.

The minister of health, however, believes that ship has sailed already.

“The fact that it was decided in the early 1990s to operate as private limited companies or sole proprietors seemed reasonable at the time,” Sikkut recalled. “We wouldn’t make that same decision today. But it can’t be undone overnight. And this development plan does not set such a goal.”

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