In case of an especially dark scenario, number of doctors may drop from 4,500 to 2,500, in 20 years – already now every 7th active physician is in retirement age, bound to quit at any moment. At the same time, amount of doctors fresh from university staying to work in Estonia comes below that of those reaching retirement.
Such a gloomy picture is painted by University of Tartu scientists Raul-Allan Kiivet, Helle Visk and Toomas Asser in their research on amount of doctors and nurses working in Estonia, by 2032.
«As humans, we are clumsy with predictions, as a rule, but this is a uniquely precise prediction on changes in numbers Estonian health care professionals,» said Joel Starkopf, dean of University of Tartu medical faculty. «It would be wrong to downplay the forecast simply because we do not like it.»
The authors of the study have calculated that only in case of a miraculous scenario – with all 120 people fresh from medical training immediately setting to work in Estonia, and no doctor ever again leaving to work abroad – would the number of physicians not decline drastically. However, real live is much more diverse.
To Finland, as general practitioner
The facts are, that an average of 15 per cent of fresh doctors are not staying to work in Estonia; for instance: of the 107 doctors graduating in 2011, only 66 went into work in Estonia. Of the 981 young doctors graduating from medical faculty in 2002–2011, 725 were working in Estonia as of April 2012 – the loss amounting to over 250 doctors.
At the same time, it is also true that not every young doctor would find fitting work in Estonia, as four and a half thousand doctors, all in all, suits Estonia well: three doctors per 1,000 people, being European average. Specialty-wise, the picture is much more varied.
«We have top specialties, where, in ten years, maybe one resident doctor is needed; to some specialties highly esteemed by students – the students being very practical, checking out which specialties promise more pay – only one resident in a year, or every two years, is accepted,» said Mr Starkopf.
«And if one doesn’t get into the desired specialty and doesn’t want to become a family doctor, they go for general practitioners in Finland, where, without passing residency, one can earn many times more than doctors teaching in (Tartu) university. Good if they come back, after a year, with foreign working experience, to try residency again. But these are the few exceptional cases,» said the dean.
The lion’s share of doctors that have left for Finland are, indeed, general practitioners without a specialty, as in Finland general practitioner jobs are available as well.
«A worthy local option would be engaging young doctors as general practitioners, as well,» is one way Mr Starkopf envisions for keeping young doctors in Estonia. «Maybe it’s just fighting windmills, however, as no one will pay doctors €6,000 a month in Estonia.»
Admissions to two hundred?
Already now, great lack of physicians is felt in the family doctor specialty: the study, figures dating a year back, shows that 54 family doctors have left for Finland. What is more – 141 family doctors have acquired, from Health Board, the certificate for working abroad. Meaning that some percentage of them, at least, may only be working part-time in Estonia, also hopping across the bay.
«Creating regional health centres is a prudent and unavoidable plan, making it possible to provide jobs with opportunities for up-to-date diagnostics – the youths want to work as they have been taught, not by themselves, somewhere,» Mr Starkopf points at another chance of keeping young doctors in Estonia. «In health centres, young physicians would also gain general practitioner experience.»
Looking 20 years ahead, the authors of the study conclude that to maintain the current amount of doctors, admission of medical students needs to be increased by 60 per cent, at least; the amount of doctors leaving Estonia should be diminished by a half, from the current (up to) four per cent. That would mean admitting 200 medical students a year, instead of the current 140 plus.
According to Mr Starkopf, within its current means, the medical faculty might accept up to 160 students i.e. have two extra groups. «180-200 would also be possible; however, then we would need more teachers. And the question arises. How many apprentices could the hospitals take?» said he.
Boys and girls 50:50
Medical faculty needs not fear lack of students – entrants with up to 90 per cent results pass the competition; and the dean has reasons to be rejoice as the amount of female and male students has, of late, been equal. The statistics show that 80-90 per cent of those accepted into medical faculty do graduate.
The dark scenario reveals a weak link: nobody knows if, when and in which numbers the nearly half a thousand doctors, currently fully occupied in Finland, may return to Estonia. The more so that, right now, there would not be enough work for them here – lest all those in their retirement age quit at once. Which, for the foreseeable future, would border on realms miraculous.
The authors of the study are convinced that, up to 2020, it is impossible to halt the decrease of numbers of doctors under age of 65, as in the coming six years the amount of medical training graduates will equal number of practicing doctors aged 59-65 i.e. those who may massively retire.