EDITORIAL ⟩ Live or die

Man: What to do? The family physician has been retired but I have no courage to use traditional medicine. There will be attack by cancelling culture for the talk of herbs and vodka socks. Cat: Some valerian? Photo: Urmas Nemvalts

• Seeing a doctor will become difficult in the future as there will not be enough doctors available.
• The Ministry of Social Affairs should consider both the future of the healthcare system as a whole.
• Why have about half of the family physician residency positions remained vacant in recent years?

Wishing one's friends a long life and good health is more important than ever before. The reason is that seeing a doctor will become increasingly difficult in the future, as there unfortunately will not be enough family physicians available. Last week, the Estonian Qualifications Authority released its OSKA study showing that by the end of the next decade, out of the current 860 family physicians, only 690 will remain if the retirement age remains unchanged and only 25 new doctors are added each year.

The situation is particularly dire in some regions, where residents haven not seen a practicing family physician for years, mainly because doctors are reluctant to work in those areas. These places include East-Viru County, Haapsalu, and interestingly, Rapla County — despite its proximity to Tallinn and its commuter belt.

To put it simply, our healthcare system, set in motion in the 1990s, has run unchanged, even though our world has transformed. One significant challenge facing family physicians is the increased burden of bureaucracy and (digital) paperwork. It is a common observation that doctors spend a large portion of appointment time on their computer, detracting from patient interaction.

Why, in recent years, have nearly half the available slots for family physician residencies remained vacant?

We are facing a scenario where dissatisfaction is widespread: among patients, emergency department physicians (who also serve in primary care and often see individuals who have nowhere else to turn), hospitals, and family physicians themselves, who are experiencing a relentless increase in workload. There are efforts underway to establish filters to manage who gets access to various levels of care. The family physicians' community is reportedly considering the implementation of criteria that would dictate how quickly patients can access services based on their ailments and when they might need to contribute more financially.

The increased presence of private healthcare could undoubtedly be part of the solution, but then what is the point of our contributions to a tax-funded, solidarity-based healthcare system? Postimees believes the Ministry of Social Affairs needs to proactively reevaluate the healthcare system in its entirety, assessing both current and future needs. Currently, the ministry has funded the Estonian Family Physicians Association to develop a strategic plan. However, this plan is just one piece of the puzzle, with other stakeholders having their plans, all of which will hopefully converge into a cohesive strategy reflecting the ministry's comprehensive vision.

Should the Family Physicians Association soon submit a 30-page proposal to the ministry, its contents will likely set the course for primary healthcare development in the upcoming years. If development plans were up to rabbits, they would undoubtedly prioritize more carrots. The Ministry of Social Affairs should start with reforming the primary healthcare system's policy-making to be more effective and integrated.

Moreover, there is a pressing need to train more family physicians. We have to investigate why recent years have seen a significant shortfall in filled residency positions for family physicians. Why has the profession lost its prestige?

Luckily, we still have our saunas, vodka, and aspirin. Often, these are enough for people to recover on their own.