Previously, the main focus has been on the national shortage of family doctors, however, there is now also believed to be serious crisis when it comes to the number of internal medicine doctors. Estonia already has a shortage of internal medicine specialists, with the situation only expected to get worse as 42 percent in the profession are due to reach retirement age in the next five to ten years.

"The current trend is that medical school graduates are no longer choosing a specialty, but are staying on as general practitioners, which has led to a decline in the number of residency applicants," said Marit Märk, head of the Estonian Society of Internal Medicine.

"As a result, only half the expected number of state-funded places for internal medicine residencies were filled last year," Märk added.

According to Märk, general practitioners have knowledge of all medical specialties, though mostly from a theoretical rather than practical perspective.

This means that general practitioners can only work in internal medicine departments as part of a team – not as independent doctors. However, internal medicine departments in hospitals have to employ trained specialists.

The University of Tartu has gradually increased the number of residency positions available for those wishing to specialize in internal medicine, though many remain unfilled.

"The core of the problem is not just the availability of positions, but also the attractiveness of the specialty and working conditions in hospitals," said Helen Reim, vice dean at the University of Tartu's Institute of Clinical Medicine.

"Increasing the number of positions alone will not solve the problem if young doctors do not want to choose this specialty," Reim added.

According to Reim, efforts now have to be made to improve the reputation of the profession and resolve issues related to the organization of work in hospitals. The workload of doctors in internal medicine departments is currently very high. Reim also pointed out that in addition to providing medical treatment for patients, internal medicine doctors are also required to deal with their social problems, which can be frustrating.

"I don't see this (problem) as being limited to internal medicine doctors, but rather as something that relates to the training of doctors, legislation, as well as where, how, and when doctors are sent to county hospitals," said Katrin Luts, director of Läänemaa Hospital.

According to Luts, a medical student can graduate from university without ever having done an internship outside the capital or Tartu. At Läänemaa Hospital, for example, there is an internal medicine doctor available, who could supervise a resident. However, the hospital does not meet the requirements set by the university.

"In my opinion, we need to take a step back and admit that, yes, quality will decline in some areas for a certain period, but young people, and I mean general practitioners in particular, ought to be directed toward county hospitals," said Luts.

"At the moment, they would alleviate the heavy workload of internal medicine doctors, and if we could reduce the workload of internal medicine doctors somewhat, then I sincerely believe that would encourage more people to enroll for the internal medicine residency," Luts added.

The distribution of residency positions will be finalized in May. For particularly strong candidates, additional positions will be created in internal medicine, emergency medicine, and family medicine, where the shortages are considered most critical.

---

Follow ERR News on Facebook and Twitter and never miss an update!