The Ministry of Social Affairs has drafted initial plans to reform Estonia's family medicine system to make it more sustainable, consistent and higher in quality. Social Affairs Minister Karmen Joller acknowledged that there are currently family physicians in Estonia who do not follow evidence-based medicine and who publicly promote pseudoscience.

"People often do not independently verify the advice they receive from a doctor. They assume the advice they get from a physician is scientific and evidence-based," she said.

Addressing such situations is complicated by the current supervisory system, which relies largely on patient complaints. Preventing such cases in advance is much more difficult.

The ministry now wants to introduce a licensing requirement for health centers that would make it far more effective to discipline such family physicians.

"If a person owns their own family medicine center and tells patients to take a homeopathic preparation, then we cannot accept that at the state level," Joller said.

Alongside supervisory measures, the ministry also wants to standardize the quality of family medicine care across Estonia more broadly.

In recent years, more and more family medicine practices have been consolidated into health centers that provide patients with a range of services. Nevertheless, the quality of family practices remains uneven and, according to the minister, there are still practices that do not cooperate with others.

"In a broader sense, we would like to see a future where there are no solo practices operating entirely independently. For example, if a family physician wants to attend training, they should not have to say they cannot go or even send a nurse because there is no substitute available. We want to encourage situations where even small practices make agreements either with one another or with larger practices," Joller said.

Against the backdrop of all these changes, however, one major problem remains: 132,000 people — roughly one in 10 residents — currently do not have a family physician at all and are instead served by substitute doctors.

Joller said the shortage of family physicians stems from a decision made decades ago to admit far fewer students into medical school. Those who were admitted at the time are now reaching retirement age.

"One option is to increase the number of family medicine residency positions, which has in fact already been done. This year, 47 young doctors began their residency training, which is actually one of the highest numbers ever. But we need to increase not only the number of family medicine residents — we also need to increase overall medical school admissions so that in the future we will have not only more family physicians, but more doctors across all specialties," the minister said.

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