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Where can Finland find 1,000 new doctors?

The new Finnish government plans to expand healthcare services, but faces an acute shortage of physicians.

Lääkäri ja potilas
The Finnish Medical Association calculates that 1000 new doctors in healthcare centres would cost around 100 million euros a year. Image: Derrick Frilund / Yle

The programme of Finland's new five-party coalition government envisages a guarantee that anyone in need of non-urgent healthcare should be able to receive it from a public clinic with no more than a one-week delay. The government estimates that in order to be able to meet that target, public healthcare centres will have to hire 1,000 new physicians.

The question that immediately arises is where these new doctors are to be found.

According to the Finnish Medical Association (FMA), at the end of 2018 there was a shortfall of 228 doctors at public healthcare centres, meaning that six percent of physician vacancies in public clinics were unfilled. The most acute shortage was in Kainuu, in eastern Finland, were 20 percent of positions were empty.

Public healthcare centres find it difficult to hire doctors for full-time jobs, even when offering flexibility over salaries and working hours.

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Tuomas Parmanen
Tuomas Parmanen, who works as the senior physician at healthcare and social services centre in Hämeenkyrö, would like more focus on public sector care in medical schools. Image: Marko Melto / Yle

There is also a bump-on effect. Doctors at centres with unfilled vacancies end up carrying a heavy workload, making these jobs even less attractive to would-be candidates.

One example can be seen in Hämeenkyrö in the south-central region of Pirkanmaa where the local healthcare centre would be ready to immediately hire three or four new doctors full time, if they were available. Nearly half of the centre's physician vacancies are empty.

Senior Physician Tuomas Parmanen says that it has become increasingly hard to hire new doctors.

"Even if the employer is flexible and, for example doesn't require on-call shifts, young doctors don't want to work in a public healthcare centre. They want to work through staffing agencies. That way, they are not only paid better, but doctors can also decline to be on call or to work evening shifts, which is something that has to be done at healthcare centres," Parmanen explains.

According to Parmanen, many young doctors are unwilling to commit to a regular position. In addition, uncertainty caused by plans for reforms in the health and social care sector has made a commitment to a job in the public sector look risky.

Dilemma in the public sector

Right now, there are close to 30,000 physicians in Finland, more than ever before. This is not, however, reflected in the numbers working in the public sector.

The FMA says that the answer to the shortage at healthcare centres is not simply to train more doctors, bur to make the public sector more appealing. The new cabinet's programme does not provide any direct solution to this dilemma.

Juho Kivistö, district chief medical officer at Tampere University Hospital, argues that the workload of doctors is unreasonably heavy, and basic healthcare services in general need to be improved in order to increase the appeal of working at public health centres.

"Young doctors need support and guidance that is often not now possible to provide with the pressures at work. More senior doctors also burn out under the workload. Untangling all this will start specifically by increasing resources for basic healthcare services," states Kivistö.

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Hämeenkyrön sosiaali- ja terveyskeskus
Both patients and doctors suffer when healthcare centres are understaffed. Image: Marko Melto / Yle

The Medical Association believes that the doctors needed to implement the government's programme could be found in the private sector, shifted from occupational healthcare, and requited from among new graduates. However, in order to do so, public healthcare centres need more funding.

Nurses also affected

According to the National Institute for Health and Welfare (THL), implementing the government's healthcare guarantee plan would require hiring 1,100–1,800 more doctors, even though the government programme refers to 1,000.

In Hämeenkyrö, Parmanen believes that even if all the staff spots for doctors were to be filled, the plan to see everyone seeking healthcare within a week would still not necessarily be possible.

Efforts to reduce access time to healthcare centre services have included shifting more responsibility to nursing staff and applying more information technology solutions.

"Doctors have a heavy workload, but they are not the only ones working, let's say, till the sweat pours. All personnel, from the nurses on, are feeling the effects of the shortage of physicians," says Parmanen.

Training requires more funding

The Dean of the Faculty of Medicine and Life Sciences at Tampere University, Tapio Visakorpi, has both praise for and concerns about the government's take on healthcare.

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Tapio Visakorpi
Tapio Visakorpi is worried that the quality of education could suffer from demands to train larger numbers of doctors. Image: Marko Melto / Yle

"The idea of increasing the number of doctors at healthcare centres by 1,000 is, of course, good. But, if more physicians have to be educated, will more resources be available to train them? What about the quality of that education? This has given rise to a lot of discussion," says Visakorpi.

Visakorpi also has doubts about the government's plan to cut the wait for non-urgent care down to no more than a week. At present, such patients are supposed to receive care in less than three months.

"That, of course, is too long if someone needs care. On the other hand, one week is a very short time for non-urgent care. I understand that [the parties] wanted the government programme to contain specific demands, but first the shortage of doctors at healthcare centres must be solved," Visakorpi points out.

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