Külvar Mand, a doctor who works in Finland and Estonia, was waking a patient up from anaesthesia at the eye clinic of the East Tallinn Central Hospital.
Wake up. Open your eyes too. Can you hear me?" Mand says in a soothing voice.
Today, Monday, Estonian doctors are waking up the whole country much less gently than Mand rouses his patient. Doctors in Estonia are launching a strike, the likes of which has never been seen in the country. Earlier, only teachers and railway workers have been on strike for more than a day in Estonia.´With their strike the doctors want to draw attention to the issue of brain drain affecting health care personnel, and to the deterioration of the Estonian health care system.
According to the Estonian Doctors’ Union, about 1,000 Estonian doctors and a larger number of nurses have emigrated since 2004, when Estonia joined the European Union. The Doctors' Union says that the trend has accelerated in recent years. The main destinations for medical emigrants are Finland and Sweden. A few hundred Estonian doctors work in Finland. This week Mand will be the physician on call at the Savitaipale Health Centre in the southeast of Finland. He will be staying at his friend’s summer cottage.
In Finland Mand earns as much in one week as he gets in a whole month in Estonia as an anaesthesiologist at Paide Hospital and the Central Hospital of East Tallinn.
Mand notes that he gets paid the same for 38 hours of work in Finland as he does when he works 168 hours in Estonia. "In addition, in Finland I get to sleep in a bed. In Estonia, the shifts are long and go through the night." Seven of the 23 anaesthesiologists at the East Tallinn Central Hospital work part of the time in Finland, Mand says. There are moments at the health centres of the Lappeenranta Regional Hospital in which a third of the doctors are Estonians. "
Estonia’s hospitals made a last-ditch offer on Friday for a six per cent pay hike for all hospital personnel. However, the doctors want more thorough changes – reduction of the work load of doctors and demands for higher pay – about 20 per cent more for doctors and 40 per cent more for nurses. Estonia’s Prime Minister Andrus Ansip says that the doctors’ demands are unrealistic.
The government has just drawn up a budget for next year in which revenue and spending are almost balanced. At present, the average monthly earnings of a doctor in Estonia are about EUR 1,700, usually comprising earnings from several different jobs held by the same physician. The amount is about a quarter of the monthly earnings of a doctor in Finland. Increasing numbers of Estonian doctors doing shift work, such as anaesthesiologists, work in two different countries.
This is not a solution to the problems of Estonian medicine, as it increases the work load of those who stay in Estonia", says Katrin Rehemaa, Secretary General of the Estonian Doctors’ Union.