The shortage of health-care professionals in Estonia has escalated from a looming crisis to a full-blown emergency, warns a report by the Estonian Foresight Centre, an independent think tank.
With an ageing workforce, a dearth of new specialists and an increasing reliance on exhausted personnel working multiple jobs, the system is under immense strain. Nowhere is this more evident than in primary care and mental health services, where gaps are widening at an alarming rate. If urgent reforms are not implemented, Estonia may soon find itself unable to provide even the most basic health-care services to large segments of the population.
The unfolding crisis: who will care for Estonia?
The most pressing concern lies in general practice. Half of all general practitioners are now over 60, a stark increase from a decade ago when only one-third were in this age group. The attrition of GPs is particularly acute in rural areas, where doctors under 50 are rare. As a result, residents outside of Tallinn, Tartu and Ida-Viru County face the prospect of losing access to essential medical care altogether.
Mental health services tell a similarly dire story. While public awareness of mental health issues has grown, the number of professionals available to meet demand has not. The chronic shortage of psychologists and psychiatrists means patients face prolonged waiting times – sometimes months – before receiving crucial treatment. This delay can be devastating, particularly for young people and those at risk of suicide.
Meanwhile, Estonia has one of the lowest proportions of foreign health-care professionals in the European Union. Just 4.5% of doctors and a mere 0.2% of nurses are foreign-born – figures that are strikingly low even among smaller EU nations. A key barrier is the stringent Estonian-language requirement, which has made it nearly impossible for third-country nationals to enter the health-care workforce. While some argue that these regulations help maintain service quality, the reality is that they are exacerbating an already critical staffing crisis.
A workforce running on empty
According to projections by the Estonian Qualifications Authority, Estonia will need around 7,700 new health-care professionals in the next ten years. However, the current rate of training will only produce 6,400, leaving a shortfall of 1,300 specialists.
The situation is especially dire for nurses, with a predicted shortage of 770 over the next decade. Despite increased efforts to attract new nursing students, retention remains an issue. Many nurses are forced to work excessive hours or take on multiple jobs to compensate for low salaries, contributing to burnout and further attrition. A 2023 survey by the Estonian Nurses Union found that over a quarter of nurses were working beyond a full-time equivalent, a rate that has risen sharply in recent years.
Across all medical professions, contractual workloads have been decreasing, yet actual working hours are rising. Many professionals now work multiple jobs or log significant overtime to fill the gaps. Statistics Estonia reveals that health-care professionals are the most likely workers in the country to have multiple jobs, with 59% of medical specialists juggling more than one position. Among psychologists and speech therapists, the figure is close to 45%.
Part-time work contracts are also on the rise, particularly among midwives, whose part-time employment rate has doubled from 25% to 50% in just a decade. This shift does not reflect an improved work-life balance but rather a restructuring of contracts that does little to alleviate the actual workload. For many, reducing contractual hours simply means working the same number of hours under different terms, often for less security.
The rural health crisis
Outside of Estonia’s major cities, the situation is even bleaker. Nearly 50% of current general practitioners will retire within the next decade, with little indication that they will be replaced. Rural communities are disproportionately affected, as younger doctors overwhelmingly prefer to work in urban areas where resources, professional opportunities, and salaries are better.
If this trend continues, Estonia’s rural areas could face a catastrophic collapse of primary health-care services. The government’s existing initiatives – such as financial incentives for young doctors to work in underserved regions – have had limited success. Without a more aggressive strategy, entire communities may soon find themselves without access to basic medical care.
As public health care struggles, the private sector is quietly expanding its reach. The proportion of health-care professionals working in private facilities has risen from 32% in 2013 to 37% in 2023. This shift is particularly noticeable in mental health services, where many specialists now opt for private practice due to better pay and greater flexibility. While this may be beneficial for those who can afford private care, it raises concerns about accessibility for lower-income patients, deepening the divide between those who can and cannot afford timely medical treatment.
What can be done?
Addressing Estonia’s health-care crisis will require immediate and systemic changes. Some potential solutions could include:
- Expanding training and recruitment: increasing medical school placements, improving incentives for health-care workers and expanding funding for nursing and psychological training programs.
- Attracting foreign talent: revising Estonia’s language requirements and easing immigration restrictions for qualified foreign health-care professionals, particularly in high-need areas like nursing and psychiatry.
- Boosting rural health care: providing better incentives for doctors and nurses to work in rural areas, including higher salaries, housing benefits and student loan forgiveness programs.
- Rethinking workload distribution: encouraging the use of non-clinical health-care workers, such as caregivers and nurse assistants, to alleviate pressure on doctors and nurses.
- Strengthening public health-care wages: addressing salary disparities between the public and private sectors to ensure that working in public hospitals remains a viable career option.
The next decade will determine whether Estonia can sustain a functioning health-care system. Without immediate and decisive action, the country faces the risk of a two-tier system in which only those who can afford private care receive timely treatment. Rural communities, in particular, stand at the precipice of a health-care collapse.
Estonia’s renowned digital advancements have made headlines worldwide, but technology alone cannot replace doctors, nurses or mental health specialists. Policymakers must act now to ensure that Estonia’s health-care system does not deteriorate beyond repair. The wellbeing of an entire nation depends on it.
Well concluded here: “Estonia’s renowned digital advancements have made headlines worldwide, but technology alone cannot replace doctors, nurses or mental health specialists.”
Myself, being a technologist, I view throwing one’s self overboard relying on technology very skeptically.
I greatly enjoyed the film “Johnny English Strikes Again” where an evil villein strives to control the world’s data. Johnny saves the world by correctly entering Estonia’s telephone country code (372) as the required pin to launch a missile and destroy the villein’s yacht, which he has the worlds data housed on.
Or even a shorter clip… shows a similar tech overloaded man talking to his house, reminded by the house that he has a dental appointment that day. Returning from said dental appointment, pouring rain outside, the house no longer recognizes his voice, due to him having received a shot in his mouth during the dental procedure.
I apply KISS to technology… Keep It Super Simple.
And yes, for medical needs, I much prefer good old fashion humanoids to administer my care. Bravo to health care workers!