Auxiliary medicine
Since 2011 a medical student who has completed the fourth year may take part in providing healthcare as an assistant doctor. EAÜS has driven the system from the start.
Since the summer of 2011, the law has allowed a medical student who has completed at least the fourth year to take part in providing healthcare services as an assistant doctor, carrying out a doctor’s duties within the limits of their competence and skills, under the guidance and supervision of a responsible doctor, without holding a healthcare worker’s registration.
Who is an assistant doctor?
In law, an assistant doctor is a person without healthcare worker registration who takes part in providing a health service, is a medical student who has completed at least the fourth year (having passed the compulsory subjects in the fourth-year curriculum), and carries out a doctor’s duties within the limits of their competence and skills under the guidance and supervision of a responsible doctor.
Where medical students had previously encountered hospital life only by working as an orderly, or after the third year as an auxiliary nurse under a nurse’s supervision, 2011 opened the possibility of practising what they had learned at university under a doctor. The work of the assistant doctor is established in law by the Act amending the Health Services Organisation Act, passed by the Riigikogu on 16 December 2010.
How it began
Passing the law regulating the work of the so-called assistant doctor — a medical faculty student taking part in the provision of healthcare services — created an additional opportunity for students to work in the profession they are training for and gain valuable experience that way. It also signalled to students that they are wanted and needed in Estonia. Medical students have now had the chance to practise their future specialty in Estonian hospitals for over ten years.
Developments in the system
From the very start of assistant doctors working in healthcare institutions, EAÜS has worked consistently to map the strengths and weaknesses of the current system and to improve it for both students and employers. To that end, surveys of healthcare institutions and of students who have worked as assistant doctors have been run almost every year; meetings have been held with the Ministry of Social Affairs and various stakeholders; and in recent years trainings preparing assistant doctors for hospital work have been organised.
The biggest bottlenecks for students have been the lack of access to the e-Health information system and the lack of a right to draft prescriptions. As a result of the work and effort of EAÜS, an amendment to the Health Services Organisation Act was adopted in 2017 which gives assistant doctors access to the e-Health information system. The change lets student assistant doctors see a patient’s earlier cases and so assist the doctor better, carry out a more thorough initial examination, and prepare the necessary documents and draft prescriptions.
After long work, since the summer of 2021 assistant doctors can also access the digital health record from their own personal account at every healthcare institution, once the student is linked to the institution and has completed at least the fourth year of medicine. Another major breakthrough came in 2021, when a minimum wage for assistant doctors was fixed in the healthcare collective agreement for the first time. The doctors’ collective agreement now includes a minimum rate for assistant doctors of at least 60% of the minimum wage of a doctor.
Plans ahead
- Continue and develop the brokering of job offers on job platforms
- Secure state funding for hiring assistant doctors, since a shortage of funds is often why small hospitals or family practices that need extra hands cannot afford to hire them
- Define the term “assistant doctor” in law as a student who has completed the fourth year and provides a health service, and set out their rights and obligations in that post
- Continue organising trainings that prepare assistant doctors for work
- Obtain the right to see a patient’s earlier prescriptions in the digital health record
- Create the structures and resources for professional translation services in the Estonian healthcare system, so that quality care is ensured for all patients
Materials
Contact
Helen Talvistu — project lead, auxiliary medicine — abiarst@eays.ee