D OCTOR 2010: Q UESTIONNAIRE SURVEY TO PHYSICIANS QUALIFIED IN 1997 - 2006

1. DOCTOR 2010: QUESTIONNAIRESURVEY TO PHYSICIANS QUALIFIED IN 1997 - 2006 Alar Sepp, MD, MA, Tallinn Health Care College, Estonia; University of Tampere, Finland Irma Virjo, MD, PhD, University of Tampere, Finland Kari Mattila, MD, PhD, University of Tampere,Finland Tallinn Health Care College international week I session, May17, 2010 Conference „Bridging between Education and Health Services“

2. ”The Challenge of Global Health” ...The fact that the world is now short well over four million health-care workers, moreover is all too often ignored. As the populations of the developed countries are aging and coming to require ever more medical attention, they are sucking away local health talent from developing countries. Already, one out of five practicing physicians in the United States is foreign-trained, and a study recently published in JAMA estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors... Source: Laurie Garrett (2007). The Challenge of Global Health. Foreign Affairs, January/February, 14-38.

3. INTRODUCTION: AIMS • The purposes of the present study are: • 1. to evaluate the life situation and working history of young doctors in Estonia. • 2. to examine retrospectively the reasons influencing physicians to study medicine. • 3. to evaluate physicians’ satisfaction witheducation, specialist training and job satisfaction. • 4. to examine the differences in physicians’ satisfaction (fifteen-year follow-up). • 5. to present physicians’ future plans, professional and social identity.

4. PHYSICIAN STUDIES 1) Junior Physician 88 Study, Finnish 2) Physician 93 Study, Finnish 3) Young Doctor 95 Study, Estonian 4) Physician 98 Study, Finnish 5) Arst 2000 Study, Estonian 6) Physician 2003, Finnish 7) Arst 2005 Study, Estonian 8) Physician 2008, Finnish 9) Arst 2010 Study, Estonian

5. QUANTITATIVE RESEARCH • Data is good when the measurement of variables is consistent and true • It means that measurement method is very close to actual situation across time, persons and settings (reliability) • The measure is valid when a measurement method captures to a high degree the totality of a variable of intrest (validity) • Testing a measurement method’s reliability and validity

6. Table 1. Number of entrants and graduated physicians (target population) from the Faculty of medicineof TartuUniversity in 1997 - 2006 (Asser 2007). 987

7. SAMPLING Physician 2010 Study sample -representative of the target population -list of physicians in the target population - Health Board National Physicians Registry (Doctors working in Estonia) -members of Estonian Doctors Association (~70% of all doctors) -random sample (1/2 of target population ~500)

8. PHYSICIANS WORKING IN ESTONIA At the beginning of May 2010, 5633doctors were registered. The majority of doctors (64%) are working in hospitals. At the same time, 997 doctors were working in family practices, which corresponds to about one sixth of all doctors in Estonia. Of all doctors ~20% were full-time private practitioners. Close to one fifth were not practising medicine.

9. THE SURVEY • Self-reported data • Collected by mail or Internet questionnaire • Questionnaire in Estonian and Russian • Questions that are clear to physicians • Lot of data (78 questions) • Response rate (~60-70%) • Large number of respondents (~500)

10. CONCLUSIONS Physicians’ views on their medical education and job satisfaction and career plans, as well as their social background, have been studied in Estonia every five years from 1995 onwards. The studies are known as Young Doctor 95, Doctor 2000 and Doctor 2005 (Saava, Sepp 2003, Sepp 2007). The study was originally initiated by Finnish researchers in 1988 (Hyppölä 2001) and adapted by Estonian researchers (Saava, Sepp 2003, Sepp 2007).The Estonian Science Foundation, the Estonian Ministry of Social Affairs, University of Tampere, the Finnish Medical Association and the Estonian Medical Association supported these studies. Results of the studies have been published.

11. Asser, T. (2007a). Arstiteaduskond 2000-2007. In K. Kalling (Edit), Tartu Ülikooli arstiteaduskond 1982-2007 (pp. 9-23). Tartu Ülikool: Tartu Ülikooli Kirjastus. • Hyppölä, H. (2001). Development and Evaluation of Undergraduate Medical Education in Finland. Doctoral dissertation. University of Kuopio. • Garrett, L. (2007). The Challenge of Global Health.Foreign Affairs, January/February, 14-38. • Saava, A., Sepp, A. (2003). Eesti noorarst 2000: Eesti noorarstide psühho-sotsiaalne taust, tööolud, rahulolu koolituse ja tööga, väärtushinnangud ning sotsiaalne aktiivsus. Tartu Ülikool. http://www.arth.ut.ee/orb.aw/class=file/action=preview/id=200843/Eesti+noorarst+2000.pdf • Sepp, A. (2005). Rahvusvahelistumise väljakutsed – Eesti arstide kogemused ja plaanid. Eesti Arst; 84(10): 707-709. http://www.eestiarst.ee/static/files/096/rahvusvahelistumise_valjakutsed__eesti_arstide_kogemused_ja_plaanid.pdf • Sepp, A., Saava, A. (2000). Eesti noorarst üleminekuperioodil. Eesti Arst; 1: 21 - 4. • Sepp, A., Virjo, I., Mattila, K. (2007). Eesti arstide tööga rahulolu. Sotsiaalministeerium.http://www.sm.ee/fileadmin/meedia/Dokumendid/Tervisevaldkond/Uuringud_ja_analuusid/Eesti_arstide_tooga_rahulolu__Arst_2000__ankeetkusitlus_1987-1996_diplomeeritud_arstidele.pdf