Working in Sweden 2009

8/3/2019 Working in Sweden 2009

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Working in SwedenInormation or doctors rom EU/EEA countries

2009

Swedish Medical AssociationNational Board o Health and Welare


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ContentsRecognition o qualifcations 3

Administrative procedure 3

Medical education and training 4

Working conditions 5

Labour market situation 6

Medical responsibility and proessional ethics 6

Medical indemnity 7

Appendix A: Medical specialties in Sweden 8Appendix B:Addresses 9

Swedish County Councils 10

Municipiality 10


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Recognition o qualifcationsa) Directive 2005/36/ECIn order to acilitate the ree provision o services, theDirective on the recognition o proessional qualica-tions Directive 2005/36/EC guarantees doctors and

other persons in regulated proessions having acquiredtheir proessional qualications in a Member State, ac-cess to the same proession and pursue it in anotherMember State with the same rights as nationalsWhat issaid hereinater about Member States is equally appli-cable to the EEA States Norway, Iceland and Liechten-stein and also to Switzerland.

The Directive provides or the mutual recognition omedical qualications on basic training level as well asspecialty level.

b) Recommendation 75/367/EECSweden has decided to comply with a recommendationadopted by the Council o the European Union withthe objective to make it possible to perorm postgra-duate medical practice in another Member State thanthat o undergraduate training. This could be an opp-ortunity or graduated doctors who need some kind opre-registration service in order to gain the qualica-tion listed in an annex to the directive.

The relevant clinical practice available in Sweden is

either the internship programme (AT-block) o atleast 18 months duration or short-time medical ap-pointments as locum tenens in a subordinate position.To practice in Sweden a decision o appointment romThe National Board o Health and Welare, is required.Further, it must be noted that in order to perorm thistraining, sucient knowledge o the Swedish languageis a condition.

Administrative procedureA condition to oer services in regulated proessions inthe health care sector in Sweden is a legitimation. TheNational Board o Health and Welare is the competentauthority and responsible or issuing evidence o ormalmedical qualications. The Board is also responsible ormaintaining the Swedish medical register or all quali-cations reerred to in the above.

A migrating doctor seeking recognition in Swedenshould approach the Board in order to acquire the ne-cessary application orm (www.socialstyrelsen.se). Inaddition to the application orm the ollowing docu-ments must be submitted:

1. Diploma, certifcate or other evidence o ormalqualication and registration o licence in the coun-try o education.

2. Birth certifcate/copy o passport. Applicants resi-ding in Sweden should enclose a svenskt personbe-vis instead (must not be older than three months).

3. European certifcate o current proessional status.This certicate is a statement that the applicant isentitled to practise his/her proession in the countryo education without limitation. This certicate hasto be issued by the competent authority in the coun-try o education or rom the EEA-country where theapplicant was last established proessionally. The cer-

ticate has to be presented in its original orm andmust be issued within the last three months. The cer-ticate must be written in English or accompaniedby a translation into English or Swedish. The trans-lation must be made by an authorized translator. Ithe applicant is able to submit a certied copy olicence rom another Nordic country this certicateis not required.

4. Summary oormal qualifcations and proessionalexperience must be presented.

The copies must be certied to be true copies by anauthority, proessional organisation or an institution.This requirement is not applicable to migrating doctorsrom a Nordic State since other routines are appliedin these cases.

When the National Board o Health and Welarehas made the ormal assessment, the applicant willbecome ully registered and the licence to practisemedicine will be issued. In order to oer services asa doctor in Sweden, national legislation must be ol-lowed. This means good knowledge o the Swedishlanguage and the relevant medical legislation. Theemployer has responsibility as well as the practitionerto ensure these circumstances are ullled.


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Medical education and training

Clinical skill and theoretical knowledge are evalua-ted continually through the whole period o specialisttraining. Thus the doctor is not required to take a or-mal nal examination beore being granted qualica-tion as a specialist. However, some specialist societieshave introduced voluntary examinations.

The Swedish Medical Association, in cooperation withthe Swedish Society o Medicine, runs a programme toreview and evaluate the quality o training in dierentdepartments all over the country. Participation is vo-luntary.

Continuing medical education and proessional de-velopment - CME/CPD -is not ormalised. There is,however, a variety o courses, seminars etc available,

mainly organised by the various specialist societies.

In Sweden medical education and training are organisedin three phases: undergraduate education, pre-registrationtraining and specialist training.

Basic undergraduate medical education takes 5 1/2 years(at least 40 weeks o ull time studies per year).

Ater graduation ollows a compulsory training pro-gramme (internship) o at least 18 months. Thisrst stage o clinical training comprises surgery (36months), internal medicine (36 months), psychiatry(three months) and amily medicine (six months). Thedoctors knowledge and skills are assessed by the seniorcolleagues and tested in a written examination undersupervision o the universities. Ater successul com-pletion o this programme the doctor obtains his/her

licence to practise (ull registration), which is grantedby the National Board o Health and Welare.

Once the doctor has got a licence to practise, the doctoris entitled to apply or a post to start his/her specialisttraining. The specialist training has a duration o mini-mum ve years and is carried out in a salaried position

with medical responsibility.

There are currently 62 recognized specialties in Sweden(see Appendix A). For each o these specialties thereis an ocial description o the training objectives in

terms o required knowledge, skills and attitudes (Ml-beskrivning). These descriptions have been made by thevarious specialist societies (within the Swedish Medical

Association and the Swedish Society o Medicine) andare authorised by the National Board o Health and

Welare. The junior doctor is entitled to have an in-dividual training programme, speciying the requiredpractical training in various departments together withadditional theoretical education. He/she is also entitledto have a personal tutor (a recognised specialist) who

will give proessional guidance during the specialist

training.The head o the department (clinical medical director)has the ultimate responsibility or the specialist training.He/she also has the legal responsibility to assess whenthe doctor has achieved the training objectives set upor the specialist training and thus should be recognisedas a specialist. The head o the department states his/her opinion by issuing an ocial certicate. The Na-tional Board o Health and Welare will then uponapplication grant the doctor the ormal qualicationas a specialist.


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Working conditionsSweden has a decentralised health and medical caresystem. The role o the Government is mainly limi-ted to providing the legal ramework and supervisingthat medical care is sae, o good quality and equitablydistributed. The County Councils have the task to o-er good health and medical services to the population

within its bounderies. To note is that in Sweden the pa-tient doesnt have the right to a certain healthcare but itis the County Councils that shall oer good health andmedical services. Financial and operative responsibilityrests almost totally with the county councils. These re-gional bodies have an independent and powerul posi-tion with their own right to levy taxes. They run some80 hospitals including all university hospitals andover 800 health centres. Medical care in Sweden has tra-ditionally been hospital-orientated, and the number ohospital beds has been high by international standards.In later years, however, primary care and other kindso ambulatory care have expanded, and the number ohospital beds has been reduced considerably.

The dominant position o the county councils is alsorefected in the employment situation. About 85 percent o all physicians are employed in the county coun-cil sector. The remainder work as university teachers,private practitioners, in occupational health and thepharmaceutical industry. The establishment o private

practice under the social security scheme is possible onlywith the consent o the county council concerned.

It should particularly be noted that in Sweden also ge-neral practitioners usually are salaried employees, notprivate entrepreneurs, as is the case in many Europeancountries. They have the qualication as specialist inallmn medicin wich can be compared with FamilyMedicine. All training posts or junior doctors are li-kewise salaried positions in the county councils healthcare.

General terms o employment are negotiated betweenthe Federation o County Councils and the SwedishMedical Association. However, the central collectiveagreements leave considerable room or local negotia-tions between the individual county council and the lo-cal branch o the Swedish Medical Association. Salariesare negotiated between the individual doctor and his/her employer.

Working hours are partly regulated in law, and partly incollective agreements. The working week is in principle40 hours. In addition most specialties have night and

weekend duty, which is compensated with money, reetime or a combination o both. The retirement age is 65years with an option to stay on until 67.

A large majority - 90-95 per cent - o the Swedish doc-tors are members o the Swedish Medical Association.

As has already been mentioned, the Swedish Medical Association represents its members in collective bar-gaining about working hours, working conditions etc,but the Association is also deeply involved in a widerange o proessional issues, e.g. medical education,medical ethics, health care politics, quality assuranceand international relations.

Posts or physicians are advertised in theSwedish Medical Journal (Lkartidningen)and ofcial publications. As a main rulephysicians are employed in a position or anindefnite period. There are exceptions tothis rule, notably the internship period, andat the university hospitals, where a contractperiod o six years is common. Employmentas locum tenens is, o course, or a defniteperiod.

http://jobb.lakartidningen.se


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Labour market situationThe number o Swedish physicians has increased stea-dily and rapidly. During the period 1970-2004 the -gure almost trebled: rom slightly over 10,000 to about30,000. There is now one doctor or every 320 inha-bitants. About three quarters are specialists (includingspecialists in Family Medicine).

The six medical aculties admit about 1100 new stu-dents every year. The Government and Parliament havecommissioned the aculties to graduate a minimum o800 new doctors annually. In addition there is an infuxevery year o some 200 doctors rom non-EU countries,

who are granted residence permit or political, humani-tarian or amily reasons.

In the middle o the 1990s there was a tendencytowards a surplus o physicians. Particularly, there was

keen competition or posts or specialist training, andmany young doctors had to be content with temporaryemployment as locums.

The picture changed in late 1998, and a certain shorta-ge o specialists was elt in several specialties, e.g. anaes-thesiology and psychiatry. The principal actors behindthis change were that the county councils increasedtheir demand or specialists, that physicians rom Den-mark and Norway working in Sweden returned to theirnative countries, and that Swedish doctors sought oc-

cupation abroad, especially in the booming Norwegianhealth sector. The demand or junior doctors also in-creased considerably: the number o new training postsadvertised in 1998 increased twoold.

Medical responsibility andproessional ethics

A doctor who is practising the medical proession inSweden either in an employed position or as a sel-employed private practitioner is subject to the super-

vision o the National Board o Health and Welare.The doctor is obliged to exercise the medical proessionin accordance with the scientic development and re-liable experience. The exact denition o these conceptsare decides by the proession as well as (court)customand changes over time. Thereore the concepts are notregulated in law or other regulation.

It is o utter importance (as has already been mentio-ned) that the migrant doctor becomes well acquainted

with current regulations and administrative provisionsgoverning the proessional duties. The denition othe concepts scientic development and reliable expe-rience must be derived rom such provisions, as well asrom individual decisions o the Medical ResponsibilityBoard.

I a practising doctor ails in his/her proessional duty intentionally or negligently and the ault is morethan trivial, disciplinary sanctions may be imposed bythe Medical Responsibility Board ater noticationrom the National Board o Health and Welare or thepatient concerned. In serious cases the licence to prac-

tise may be revoked and the doctor removed rom themedical register.

The Swedish Medical Association has adopted a code omedical ethics. The code o ethics states inter alia thatthe doctor must act in accordance with the scienticdevelopment and reliable experience, and continuallystrive to expand his/her knowledge. The physicians pri-me objective is to promote the health o his/her patient.He/she must respect the patients right to integrity andautonomy as well as the patients right to inormationon his/her health and possible alternatives o treatment.

The physician must always adhere to the principle o allhuman beings equal value and never expose a patientto discriminatory treatment o any kind. Condentia-lity must be upheld on all patient inormation.


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Medical indemnityAll patients, in public as well as in private care, are co-vered by an insurance (Patient Insurance) paid by thecounty councils and other care providers. The insuran-ce gives the patient economic compensation or injuriesthat occur in connection with medical examination,treatment and care. It operates on a no-ault principle,i.e. the patient does not have to prove that the injury isdue to negligence on the part o the physician or otherpersonnel. The requirement is that the relation o causeand eect between treatment and damage is establis-hed, and that damage is not a normal risk o the med-ical procedure in question. The doctor responsible orthe treatment is obliged to inorm the patient, i he/sheconsiders that damage has occurred, and also to assistthe patient in applying or compensation.

It is, however, recommended that doctors also have aprivate liability insurance as a complement. The premi-ums or a private liability insurance are low, since thePatient Insurance covers almost all cases o demands orcompensation.


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Appendix AMedical specialties in Sweden

(In the process o beeing updated)The ocial designations in Council Directive 93/16/EEC are used.

Specialties not listed in Council Directive 93/16/EEC are reerred to in italics and marked with *

Surgical SpecialtiesGeneral surgeryOrthopaedicsUrologyPaediatric surgeryHand surgery*Plastic surgery

Neurological surgeryThoracic surgeryAnaestheticsObstetrics and gynaecologyGynaecological oncology*Oto rhino laryngologyPhoniatrics*

Audiology*Ophthalmology

Internal Medicine Specialties

General (internal) medicineCardiologyGastro-enterologyEndocrinologyRenal diseasesRespiratory medicineGeneral haematology

AllergologyRheumatologyOccupational medicineGeriatrics

Paediatric SpecialtiesPaediatricsChild & adolescent allergology*Child & adolescent neurology*Child & adolescent cardiology*Neonatology*

Family Medicine*

Psychiatric SpecialtiesPsychiatryForensic psychiatry*Child Psychiatry

Radiological SpecialtiesDiagnostic radiology

Neuroradiology*Child & adolescent radiology*

Clinical Laboratory SpecialtiesTransusion medicine*Coagulation & bleeding disorders*ImmunologyMicrobiology-bacteriologyClinical virology*Clinical physiology*Clinical neurophysiology

Biological chemistryPharmacologyClinical genetics *Pathological anatomyClinical cytology*Forensic medicine*

Community MedicineIndustrial Health *Student Health*Dermatology-venereology

NeurologyCommunicable diseasesPhysiotherapy (Rehabilitation)RadiotherapyNutrition*Pain management*Nuclear Medicine


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Appendix BAddresses

(In the process o beeing updated)

National Board o Health and WelareSocialstyrelsenSE-106 30 STOCKHOLMTel +46-8-555 530 00Fax +46-8-555 534 20email: [email protected]

www.sos.se

Swedish Medical AssociationSveriges lkarrbundBox 5610SE-114 86 STOCKHOLMTel +46-8-790 33 00Fax +46-8-20 57 18email: [email protected]

www.sl.se

The Swedish Medical JournalLkartidningenBox 5603SE-114 86 STOCKHOLMTel +46-8-790 33 00Fax +46-8-20 76 19email: [email protected]

www.lakartidningen.se

Swedish Society o MedicineSvenska LkaresllskapetBox 738SE-101 35 STOCKHOLMTel +46-8-440 88 60Fax +46-8-440 88 99email: [email protected]

www.svls.se

Medical acultiesMedicinska FakultetenKarolinska institutetSE-171 77 STOCKHOLMTel +46-8-728 64 00Fax +46-8-31 03 43email: [email protected]

www.ki.se

Medicinska FakultetenUppsala UniversitetBox 256

SE-751 05 UPPSALATel +46-18-471 00 00Fax +46-18-471 18 58

www.uu.se

Medicinska FakultetenLinkpings UniversitetetSE-581 83 LINKPINGTel +46-13-28 10 00Fax +46-13-10 44 95

www.liu.se

Medicinska FakultetenLunds UniversitetBox 117SE-221 00 LUNDTel +46-46-222 00 00Fax +46-46-222 45 40

www.lu.se

Medicinska FakultetenGteborgs Universitet

Box 400SE-405 30 GTE BORGTel +46-31-773 10 00Fax +46-31-82 58 92

www.gu.se

Medicinska FakultetenUme UniversitetSE-901 87 UMETel +46-90-786 50 00Fax +46-90-786 99 95

www.umu.se


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Federation o Swedish County CouncilsLandstingsrbundetHornsgatan 20SE-118 82 STOCKHOLMTel +46-8-452 72 00

Fax +46-8-452 72 10e-mail:[email protected]

Landstinget i Kalmar lnBox 601SE-391 26 KALMARTel +46-480-840 00

Fax +46-480-841 97e-mail:[email protected]

Landstinget BlekingeSE-371 81 KARLSKRONATel +46-455-73 10 00Fax +46-455-802 50e-mail:[email protected] SkneSE-291 89 KRISTIANSTADTel +46-44-13 30 00


Landstinget HallandBox 517SE-301 80 HALMSTADTel +46-35-13 48 00Fax +46-35-13 54 44e-mail:[email protected]

Vstra Gtalandsregionen

SE-462 80 VNERSBORGTel +46-521-27 57 00Fax +46-521-27 56 00e-mail;[email protected]

Landstinget i VrmlandSE-651 82 KARLSTADTel +46-54-61 40 00Fax +46-54-61 42 98e-mail:[email protected]

County CouncilsStockholms lns landstingBox 22550SE-104 22 STOCKHOLMTel +46-8-737 25 00


Landstinget i Uppsala lnBox 602SE-751 25 UPPSALATel +46-18-17 60 00Fax +46-18-12 28 91e-mail: [email protected]

Landstinget i Srmland

SE-611 88 NYKPINGTel +46-155-24 50 00Fax +46-155-28 91 15e-mail:[email protected]

Landstinget i stergtlandSE-581 91 LINKPINGTel +46-13-22 70 00Fax +46-13-22 71 00e-mail:[email protected]

Landstinget i Jnkpings lnBox 1024SE-551 11 JNKPINGTel +46-36-32 40 00Fax +46-36-16 65 99e-mail:[email protected]

Landstinget i KronobergSE-351 88 VXJTel +46-470-58 85 00Fax +46-470-58 85 30

e-mail:[email protected]


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National Board of Health and Welfare

Socialstyrelsen

SE-106 30 STOCKHOLMTel +46-8-555 530 00Fax +46-8-555 534 20

email: [email protected]

Swedish Medical Association

Sveriges lkarfrbund

Box 5610SE-114 86 STOCKHOLM

Tel +46-8-790 33 00Fax +46-8-20 57 18email: [email protected]

www.sl.se


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rebro lns landstingBox 1613SE-701 16 REBROTel +46-19-602 70 00Fax +46-19-611 81 32e-mail:[email protected]

Landstinget VstmanlandSE-721 51 VSTERSTel +46-21-17 30 00Fax +46-21-17 45 09e-mail:[email protected]

Landstinget Dalarna

Box 712SE-791 29 FALUNTel +46-23-49 00 00


Landstinget GvleborgSE-801 88 GVLETel +46-26-15 40 00Fax +46-26-15 57 00e-mail:[email protected] VsternorrlandSE-871 85 HRNSANDTel +46-611-800 00

Fax +46-611-802 00e-mail:[email protected]

Jmtlands lns landstingBox 602SE-832 23 FRSNTel +46-63-14 75 00Fax +46-63-14 75 15e-mail:[email protected]

Vsterbottens lns landsting

SE-901 89 UMETel +46-90-785 70 00Fax +46-90-13 68 82e-mail:[email protected]

Norrbottens lns landstingSE-971 89 LULETel +46-920-780 00Fax +46-920-147 26e-mail:[email protected]

MunicipalityHlso-och sjukvrdsrvaltningen,Gotlands kommunS:t Gransgatan 3SE-621 84 VISBY

Tel +46-498-26 80 00Fax +46-498-20 35 58e-mail:[email protected]

Documents

Working in Sweden 2009