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The editorial from Dagens Nyheter, [b][color=#00BF00]frames[/color][/b] the issue of the knowledge demands for obtaining a medical license in an [b][color=#00BF00]non-precise[/color][/b] way, and is on at least [b][color=#BF0000]one occasion plainly wrong[/color][/b]!


First, I agree with the editorial that the time-consuming process of validating your medical education and license is highly problematic and a waste of knowledge! The personal tragedies speak for themselves. Now hopefully, with the additional funding and staff, Socialstyrelsen will be able speed up the process, and validate the applications within 3-6 months.
The language learning process would surely also benefit from an economical ”booster”, not to mention the allocation of resources to hospitals offering internships and probationary service.

Regarding the knowledge demands, let me first disclose that I personally find it beneficial that we in Sweden expect a broad level of knowledge, among our physicians.
However, it should non the less be noted that the knowledge level expected for obtaining a Swedish medical license are in no way near that of a specialist in the fileds mentioned.
What is for example
[quote]sufficient knowledge in for instance gynecology, pediatrics and psychiatry.[/quote]

These are in no way that of a specialist in the given fields. However, should not a ”[i]super skilled orthopaedic surgeon[/i]” be expected to recognise the most common symptoms of depression or heart failure? And in addition know what is a suitable treatment to start with, or at least where that knowledge can be obtained, without having to call in a consult in the relevant field? I don’t find those knowledge expectations ”[i]unreasonable[/i]” at all.
I have personally worked abroad, in a country where they had more of a ”not my field, call the consultant”-culture, and requests were not rarely trivial, even borderline-ridiculous;
(1) cardiologist for decision to increase beta-blocker for a patient with known a.fib and therapeutical Warfarin
(2) dermatologist for treatment of reoccurring (non-serious) psoriasis
After 5+ years of medical education, and possible additional clinical practice, I firmly believe that one should be able to make those calls, or at least be able to reason oneself to a suitable answer together with nearby colleagues, without having to call in a specialist. But maybe that’s just me?

Also, the examples given in the editorial, a ”world renowned heart surgeon” and a ”skilled orthopaedic surgeon”, are both unfitting. [color=#BF0000][b]Neither[/b][/color] of these surgeons [color=#BF0000][b]would havet o take the knowledge test (TULE)[/b][/color] nor do the 18+ months internship (AT).
[quote]skilled orthopedic surgeon from Syria has to sit at home because he did not pass a sufficient number of the gynecology questions in the knowledge test[/quote]
Since that they are both specialists with experience (how else do you become "[i]skilled[/i]" or "[i]world renowned[/i] "?), they would be eligible for the [b][u][color=#400080]probationary service[/color]*[/u][/b], consisting of six consecutive months within a relevant field of practice, i.e. in the two examples, thorax/heart surgery/vascular surgery and orthopaedics, respectively.

* [color=#400080][i]See[/i] [b]Step 3.[/b][/color]
[url]https://www.socialstyrelsen.se/applicationforswedishlicencetopractiseothercountries/doctorofmedicine[/url]


For those interested, the goal with this [color=#400080][b]probationary service[/b] [/color]is to assess the candidate's:
- Medical knowledge in relation to the requirements of Swedish certification /medical license
- Discernment / clinical judgement
- Approach to patients and staff
- General suitability as a doctor

Read more about the goals and assessment criteria here (in Swedish):
[url]https://www.socialstyrelsen.se/ansokaomlegitimationochintyg/legitimation/utbildadiannatland/lakaresteg3[/url]

Dagens Nyheter, a centre-left liberal newspaper often regarded as the centre of political debate in Sweden, has published an editorial about the long waiting times for immigrating physicians.

http://www.dn.se/ledare/huvudledare/lat-den-ratte-komma-in/

Here is a manual translation for those who lack faith in Google translate:[quote][b]The Swedish licensing system in healthcare has served us well. But when foreign physicians come to Sweden, it does not work anymore. Sweden must think again. If we lose specialists because everyone has to be a generalist, then the price is too high.[/b]

The stories are now becoming as many as they are upsetting. Year after year we hear about immigrating physicians and other healthcare personell in license-requiring professions that get stuck in the Swedish bureaucracy. And year after year representatives of Socialstyrelsen (the National Board of Health and Welfare) are interviewed and year after year they promise changes for the better, all the while the application processing times get ever longer.

There are several blockages in the system. Even errands that should go smoothly get stuck. The first obstacle is to get an administrator to deal with the application for Swedish licensing.

[b]A year ago[/b] we were upset that this could take eight months. Today the waiting times exceed a year. After that, even more waiting remains.

For a specialist physician, it takes three years on average to get a license. For those who are not specialists, it takes an additional three years. What is the problem? Is it resources, inefficiency or squareness?

The issue of resources is not easy to resolve. Socialstyrelsen has through two government decisions last spring been granted 18.6 million SEK to speed up the process. The recruitment of administrators just finished. But it will of course take time before the investment yields dividends.

[b]This is the first time[/b] Socialstyrelsen get earmarked funding for this purpose. Earlier the money has been taken from the yearly appropriation. And since certain earlier tasks, such as supervision, have been shifted to a new authority, it is difficult to already now draw any definite conclusions as to whether the resource allocation has become too meager as the applications increase.

The government, the current one as well as the last one, can be criticised for not creating any system for simplifying the process despite wishes from Socialstyrelsen.

Once Socialstyrelsen has made its first decision, that the medical education is adequate, sufficient education in the Swedish language remains - unless you come from a different EU/EEA country, in which case no knowledge of Swedish is required at all. After that comes a medical knowledge test or a probationary service. The test is given in Swedish and perhaps this is the reason why so many try to find an employer who can offer a probationary service, which is not the easiest.

But that path is tricky too for other reasons, says Pernilla Ek at Socialstyrelsen. The employer is not only to assess the performance of the probabionary physician in the clinic but also whether they possess knowledge equivalent to the Swedish AT internship.

Swedish physician or nurse license requires that you are a generalist. It is not enough to be a world famous heart surgeon to get a job at a thorax ward. You also have to possess sufficient knowledge in for instance gynecology, pediatrics and psychiatry. And in healthcare related, Swedish legal code.

All of this is in some sense reasonable. It is important that everyone with a licensed profession knows about their duty to report things such as children suffering. It is also reasonable that a heart surgeon knows a bit about psychiatry since even the mentally ill can end up in a thorax ward.

[b]But at the same time it seems[/b] unreasonable that a super skilled orthopedic surgeon from Syria has to sit at home because he did not pass a sufficient number of the gynecology questions in the knowledge test. Perhaps we should instead consider whether it is really necessary to have a licensing system which gives the individual [i]carte blanche[/i] to work at any clinic or ward.

Our all or nothing model collides with some countries' specialist systems where everyone has not read everything. Both the individual and the society wins out if the one who is good at something - even if not at everything - gets a chance to work with what he or she knows. People are ground down by waiting. Professional knowledge erodes. It must be better to get physicians out there, give them a limited mandate or a strong supervision, than to make them stuck at home.

If it is completely impossible to imagine any form of limited or conditioned license, there remains the possibility to make a hard push for speeding up the process. At the county council of Norrbotten there are examples of physicians with non-EU/EEA education who have been afforded private tutoring in Swedish and an internship. And who progressed to a job relatively quickly. If this is possible there, it should be possible in other parts of the country as well.

[b]There is money to be made.[/b] The Swedish National Audit Office has calculated that merely a month of shortened waiting time for a foreign physician would mean a profit for the public sector amounting to 42,000 SEK.[/quote]