Speed up licensing of non-EU medics, say universities

Health professionals from outside Europe are having to wait an average of four years to get a licence to practise in Sweden, despite pleas from universities to allow them to speed up the education needed to meet requirements.

Applicants approaching the National Board of Health and Welfare, or Socialstyrelsen, responsible for authorisation of licences to practise for 21 health professions, were told earlier this month that the board needed time to process their applications, by which they meant that they needed time to evaluate previous education compared to Swedish requirements.

“As of today [1 May] we are handling applications from June 2014,” a message from the national board said.

The message adds to the frustration felt by migrants such as Syrian refugee, Hammad Rasheed. He had 28 years of practice as a heart specialist before coming to Sweden, where he is now living in a refugee camp in Vänersborg – one hour’s drive from Gothenburg.

But he is facing an uphill battle finding courses in Swedish and complementary courses in certain medical fields at a Swedish university before he can get authorisation to practice.

“I have worked as a heart specialist for 28 years and I love to work,” Rasheed told Swedish television, Svt.se. “But to wait for courses in complementary education and language courses is very frustrating.”

Demand has risen sharply

Demand from non-European Union foreign professionals has risen sharply in recent years but the number of licences granted has decreased.

The number of applications for a licence to practise from health professionals from outside the European Union, or EU, increased from 1,229 in 2012 to 1,973 in 2014, a 60% increase, while at the same time the number of licences awarded dropped from 371 in 2012 to 317 in 2014, a fall of 15%.

The Swedish Medical Association estimates that each year between 300 and 400 medical doctors from outside the EU receive licences to practise in Sweden.

This represents a significant additional contribution to the profession, compared with the 1,600 medical doctors who graduate each year from Swedish universities.

But the process takes on average three years if you are a medical specialist in your home country and six years if you are a medical doctor.

The Swedish authorities have repeatedly tried to find out what can be done to improve this situation, and the Swedish National Audit Office has criticised the often very long delays, but the situation has not improved.

The requirements for licensing vary between professions. The language tests are mandatory: first there is a test in Swedish for immigrants and after that a test equal to secondary education-level Swedish.

Most professions then require a medical competence test or complementary courses, some praxis and lastly a course in Swedish legislation related to health and welfare.

What can be done?

The Swedish government mandated Professor Ingvar Karlberg to find out how the system of authorisation is working and what can be done to improve the handling time. He delivered his report in 2013. Karlberg told Svt.se that the system of authorisation is fragmented and not transparent.

“When approaching the governmental work employment office, the applicants get a message on what to do. But the refugees have to find their way through the legitimation maze themselves – they have to find the courses, the places for practice and eventually also the complementary courses, and there are often queues for these,” Karlberg said.

He said the government needs to take greater responsibility for creating a system that works.

The University of Gothenburg School of Business, Economics and Law has previously proposed speeding up the education of foreign health personnel in Swedish universities, concluding that an investment of SEK5 million (US$605,000) would provide a benefit to society of SEK150 million (US$18 million).

Rising migration

There is broad political consensus that immigrants should be able to work in their area of competence – that doctors should be able to work as doctors rather than taxi drivers, for instance – but the challenge of achieving that has been magnified over recent years, as migration to Sweden has risen strongly.

In 2010 it was estimated that 1.33 million people or 14.3% of the inhabitants in Sweden were foreign-born, two-thirds of them born outside Europe. In 2013, immigration reached its highest level since records began with 115,845 people migrating to Sweden.

Some 81,300 applied for asylum in 2014, up 50% on 2013, and the most since 1992. Among asylum seekers, 47% come from Syria, followed by 21% from the horn of Africa, mostly from Eritrea and Somalia. A high proportion – some 77% of requests (63,000) in 2014 – were approved.

It is estimated that between 2015 and 2019 up to 350,000 refugees could settle in Sweden and the Swedish Migration Agency has request SEK157 billion (US$19 billion) to deal with this.

A need to speed up the process

The increasing number of people migrating from Syria, in particular, many of whom are highly educated, and many in the health professions, is accentuating the need to speed up the process of recognising their medical skills in Sweden.

Solange Berleen Misuke, who researched the issue in a thesis in 2012 concluded: “The results showed that doctors from non-European countries have stricter requirements to fulfil in order to be able to practise medicine in Sweden than doctors coming from European countries.

“The system for accepting foreign doctors and validating their competence was confusing, frustrating and unnecessarily long.”

The chairpersons of 10 health professional associations, including the Swedish Medical Association representing 46,000 medical doctors, wrote a letter in March this year to the National Board of Health and Welfare stating that “the processing time for treating applications for authorisation of health personnel from outside Europe is now unreasonable, being on average eight to 10 months just to have the higher education diploma and licence from the home country examined”, which is only the first step in the process.

Pernilla Hultberg, the education officer coordinating complementary education for medical doctors, nurses and dentists at Sahlgrenska Academy at the University of Gothenburg, told University World News:

“As you probably know there are two ways to get a Swedish licence – through knowledge tests and assessed practice which the individuals have to arrange themselves without any contacts within the medical field and without finance. It is possible to study on your own and manage to pass the knowledge tests, but the next step is much more problematic and almost impossible.

“The other option is to apply for the complementary courses that a few medical universities arrange. The problem here is that we accept so few students. The reason for that is the stiff competition with the other programmes and courses, and we often hear the argument that ‘we don't even have room for our own students’, which is frustrating. All students should be considered ‘our own’.

“There are a number of obstacles, both within the university courses and on a national level, but also many good ideas of how these obstacles could be dealt with. And a political consensus. But nothing is happening. Just talks and different statements, mostly political, but almost no action.”

Marja Grill is a journalist at the Sweden television company Svt.se and Jan Petter Myklebust is a regular correspondent on Scandinavia for University World News.