Moving to Sweden as a doctor: Practical training

In this post, I am documenting my experiences during the mandatory practical training (PT) that you have to undergo for qualifying for the medical license in Sweden.

Before I passed the practical exam, I thought that it would be a good idea to shadow a doctor at a hospital (called praktik in Swedish) so that it helps me build confidence for the exam. It was September 2020, and one was not allowed to do practical training before one passed the practical part of the medical license exam. So, I wrote to the manager (verksamhetschef) of the Vårdcentral near to my home, explaining my situation, and asking if they will be interested in taking me in for a praktik a few days a week. In the same mail, I expressed interest in continuing in the same Vårdcentral (VC) for my PT once I pass the exam. After a week or so, I was called in for an interview at the Vårdcentral. I explained my situation to them, and they were not only interested in allowing me for the praktik, but also were generous to offer me a place for PT. This was the only Vårdcentral that I applied to, and I was lucky to be chosen to work there. I have heard from many students that they have found it hard to find a hospital which would take them in for PT. Here are some tips for those applying for a PT:

  1. PT is a relatively new service and many managers do not know about it. When you write a mail to the manager asking for PT, you have to also explain what PT is, and if possible, provide relevant links to the website containing descriptions of PT. The hospitals usually do not have the finances to hire you, so you have to tell them clearly that it is the Region (i.e. VG region in my case) or Arbetsförmedlingen that pays your salary and your supervisor’s compensation. This means that the hospital/VC is essentially getting an extra person to work for them without incurring any cost from their side. They are usually happy due to this prospect. If your manager does not know this part, you are unlikely to find a job.
  2. Applying to the VC or hospital near your home versus applying at a faraway place is always beneficial. You can tell in the email to the manager that you live quite close by the VC, and you are open to the possibility of continuing to work for them after the PT is over. There is usually a scarcity of qualified licensed doctors, so smaller hospitals and VCs are interested in keeping you there if you happen to perform well enough during your PT. They know that, if you live near the place of work, chances are that you will stick to it because of easy commuting.
  3. You have to tell about your past experience in the email. In my case, I had a PhD. Many of the doctors who come to Sweden are specialists in their home country. If you are a specialist in, say, family medicine in your home country, chances are that you are preferred for the job in VC. Always attach your CV to the email that you are sending to the manager.
  4. I have found from others’ experience that you are more likely to get a position if you apply to VCs in areas where a lot of immigrants live. Such VCs usually want doctors who cater for multicultural patients, and your Swedish language skills do not matter so much because most of your patients (and sometimes colleagues) will be foreign-born.
  5. Never ever write your email in English. Always write in Swedish, and if possible, get the text of the email verified by a Swedish speaker to avoid embarrassing mistakes.
  6. Make your email easy to read and understand. The managers usually get dozens of mails every day, and they are usually very busy. Your email title and content has to grab their attention. Have good amount of text in the body of the email and attach the CV as a pdf (not zip). The manager might skip reading your mail if you have a lot of downloadable material and unclear text in the body.
  7. I have heard that some doctors visited the VC or the hospital directly and asked for meeting the manager. Doing this is hard because the manager is usually busy with other things, but this is definitely worth trying. If you haven’t got any reply for your email for a month or so, you can also call them via telephone and ask about the status of your application politely.

Most often, you apply by directly writing an email to the manager. If you are in VG Region, you can get the list of all VCs here. Go to each VCs page, find the email of the verksamhetschef and write an email to them. You can also apply to the VG Region web portal here, but it takes time for them to find a place for you and their process is quite slow. Apply to many VCs and hospital wards at the same time – you never know who will call you for an interview first.

My interview for the PT at the VC was approximately an hour long. I and the manager talked for around 30 minutes. I was mostly asked about the reasons for choosing to go to Sweden, details of my PhD project, future career plans, reason for choosing to apply to this particular VC and what I expect to learn from the job. We spent the rest of the 30 minutes going around the VC, meeting people and getting used to the rooms and facilities there. I was impressed by the way the VC worked so efficiently. Even before I cleared the practicals, the manager told me that I can join there as a PT doctor once I pass my exam.

I passed the exam in September 2020. It took a week or so for me to get the approval from Socialstyrelsen to continue with PT. I sent the approval documents to the VC, and the VC did the rest of the work for me, including fixing the finances, getting the necessary approvals required for the workplace to employ me. It took almost one and half months for this process to complete. During this period, I worked on a part time project with Creative Commons to create an educational resource for pathology. I also got to work on a research paper about stroke. Being busy with these prior commitments, I could only start PT by December 1, 2020. I signed a contract with a salary of 30,000 SEK per month (much less than my previous salaries, but PT is mandatory, so I had to take the job regardless of the salary). Some say that you can negotiate your salary, but I didn’t do it because I was thankful that I got a PT at the first place. Secondly, I had no experience whatsoever with the healthcare system in Sweden, so I didn’t see why my employer should give me a higher salary for taking in someone who is a beginner. The Region only gives 30,000 SEK per PT, and any extra money going into your salary has to be put in by your employer. Before signing my contract, I did not discuss about vacation, and it so happened to me that I got no vacation days whatsoever. Before you sign your contract, talk with your manager about the terms regarding number of vacation days (usually it is 14 days). You are also qualified for a fitness allowance of around 600 SEK.

The first two weeks of my PT were actually a training period. I had to learn Asynja Visph, the software used for recording journal notes. There are also other portals and software such as Pascal (for Apodos), Melior (for reading notes from the hospital) and Picsara (for adding pictures of skin lesions etc to the journal), but I found them easy to learn. The tough part for me was to get used to the routines that are practiced in the VC and to counsel the patients regarding their disease condition. I found out early on that you cannot satisfy all your patients. There will invariably be patients who ask for unnecessary medication, unwarranted sick leave or advanced diagnostic tests. If you judge that their request is inappropriate, you have to politely refuse it. Learning to say ‘no’ is a big part of your training. Always remember that your main aim is to have disease-free individuals, not happy customers. It is the managers job to keep the customers happy, and your job as a doctor is to do the optimal thing to ensure the long term well-being of the patient as well as the society in general, and to explain to the patient the reasons for your choice of treatment.

I started seeing patients on my own starting from my third week of PT. I would talk with patients and explain the history and examination findings to another doctor, who will then decide the diagnosis and treatment. After two more weeks of doing this, I started taking patients independently, even though I consulted with a senior most of the times in between or after the patient visit. On an average day, I usually took 5-6 patients, made 2-3 follow up phone calls, and renewed one or two prescriptions. This might sound like an easy job for those of you who used to seeing up to 50 patients a day in your home country, but that is not how things work in Sweden. There is a good deal of documentation to do, and you are supposed to spend quality time with your patient. In my case, time just flied between 8 am to 5 pm, and most of the time, I used to forget about fika breaks.

A good part of the job in Sweden is that you can always look up a variety of web resources in medicine. Here is the list of some of them I know.

  1. REK list: Most important reference book for everything related to patient management in primary care. For any disease, refer REK list first. You can check other resources only when the description in REK list is inadequate. Available in booklet format also.
  2. Äldrekompassen: Guidelines regarding medications for the elderly (available as booklet also).
  3. Medibas : Contains commonly encountered diseases and their management. Paid membership, but you can use Institutional access to get full access.
  4. Internetmedicin: Contains description and management of diseases both at the primary care level as well as the specialist level. Useful when your patients need to know about what could happen next after being referred to a specialist.
  5. UpToDate: Contains newer and updated worldwide guidelines about several diseases.
  6. Krav- och kvalitetsbok Vårdval: If you are interested in management and is looking forward to become the manager of a VC, or if you are just curious about the specifics of how a VC works, this book is for you.
  7. FASS : Contains information regarding all available medicines in Sweden, including its pharmacokinetics, interactions, dosing and contraindications.
  8. Smörjschema: Several patients would need to use cortisone creams, and the scheme for tapering the medicine is quite lengthy. I usually give a print out from this website to ease my job of writing out the instructions in detail.
  9. JanusInfo: Lot of good information about medications, including medications for pregnant and lactating individuals.
  10. STRAMA: Antibiotic prescription has to strictly follow STRAMA guidelines. No exceptions.
  11. 1177: Information about self-medication for minor disease conditions can be found here. I usually encourage my patients to read 1177 for knowing more about their diagnosis and self-help remedies.
  12. Läkemedelsverket: Contains details about why some medicines have been phased out, and which medicines can be used in their stead.

At the end of the practical training, your supervisor and manager fill up a form, which you can send to Socialstyrelsen along with other relevant documents. I sent my documents to Socialstyrelsen in the second week of June 2021 and received my Swedish medical license via e-mail within one week after application.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish
  3. Moving to Sweden as a doctor: Medical license exam
  4. Moving to Sweden as a doctor: Practical exam

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