– I have been a fully qualified doctor for six years, and now I have to start all over again in the specialization course, says Cecilie Riis Iden to news. She has just moved home to Norway after twelve years in Denmark and is soon expecting her first child. Her hope is to continue the specialist training in cancer medicine, which she has started in Denmark, when she returns from maternity leave. But for now it looks like it will be a long race to the finish line. Now Iden is one of 180 doctors behind a lawsuit against the state. Believes the state is violating EEA law It is the Medical Association that sent the summons on Tuesday night, and which is a party to the case on behalf of the students. They require that doctors trained in Denmark have their rotation year, called KBU, approved as part of the first part of specialist training (LIS 1) in Norway. – When the state refuses these doctors approval, they violate EEA law, says president of the Medical Association Anne-Karin Rime to news. President of the Medical Association Anne-Karin Rime. Photo: Remi Sagen / news The grounds for the lawsuit are the EEA court’s rules on free movement of workers and the right of establishment. The Ministry of Health and Care has not responded to news’s questions in the matter. – The ministry has not received the lawsuit. It will be dealt with in the usual way when it comes, writes State Secretary Ole Henrik Krat Bjørkholt (Ap) in an email on Monday. Previously, the ministry replied that they believe that the two rotation periods cannot be compared, because the Danish scheme is part of basic education. It must therefore be carried out before the doctors have the right to work independently. How the rotation arrangements work To become a medical specialist in Norway, you first need 18 months in an LIS 1 position after you have finished your medical education. LIS 1 is a common first part of the specialist education. In the next stage, you specialize in a specific area of medicine, for example in cancer medicine. In Denmark, the system is slightly different. There is the basic education for doctors of six years, which includes one year in rotation, called basic clinical education (KBU). This is the year the medical students believe corresponds to the rotation period in Norway. Every year, medical students from Denmark take up between 40 and 60 LIS 1 positions in Norway, according to the Medical Association. At the same time, there are too few LIS 1 positions compared to both the number of applicants and the need in the health service. In 2022, there were twice as many applicants as there were positions, and newly qualified doctors in Norway often have to wait a long time before they can start the specialist course. – A change to the approval practice could free up positions for doctors who really need LIS 1, says Rime in the Medical Association. Law professor: Have a good case Mads Andenæs, law professor at the University of Oslo, believes the students have a good case. – Both Norwegian law and EEA law are on their side, he says. – Here we are talking about fundamental principles in EEA law. They have earned the shift time they are supposed to have, and this must be credited. – Can they still lose the case? – The state will line up with its apparatus on the other side, and then it will take a lot to win. But in this case, their arguments are so strong that I can’t imagine anything but them winning. Law professor Mads Andenæs at the University of Oslo (UiO). Photo: Bjørn Olav Nordahl / news Resource persons Already before the summers of last year, the doctors who were educated in Denmark announced that they would go to court if the state did not change the practice of not approving KBU as part of LIS 1. – After a long wait, we received an answer from the authorities in October. They do not respond concretely to any of our legal arguments, says Sigurd Stette, who was the initiator of gathering the doctors for a lawsuit. – Then they say that we do not have the right to free mobility, and I believe that it is a fundamental employee right for all employees in the EU and EEA, he says. This is the reason why the doctors have now teamed up with their trade union, the Medical Association, to take the case to court. Sigurd Elias Stette is the spokesperson and initiator for 180 doctors who believe that they should have the rotation period from Denmark approved in Norway. Photo: Sigurd Elias Stette / Private – The doctors behind the lawsuit are resource persons. There are experienced doctors who have worked in both Norway and Denmark, and for whom we certainly have a great need in Norway, says Stette. He believes the state is undermining national interests by not approving the skills Stette and his colleagues educated in Denmark have. – And this is happening at a time when we are in the middle of a serious health crisis in Norway. Stette points out that KBU was previously approved in Norway, but that an organizational change in 2019 led to a change in practice. – My opinion is that the Danish education system and further education system stand out very strongly academically. Denmark has several hospitals and universities that are ranked better than Norway’s best. – Can’t hide behind formalistic arguments In the past, the ministry has argued that the Danish rotation is to be considered part of the basic education for medical students in Denmark, and that the Danish rotation period cannot therefore be compared to the rotation students go through during LIS 1 in Norway . – This argument is untenable, says Martin Hennig, associate professor of jurisprudence at UiT Norway’s Arctic University, believes there is no tenancy in the ministry’s argument that KBU is part of basic education and not specialisation. – It is a formalistic way of thinking with which the state cannot be consulted, he says to news. Martin Hennig, associate professor at UiT Norway’s Arctic University. Photo: Erik Waagbø / news Hennig points out that the ministry has a duty to step in and make a concrete assessment of whether the qualifications that newly qualified doctors acquire in Denmark fully or partially correspond to the qualifications that doctors in Norway acquire during the LIS 1 specialisation. – You have to look at what qualifications the students are actually left with. And it is my position that “practice is practice”, and the two practice schemes have many similarities. Hennig points out that the biggest difference between the Danish and Norwegian arrangements is that the rotation period in Norway is 18 months, while it is only 12 months in Denmark. Thus, he does not believe that the doctors with an education from Denmark will be able to get KBU approved as a full LIS 1. Associate professor at the Faculty of Law in Tromsø Martin Hennig believes the students have a good case. Photo: Erik Waagbø / news – The ministry’s stance, that the practical year completed in Denmark has no transfer value to Norwegian conditions, appears to me to be completely far-fetched. As long as the ministry does not emphasize objective differences between the two schemes, the argument appears as training and unfair discrimination, Hennig believes. – In this case, the state has to do what they are obliged to do under the EEA agreement, and cannot hide behind formalistic arguments that the internship period is called something else in Denmark and must therefore be useless and useless in Norway. – Not fun. For Iden and the other doctors, double shifts have financial consequences. They lose time as fully qualified medical specialists and may lose seniority built up in Denmark. But it also has social consequences, the doctors believe. – I have to repeat a piece of work I did in 2018 and 2019, and take up a position that other doctors queue for months to get. It is thought-provoking that I will now be taking a LIS 1 position which should have been reserved for a newly qualified doctor. Cecilie Riis Iden would like to work as a cancer doctor. Now years of education await before she reaches her goal. Photo: Private – How does it feel to now have to sue the state in this case? – It’s no fun, but it feels like a necessary step. Nobody wants to go to court against the health authorities in the country where they want to work. Iden is now likely to have years of delays on the way to medical specialization in Norway. – I would very much like to be a medical specialist, and as my situation is now, it is in Norway that I want to work. So I will apply for LIS 1 positions after maternity leave, she says, and adds: – If the situation doesn’t change, then. We can hope that something will happen before I go back to work.
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The medical association is suing the state – news Troms and Finnmark
