In order to ensure enough doctors in the municipalities, the government would like to increase the competence requirement for GPs. The ministry reports this on its website. – To make it easier for the municipalities to ensure proper medical staffing, we are granting exceptions for certain competence requirements until 2023, says Minister of Health and Care Ingvild Kjerkol (Ap). In practice, the change means that the municipalities can now use “EEA doctors” who have not completed the Norwegian rotation test (LIS1, see fact box). Medical education in Norway and Denmark Medical education in Norway The education lasts six years. After six years of education, one applies to the Directorate of Health for authorization as a doctor. Most continue their education as a specialist. The specialist training is divided into three parts. The first part is called “LIS 1”, which stands for doctor in specialization part 1. “LIS 1” is common to all specializations and has replaced the former turn test. It still consists of practice in hospitals and in the municipal health and care service. In total, the internship is for one and a half years. Medical education in Denmark The education lasts six years. After six years of education, one gets authorization as a doctor. In order to be able to work independently, one must complete basic clinical training (KBU). This consists of practice in a hospital, medical or surgical department, and general practice or in a psychiatric ward. In total, the internship is one year. After the rotation test has been completed and you have obtained authorization as a doctor in Denmark, you must apply for authorization as a doctor in Norway. After you have obtained authorization, you must apply for “LIS 1”. In several rounds, the medical association has asked the health authorities to change administrative practices so that practice services (such as KBU) from other EEA countries can be assessed as counting towards LIS 1. The central question in the case is the legality of the Norwegian regulations which established requirements for LIS 1 which conditions for LIS 2/3, cf. specialist regulations § 18, which according to the Norwegian Directorate of Health apply to all doctors regardless of country of education. The Medical Association has argued that the Norwegian regulations that require LIS 1 for doctors with practice from other EEA countries must be in conflict with the EEA Agreement’s rules on the four freedoms. In total, there are 175,000 Norwegians who lack a GP, and half of the municipalities say they have major challenges in getting enough health personnel. – To ensure proper medical staffing, we are granting exceptions for certain competence requirements until 2023, says Minister of Health and Care Ingvild Kjerkol (Ap). Photo: Even Bjøringsøy Johnsen / news – A bit like peeing in your pants The new regulations specify that the municipalities can only make use of the exception when it is necessary to “ensure sufficient general practitioner competence”. A similar exception was first introduced due to a shortage of doctors during the pandemic, and then extended to meet the refugee trauma from Ukraine. The scheme has now been extended up to and including 31 December 2023. – This is fine and dandy, and solves an acute problem here and now, says Kristine Brix Longfellow, who is the chief municipal doctor in Høyanger. She adds that the government “must address the underlying problem”: – The fact that Danish and other foreign doctors must take over the entire Norwegian LIS1 in order to start specialisation. The Association of General Practitioners responds to Nils Kristian Klev, head of the Association of General Practitioners – It is positive that the municipalities now do not have to terminate agreements with doctors who have worked as general practitioners on these exemption rules. It is important that these doctors are ensured good training and guidance, and that the exception does not become an obstacle for doctors who wish to be in specialization courses. news has previously told about several Danish doctors who come in a pinch due to a disputed rotation requirement from 2019. – This is a step towards a solution, but also a bit like peeing in your pants to keep warm. Ideally, a permanent solution will be put in place, says Andreas Stoklund Riis, who is Danish and has moved back and forth between Denmark and Kragerø several times due to the rotation requirement. The rule change states that anyone who has been educated abroad and wants to start as a doctor in a specialisation, must first complete a Norwegian rotation. Andreas Stoklund Riis has moved back to Denmark as a result of the rule change from 2019. – We would prefer to stay in Kragerø, he says. Photo: Privat Rotation requirement to increase competence For the Danish mother of young children Annika Dyrkjær, who works as a doctor in Luster in Sogn, the requirement is that she must, in practice, live in a different place than her family for 18 months. It is a price she does not want to pay. – I still miss that a distinction is made between doctors who have completed a service that corresponds to LIS1 abroad and doctors who come straight from their studies without clinical service, she says to news. The rotation requirement is motivated by a desire to raise the competence of doctors in specialisation, “since the municipalities have to provide more complex health services”. But the resistance is great, and among front-line doctors it is claimed that “we cannot afford to make such formal demands” and that “the best becomes the enemy of the good”. – It’s nice that they call the scheme what it is and don’t explain it with covid or refugees from Ukraine, says Annika Dyrkjær, who risks having to move from Luster municipality. Photo: Privat The next half of doctors are educated abroad. In total, there are 28,659 working doctors in Norway under the age of 70 (as of 20 April 2020). Almost half of these (43.5 per cent) were educated abroad. Hilde Ellingsen, expert in EEA law, has seen question marks as to whether the rotation requirement from 2019 harmonizes with the EEA agreement on the four freedoms. – It is the real qualifications of the applicant that must be considered, regardless of formal labels, she told news in January. The Norwegian Medical Association also believes that the “Norwegian requirement” conflicts with the EEA agreement. The Ministry, for its part, believes that they have taken account of the EEA agreement when they write that “this (is) not a question of approval of professional qualifications, but a question of academic integration.” The mayor of Luster, Ivar Kvalen (Sp), is happy about the easing, as long as it lasts. – This is very good, and exactly what we asked the government and the ministry to look at, he says.
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The state relaxes rules to get more GPs – news Vestland
