The doctor exodus – with focus on the Scandinavian context.

 

The last few years we have increasingly been reached by news of the nurse staffing crisis. Nurses are leaving the public health sector in drones and around the globe there is a growing wave of nurses strikes and protests. They demand better staffing, more humane workload, fairer wages, and rightfully so. From personal experience, working as a medical doctor in several of the Nordic countries, the nurse problems have been diligently discussed both at work and on media, the strikes have been backed by most and the need for changes has been loudly cheered. Discussions about the doctor situation, at least in Scandinavia, however, are missing from current global health discourse and there is no mention of it on social media platforms like Twitter. Is this because we do not have a staffing problem among physicians?

Well, according to a new study published in the Lancet there is a shortage of 6.4 million medical doctors worldwide in order to meet the goals for universal health coverage and WHO announces that current trends show that this number will not be reduced to meet the goals for the 2030 agenda. The Scandinavian countries paint a similar picture. Clearly there seems to be a crisis among the medical profession as well. How serious is it though, what does it depend on and why is it not being as rigorously discussed as the nurse shortage crisis?

A survey conducted by the Swedish medical association last year showed that 6 out of 10 doctors in Sweden are thinking about leaving their workplace, reducing their working hours or leaving the profession all together. A staggering one third of residents contemplate quitting. According to a 2022 report by the National Board of Health and Welfare, each of the 21 regions in Sweden state a shortage of specialised medical doctors. The situation does not look much brighter for our Scandinavian neighbours: In Denmark, ER-doctors are leaving their full-time jobs to earn significantly more as consultants. Furthermore, the deficit of general practitioners in Denmark has been described as a ticking bomb. From Norway there are also reports of Doctor’s crisis in many areas, not least in primary care, where municipalities across the country are struggling to hire and keep GPs. Finland as well faces a public sector doctor shortage. What are the reasons behind these alarming numbers?

Medical students enter medical school and battle through one of the most demanding educations there is with noble ambitions, big dreams and high hopes of saving lives, caring for patients and making a significant change, only to find themselves “slaving away” at understaffed, overcrowded ERs with dissatisfied patients and burned-out colleagues. They don’t see guarantees for a brighter future in their older colleagues either; Specialists with years of experience and a well of knowledge end up spending hours of their time working on an ever-growing amount of administrative tasks. General practicians work overtime renewing people’s sick-leaves while they themselves run down with stress trying to satisfy ever growing demands from “not really sick” patients. Despite the alarming numbers regarding the physician situation in the Nordic countries, no effort has been made to understand the drivers. Some qualitative studies from other European countries have found that impact on family time, perceived bad quality of care and increased administrative burdens and non-patient related tasks are some for the reasons for the growing doctor job dissatisfaction.

Critics would argue that being a doctor is a calling rather than a job and something one chooses to do out of altruistic reasons. Complaining about salary, work satisfaction, lack of appreciation, life-quality and so on is thus taboo for a doctor, not least in the Nordic countries where the famous law of Jante is the golden standard of conduct.  For the same reasons, doctors shouldn’t strike; They are under obligation to serve the people! Well, times are changing. Doctors too are starting to focus more on their own well-being, family time and quality of life. I used to work at a major cardiothoracic department in Scandinavia where in less than a year three younger specialists quit for the reasons mentioned, to a great surprise of the older colleagues. Doctors have now started striking too: Thousands in Madrid have been on strikes since November over poor wages and working conditions. Last summer Turkish doctors went on a nationwide strike also demanding better working conditions and at this moment tens of thousands of junior doctors in England are striking for the same reasons.

Clearly, there seems to be a problem of doctor shortage and work dissatisfaction, also in high-income countries like the Scandinavian. It is about time we remove the taboo against doctors’ complaints, start talking about the problems and pressure policy makers to act. If not, we are about to witness a doctor exodus too, only this one in silence.

About the author: Mateja Ladan, Medical Doctor from the University of Copenhagen. 7 years of working experience within the medical field in Denmark, Sweden and Norway: amongst others in Thoracic Surgery, Vascular Surgery and emergency care. Currently Master’s degree student in Public Health at Lund University.

Competing interest: None

Handling Editors: Neha Faruqui and Seye Abimbola

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