Recruitment and Retention
of Health Care Providers in
Remote Rural areas
Status report for Sweden
Anette Edin-Liljegren
Peter Berggren
Britt-Marie Nordström
Helge Brännström
Kalle Ängkvist
Leif Sollén
Mante Hedman
[2011-10-07]
Contents
1
Introduction....................................................................................................................... 3
2
Geography ......................................................................................................................... 3
3
Demography ...................................................................................................................... 5
4
The organization of the health care services .................................................................... 9
4.1
Primary health care ......................................................................................................... 10
4.2
Hospitals / Specialized service ......................................................................................... 12
5
Health care professionals ................................................................................................ 18
6
Urban area ....................................................................................................................... 19
7
Education and training .................................................................................................... 22
8
Recruitment / Retention problems ................................................................................. 23
9
Summary ......................................................................................................................... 23
1
Introduction
There is a great need to recruit and retain people to rural areas in northern Sweden, especially
in the inland and mountain areas. The population gets older and the young people, 18–24 years
are moving out to get education. There are difficulties to find people with higher education,
especially physicians who wants to move to and retain in the rural area.
In this project the rural area are defined as the inland and mountain areas of the Countyof
Västerbotten. It is the same area as the primary health care area in Southern Lapland, which is
compared with the denselypopulatedCounty of Uppsala in the east of Sweden, with excess to all
possible health care within short distance.
2
Geography
The County Council of Västerbotten is situatedin the northern part of Sweden, figure 1. There are
259 000 people (Statistics Sweden, 30 jun 2011) currently sharing a living space the size of
Denmark, approximately 67 200 km2 (Statistics Sweden, 1 January 2011). The county is both
sparsely and densely populated, dense in the costal area and sparsely in the inland and mountain
areas next to the Norwegian border. In average there are four inhabitants in every square
kilometres.
The County of Västerbotten has three cities, Umeå, Skellefteå and Lycksele and in every town
there is a hospital. In Umeå there is also a university with more than 30 000 students.
The rural area consists of vast forests and swamps and mighty mountain scenery bordering to
Norway. In inland area grows pine mixed forest in flat or wavy terrain and on hills. A little further
west there are conifer forests, birch forests, plains and isolated mountain ranges. Far northwest
towards the Norwegian border there are steep mountains and glaciers.
In Åsele municipality is the National park of Björnlandet placed and in Storuman and Sorsele
municipalities is the National Park of Vindelfjällen which covers 560 000 hectares and is the
largest protected area in northern Europe. From the mountains down to the coast the landscape
are crossed with several rivers flowing in southeasterly direction into the Gulf of Bothnia, such as
Ångermanälven, Ume- and Vindelälven. The Vindelälven is one of four national rivers inSweden.
The Foundations of the economy in the County is the natural resources, iron ore, forests and
waterpower.
Public bus transport is available into, from and within the county and there are some trips every
day to the mountain regions. The blue road or European highway 12 (E12) crosses the inland and
go’s from Umeå in northwesterlydirection through Lycksele, Storuman, Tärnaby to Norway. In
Storuman the European highway 45 (E45) and E12 crosses each other and E45 continues to the
northeast, towards Sorsele and further north.
In the rural area there is three airports open for passengers, in Vilhelmina, Lycksele and Hemavan
and the longest distance is about 100 km between a conurbation in rural areas and to the nearest
airport. Broadband is relatively well developed in several towns in the inland as well as mobile
phone network. However, the mobile phone network does not work so well in the mountain
regions.
Figure 1. The County Council of Västerbotten and the Southern Lapland rural area in Sweden and Europe.
Southern Lapland rural area covers approximately 37 200 km2land (Statistics Sweden, 1
January, 2011) with a total population of about 37 400 inhabitants (Statistics Sweden, 30 June,
2011), thus approximately 1 inhabitant per km2, In this rural area there are seven
municipalities, table 1. The largest town or village in the rural area is Lycksele with
approximately 12 400
Municipality
Land area km2
Inhabitants
Inh/km2
inhabitants (statistics
Sweden, 30 June 2011).
The number of
inhabitants, land area and
population density,in the
municipalities in the rural
area, can be seen in table
1.
Table 1. Municipality, land area,
number of inhabitants and
population density in the rural
area of Southern Lapland.
3
Dorotea
2 795
2 878
1,0
Vilhelmina
8 120
7 135
0,9
Storuman/Tärnaby
7 378
6 120
0,8
Sorsele
7 465
2 736
0,4
Åsele
4 277
3 039
0,7
Lycksele
5 560
12 376
2,2
Malå
1 609
3 274
2,0
37 204
37 558
1,4
Sum/mean:
Demography
Migration last five years
It has been a negative net migration, i.e. more people have moved out fromthe municipalities
than into the area, in all rural municipalities in theCounty 2009, in the age group 18–24 years.
However, there was a net increase
in the County Council
of Västerbotten, in
the same age.
Municipality / County Council of
Västerbotte/Sweden
Åsele
- 35
-5
1
Table 2. Net migration in
different age groups, in
Southern Lapland rural
area, the County Council
of Västerbotten and in
Sweden. Source:
Statistics, Sweden2010.
Dorotea
- 15
-8
4
Vilhelmina
- 30
18
-4
Storuman/Tärnaby
- 45
-9
0
Sorsele
- 18
7
- 14
This is probably
caused by young
people who moves to
Umeå to study at the
University, table 2.
Malå
- 11
2
-3
Lycksele
- 55
- 10
10
Västerbottens län
669
- 540
- 62
11 921
24 803
1 070
Sverige
Total
18–24 y
Total
25–54 y
Total
55– y
The age group 25–54 years was a deficit in four of seven municipalities and in three of seven
municipalities in the age group over 55 years of age. In the total County Council of Västerbotten
it was a negative net migration in the two oldest age groups. In Sweden, both overall and in all
ages, there was a migration surplus (Source: SCB, municipal facts, SCB).
During the period 2006 to 2010 has the negative net migration decreased, since fewer women
moved from the area and in the comparing County Council of Uppsala it was the opposite, figure
2.
Community
Figure 2. The total net migration for men and women in all age groups, in 2006 to 2010 in the rural area of Southern
Lapland in the County Council of Västerbotten and in the urban area, the County Council of Uppsala. Source: Statistics,
Sweden 2010.
Age distribution of population
The population in Sweden is very unevenly distributed. Most people live in the southern parts
and along the coastline to the Baltic sea, figure 3. The Southern Lapland parts of the country are,
as they say in the European union, not yet totally abandoned
areas. The population also gets older and it enhanced by the
migration of young people moving to the cities to get education.
This is obvious in rural areas where it’s a lack of people. In
Southern Lapland it is also obvious since there are few people in
the area and its difficult to get educated people for different
professions. The age distribution of men and women in the rural
area of Southern Lapland with more inhabitants in the age of 40–
80 years, is demonstrated in figure 4.
Figure 3. The distribution of the population in Sweden.
Figure 4. The age distribution of the
population in Southern Lapland rural area in
the County of Västerbotten.
Life expectancy
Life expectancy at birth in the rural
municipalities in Southern Lapland is
almost the same as in the total
county of Västerbotten and in
Sweden, especially for women. However, the women in Malå and Storuman live slightly shorter
than in other municipalities in the rural area. Among men is the major differences 5,5 years
between Åsele and Dorotea, two municipalities in the rural area. It is still a mean difference in
life expectancy of approximately five years between men and women, table 3.
Municipality/County Council
of Västerbotten/Sweden
Dorotea
81,4
Women, mean age,
(year)
83,8
Vilhelmina
77,4
83,0
Storuman/Tärnaby
78,8
81,8
Sorsele
77,3
83,5
Åsele
75,9
83,4
Lycksele
79,4
83,2
Malå
76,2
82,5
The County of Västerbotten
79,2
83,2
Sweden
79,1
83,2
Men, mean age, (year)
Table 3. The mean life expectancy at birth in the municipalities in Southern Lapland, in the County Council of
Västerbotten and in Sweden during 2006–2010. Statistics Sweden, 2010.
Employment status last five years
The Swedish Public employment service makes forecasting interviews with selected employers
every spring and fall. It is obvious that occupations requiring identification is lacking, doctors in
all categories,specialist nurses, psychologists and dentists. These are rarely registered at The
Swedish public employment service. Other professions as teachers, language teachers,
automotive teacher, preschool teacher, mining engineers, engineers, electrical power and wind
power technologies, environmental inspectors, forest machine, excavator lard, machine
operators is lacking. Norway attracts with higher wages and better working conditions so some
job seekers living near the Norwegian border works in Norway as nurses, engineering mechanics
and other jobs dealing with road management (The Public Employment Service, Storuman,
2011).
The most common professions in the rural area are professions in personal care where most
women are working.
The most common male job was motor vehicle drivers and for female it wasprofessions within
personal care and related workers.
Table 4. The most common professions in
the rural area in Southern Lapland in 2009.
Statistics, Sweden according to SSYK
(Swedish Standard of classification of
occupations (SSYK).
Profession
Women %
Personal care and related workers
78–91
Shop, stall salespersons and demonstrators
56–68
Motor-vehicle drivers
3–4
Wood-products machine operators
30
Building frame and related trades workers
12
Are there any specific problems that need to be in focus
The problem is that it is few people living in the rural area and it’s a deficit of highly educated
people, especially physicians. There is a vacancy situation of more than 30 % in this area, table 5.
There is a great need to recruit and retain educated people to the rural area in southern Lapland.
Municipality
Vilhelmina
Lycksele
Dorotea
Åsele
Tärnaby
Storuman
Sorsele
Malå
Total
Budget
4,75
5
2
2
2
3,25
2
3
24
No of
physicians
3
4
1
1
1
4
1
2
17
Working
time
2,25
3
0,6
0,67
1
2,95
0,5
1,55
12,52
No of ST
physicians
Working time,
ST physicians
0
2
0
2
1
1
0
0
6
0
1,8
0
2
1
0,8
0
0
5,6
Table 5. The budget, number of physicians, working time, number of “specialist physicians” and working time of the
“specialist physicians” in the different municipalities in the Southern Lapland rural area.
4
The organization of the health care services
Sweden is divided into six medical care regions for the purpose of collaborating in matters of
highly specialized medical care. The Northern region include half the area of Sweden and since
1984, the northern region encompasses the County Councils of Norrbotten, Västerbotten,
Västernorrland and Jämtland and their 877
000 inhabitants.
Figure 5. Sweden is divided into six medical care
regions and the Northern region includes half the
area of Sweden.
The collaboration between the northern
County Councils is regulated in a separate
regional agreement. First and foremost it
refers to collaboration in matters of health
and medical care, but also extends to other matters of common interest such as research,
education, and matters of regional politics.
The purpose of collaboration should, in particular, promote development of highly specialized
medical care at the University Hospital of Umeå – as the regional hub for education and
research.
During 2003, the number of treated patients from the three other northernmost county councils
to the University Hospital of Umeå – inpatient and outpatient medical care – amounted to
22 788. Altogether, the County Councils of Norrbotten, Västernorrland, and Jämtland spent
578 M SEK on regional health care in Umeå.
The most significant regional specialities are general and gynaecological oncology, cardiology at
the thorax and medical clinics as well as the radiology department, neurosurgery, and hand and
plastic surgery. The neurology, surgery, paediatric, rehabilitation, and ear and eye clinics
respectively also receive a relatively large amount of regional patients. Medical services and
consultants visiting the County Hospitals in the region add to this number.
4.1
Primary health care
Health and medical care can be defined as follows:
Health care is a preventive measure and includes, among other things, health check ups,
sanitary precautions, health education, advisory services for the general public and other
precautions preventing disease to the greatest possible extent.
Medical care is administered to those who, due to disease, injury, physical defects, or delivery
are in need of care. This care can be divided into diagnostics and various kinds of therapy, i.e.
research and treatment.
The County Council aim is to offer its residents the highest quality care possible as close to the
patient’s home as possible. The same principle applies to elderly care where medical care in the
home is a central element.
The County Council of Västerbotten has their own health care centres and community health
care centres in all communities. The community health care centres function like community
hospitals with emergency beds.
Definition of primary health care in the area i.e. what services are offered
The community health care centre is the foundation of the Swedish health care system.
Västerbotten has 25 community health care centres and 7 Cottage hospitals with emergency
beds owned and operated by the primary health care of the County Council. The county also has
six private health centres working on behalf of the County Council. The cottage hospitals
(sjukstugor) is situated in the rural area of Västerbotten , figure 6.
Figure 6. The distributions of health and medical care servicesacross the Countyof Västerbotten. There are
32community health care centres, of these 7 community health care centres with emergency care (sjukstugor) and
three hospitals in the county.
The mission of the Community health care centre includes health promotion and disease
prevention, emergency and planned care and treatment, rehabilitation and habilitation,
diagnostic and medical services. Community health care centre also provides palliative care. In
addition, some health care centres have additional tasks, such as family centre operations or
emergency sites in the inland.
Psychiatric services is available at the county's three hospitals and two outpatient clinics in
Southern Lapland. figure 6.
Sorselegården is a part of the clinic in behavioral medicine and it provides residential group
treatment for healthierlifestyle and better eating habits and is situated in Sorsele, figure 6.
In the county of Västerbotten the health care service are also equipped with 15 ambulance
stations and 1 helicopter air ambulance.
Björkgården in Sävar is a part of Rehabilitation Medicine center and it conducted rehabilitation of
people affected by stroke, or people with other brain injuries, spinal cord injuries or neurological
diseases, figure 6.
Distance between the centers, Travel time, ease of travel (winter / summer), means of travelling
There is 100–230 km to the nearest hospital in Lycksele, from the villages in the rural
area.Inhabitants in Tärnaby have the longest distance to both Lycksele and Umeå. The distance
to the university hospital in Umeå is between 120–350 kilometer and it can take more then five
hours to get there in the winter season. During the summer it takes approximately 4,5–5 hours
by car.
4.2
Hospitals / Specialized service
Numbers of hospitals in the area
In Västerbotten there are three hospitals. The University Hospital of Umeå and theCounty Hospitals of
Skellefteå and Lycksele which both are regional hospitals with 227 and 93 beds respectively, figure 7.
Figure 7. The number of beds at the hospitals and the provision for emergency care available at the inland in the
cottage hospital emergency beds(sjukstugor).
The service area of the University Hospital of Umeå encompasses the counties of Norrbotten,
Västerbotten, Västernorrland and Jämtland. It is also a county and regional hospital. The
University Hospital has 712 beds and is the largest hospital north of Uppsala.
The county district hospitals are smaller and do not have all type of specialist clinics but they
have the expertise and medical equipment, covering most diseases.
The number of beds has decreased over the last few years, but on the other hand outpatient
provision has increased.More patients leave the hospital the same day they had an operation.
Consequently they do not require a bed. Sweden is today the country in Europe with fewest
hospital beds compared with the population. Few beds and short periods of care are considered
internationally as a sign of a technologically advanced medical care.
Definition of hospital services in the area (e.g. secondary, tertiary etc.)
The University Hospital of Umeå has three main tasks which is to perform a qualified health care,
research and teaching. It is Norrland's largest workplace with 5 700 employees.
As a regional hospital the University Hospital in Umeå provide service to 877 000 people spread
across the half of Sweden. They performe highly specialized care and the hospital is also
responsible for medical training and research.
The University Hospital presents the best survival in the world for patients with head injuries.
They have a unique flight medical expertise and intensive care of premature babies that is a
model for the entire country. The genetic tests and treatment of adolescents with congenital
heart disease can make Umeå, to a Centre for Cardiovascular Genetics for the whole country.
Core area at the University Hospital are
•
Oncology for adults and children
•
Cardiovascular health
•
Obesity and overweight
•
Neonatal Intensive Care
•
Functional neurosurgery
•
Healthcare Infection
•
Airborne transport of intensive care patients
The hospital in Skellefteå is a county hospital with many specialties and extensive surgical
operations in surgery, orthopedics, gynecology, ear and eye, including many cataract
operations.There is also an extensive rehabilitation clinic and a large psychiatric clinic. The
county's infertility clinic is placed here.
The hospital carries out clinical research on cardiovascular disease, stroke, lung diseases,
gastrointestinal diseases and research about the optimal use of medicines. Research currently
covers nursing care research.It is a county hospital with 1 200 employees.
The third hospital in the county, with a very important geographic location in the rural areais the
hospital in Lycksele. It is a small hospital with emergency care and maternity ward. It is also were
the county's obesity surgery is performed with almost100 obesity operations every year.
Although hip replacement surgery is a Lycksele business. In 2009, 350 hip and knee surgery were
performed at the hospital.
At Lycksele Hospital is Västerbotten County Council’s helikopter ambulance stationed. It is a
county district hospital with 596 employees.
Specialized receptions outside hospitals and health care centers in the area (type, number)
The County Council of Västerbotten is the principal provider of other services for their citizens
except medical care, for instance dental care, service for people with disabilities and
development of eHealth, among other duties.
Telemedicine
The county of Västerbotten is very large and working in distance is necessary. Today there are
145 video conferencing systems at nursing homes, health care centers and hospitals, figure 8.
More and more meetings takes place via the link and medical staff around the county will save
time, money and environment. The use of videoconferencing system is growing and the increase
is now approximately 40 % annually.
Remotely logopedics help many patients who suffer from aphasia after brain injury. When there
is a shortage of speech therapists in the inland, is the use of videoconference system a great
possibility. Another group that has great use of telemedicine are patients with skin problems.
With the patient in the rural area and the specialist in Umeå can consultations be made through
the screen. Another example is the rehabilitation team at the clinic of hand and plastic surgery
where physical therapists and occupational therapists provide consultations and evaluations at a
distance. This has previously resulted in a referral and a visit to a hospital.
Figure 8. The telemedicine and videoconference applications in the County of Västerbotten.
Public dental health service
The County Council has by the Public dental health service total responsibility for providing all
children and youth in the county a regular health-oriented dentistry.The Public Dental service is
also responsible for specialist and dental care to patients with special needs. By agreement with
the state the County Council is responsible for clinical resources and money for clinical research
at the Department of Odontology at the university of Umeå. The Public Dental service should
also ensure that general dental care is available throughout the county. The business is operated
as an internal company.
The public dental health service in the County of Västerbotten includes a total of 31 clinics. The
County Council further carries the responsibility for clinical work at the Dentist College in Umeå,
figure 9. The College covers all specialist dental care services. This is the only place north of
Stockholm that provides some of the specialist services, and therefore the College caters to a
region-wide patient base.
Public dental health service has over the years undergone a very positive development. On a
yearly basis, it provides regular dental care for more than 45 000 children and youths, and treats
about 60 000 adults. A scientific study from the early 1990ies shows that approximately half of
the adult population receives medical care from the public dental health service system.
Excluding general dental care, the public dental health service is also responsible for specialist
services in Västerbotten.
Figure 9. The distribution of dental clinics, orthodonic clinics and dental college in the County of Västerbotten.
Most specialist dental treatments are performed at the Dentist College in Umeå, while orthodontic
treatment is also available in Skellefteå and Lycksele. Skellefteå also provides oral surgery – both general
and specialist services geared towards implantation surgery.
The three hospitals in the County all have dental clinics offering treatment for patients in hospital,
handicapped, and weak patient groups. Treatment under general anaesthetic is also offered to patients
who are scared of going to the dentist.
Oral health among children and youths today is very good, even on a national scale. A certain stagnation
can be observed, however, and a decrease in ambition today would in the long-term lead to increased
costs of dental care, both for the individual and for society.
Regional variations between the coast and inland regions where oral health among adults is concerned is
levelling out. When it comes to older patients, those that live in inland regions tend to have fewer of their
own teeth and more prosthetics. In inland regions, public dental health service is the main care provider
and will be the foundation for a positive development of oral health in the area.
Services for people with disabilities
The child and youth habilitation in Västerbotten offers advice, support and rehabilitation to children and
adolescents with mental retardation, autism, physical disabilities or other severe disabilities, figure 10.
The department of special assistance and rehabilitation for adults is available in Umeå, Skellefteå, Lycksele
and Vilhelmina and they will help people with great and lasting disabilities throughout the county, figure
10.
Low vision rehabilitation is a habilitation and rehabilitation unit for people of all ages with loss of vision,
living in the county. It is a department of visual and hearing rehabilitation, and are at the hospitals in
Lycksele and Skellefteå and at the University Hospital in Umeå, figure 10.
The hearing rehabilitation is for adults and children who feel that their opportunities for participation and
interaction with the environment decreases as a result of a permanent hearing loss, hearing and visual
impairment, deafness or deaf and blindness, hyperacusis or tinnitus. The centre of Assistive technology
are working with devices for people with mobility and cognitive impairments and communication
difficulties.
Services for people with disabilities is a specialized service provided by the County Council to offer:




habilitation in accordance with the provisions of law (HSL, including certain aids) for children and
youths with physical disability and/or mental handicaps
habilitation in accordance with the provisions of law (HSL) for people with permanent hearingimpairments, and interpretation assistance for
the deaf, deaf-blind, and hearing-impaired
advisory services and other individual support for children, youths, and adults as well as their
families, in accordance with the provision of law (LSS)
The services are regional in their scope. They are the result of interdisciplinary teamwork, where
psychological as well as social, pedagogical, and medical skills are utilized.
Figure 10. The distribution of service for people with disabilities in the county of Västerbotten.
Services for people with disabilitiesoffers a versatile specialist support derived from the needs,
requirements, and wishes of the individual, as to reduce and compensate for functional impairments, and
to produce the best possible conditions for a sense of community in society.
Spreads knowledge and actively works to eliminate obstacles and inadequacies in different environments
and services, so as to prevent or decrease the risk of handicap occurring. Endeavours should contribute to
achieve equality in living conditions for people with significant and permanent functional impairments,
and their families, so they can live normal lives. Services for people with disabilities will utilize existing
experience within the different fields, and stimulate progress and research within specialist handicap
services so that the methods within the various services are further developed.
The County Council’s undertakings for certain disabled people are, in practice, run by the Disability
Committee.
5
Health care professionals
The medical centres are generally staffed with general practitioners, nurses, midwives, occupational
therapists, dietician, physiotherapists and sometimes psychologists. Seven of the medical centres are
located in the rural area and have facilities to provide emergency care including ambulance service and
between 2–6 acute beds per unit. These beds are often in cooperation with nursing homes and most often
located adjacent to the surgery. The staffing in a community hospital is shown intable 6
Professionals in a community hospital (sjukstuga)
Number
Primary care physicians (Gp)
1–5
Specialist nurses (district nurses, midwifes)
1–5
Nurses
1–13
Physiotherapists
1–3
Occupational therapists
1–2
Ambulance nurses
2–4
Table 6. Number of professionals in a community/cottage hospital (sjukstuga).
The turnover rate is in general 4-6% in all professionals. Lower in the inland and higher in the
coastal area.
6
Urban area
The comparing urban area are the County Council of Uppsala, figure 11. The county is located in east
of Sweden and the ”capital” city is Uppsala.The county are
situated 67 km north of Stockholm the capital of Sweden and has
322 000 inhabitants.Uppsala is the fourth largest town in Sweden.
The land area is approximately 6 000 km2 and has 54 inhabitants
per square kilometre. There are eight municipalities in the county
with 2000–200 000 inhabitants. In every municipality there are 1–
13 health care centres. The land area is mostly cultivated flat land
and forest.
Figure 11. The location of the County of Uppsala (dark blue).
Table 7. Land area, number of inhabitants and inhabitants in every square kilometre in the County of
Uppsala.
Municipality
Folkmängd = Folkmängd (201106-30)
Area = Totalareal inklusive
havsvattenareal (km²) (2011-0101)
Land = Landareal (km²) (201101-01)
Sjö = Inlandsvattenareal (km²)
(2011-01-01)
Hav = Havsvattenareal (km²)
(2011-01-01)
Täthet = Befolkningstäthet
(invånare/km² land) (2011-06-30
och 2011-01-01)[1][2]
Land area km2
Inhabitants
Inh/km2
Enköping
1184
39914
34
Heby
1172
13398
11
Håbo
143
19658
137
Knivsta
283
1 850
52
Tierps
1550
20121
13
Uppsala
2 189
198109
91
213
9076
49
Östhammars
1472
21420
15
Total/mean:
6 018
321 696
49
Älvkarleby
Health care service
There are 43 health care centres and two hospitals (Uppsala, Enköping) in the County of Uppsala.
Uppsala university hospital is one of the largest in Sweden and continues allpossible specialties.
A common Health care centre in this area isequipped with









Day care service
Physicians
Health care nurse
Physiotherapist
Occupational therapist
Midwife
Dietician
Counsellor
Psychologists for children, youth, adults
There are great opportunities to study in Uppsala and Enköping, there are educations for all health
care professions. The life expectancy at birth is higher, especially for men, in Uppsala than in
Southern Lapland rural area.
Area
Men (y)
Women (y)
Southern Lapland, rural area
76.2
82.5
County Council of
Västerbotten
79.2
83.2
County Council of Uppsala
80.2
83.6
Sweden
79.1
83.2
The population in the county are considerably younger.
Net migration…
7
7.1
Education and training
Medical education
There are 6 Faculties of Medicine in Sweden responsible for teaching and research in the field of
medical science. The most northern one is located at the University Hospital in Umeå. The
Faculty in Umeå graduates approximately 120 doctors every year. In Sweden you must
undertake 5,5 years of undergraduate education followed by a compulsory 18-21 month clinical
training programme to get medical license as a doctor. To become a specialist you need at least
another 5 years of clinical training regardless type of speciality including general practitioner.
7.2
Nursing education
There are several schools of nursing in Sweden. In Västerbotten county most nurses are
educated at the University in Umeå. It takes 3 years to become a nurse. You can also study to be
specialised nurse, for instance in operation, emergency care, ambulance nurse, midwife and
district nurse. This will take another 12-18 month. In addition to nursing school at the university
there are several possibilities to study by distance learning.
7.3
Other health care education
Mostother types of health care education can be studied atthe University in Umeå for instance
occupational therapy, psychology, dietician, and physiotherapy.
7.4
Continuing education
Continual educational support is quite well organised in the county but educations most often
mirrors needs in the coastal urban region and not the western rural areas. Here is a gap
between needs and available education.
8
Recruitment / Retention problems
The most evident recruit and retention problem in the rural area is the lack of well-trained
general practitioners. The demography amongst health care personal mirrors the population at
hole, which means that there is a lot of doctors and nurses that will retire in 10 years to come.
In the hospitals some specialists as radiologists, anaesthesiologists, psychiatrists and some
laboratory doctors are difficult to find. There’s also a problem with increased specialisation. The
all-round surgeon or internal medicine doctor is nowadays difficult to find.
9
Summary
There has almost always been difficult to recruit high-educated health care professionals to
southern Lapland. Most evident is the shortage of general practitioners. In addition the skills
needed to work in rural areas as a doctor or nurse is not always fulfilled by ordinary education. It
sometimes frighten doctors away when they realise that the area they need to cover in their
profession is significantly larger than what they are trained for.