Specialist postgraduate training

in Finland Docent Hannu Halila

Director, Education and Research Finnish Medical Association

Specialist in obstetrics and gynaecologyPast President of UEMS (2002 – 2005)

NordÖl Helsinki 6 June 2008

SNAPS 2008

SNAPS 2008

Specialitetsstrukturen i Norden

Sverige

Danmark

Finland

Norge Island

Grundspecialitet

31 38 49 30 33

Grenspecialitet

23 + 2 14 39

SNAPS 2008

Gula Boken

Anm: *) Samtidigt med specialistutbildningen kan det ingå två års ”euroläkare utbildning”, som ger självständiga rättigheter som allmänläkare

**) Från augusti 2008: 1 år

Sverige

Danmark

Finland Norge Island

Grund-utbildning

5½ 6 6 6 6

AT/turnus 1½–2 1½ **) – *) 1½ 1

Specialist-utbildning

min 5 5–6 5–6 5–7 4½–7½

Summa år

min 12 11–12 11–12 12½–14½ 11½–14½

Specialist training in Finland

• Administered until 1960 by the Finnish Medical Association

• National Board of Health (under the Ministry of Social Affairs and Health) administered 1960 – 1985

• From 1986 a postgraduate training of the medical faculties of universities

Doctors in Finland 2008:

22 358

17 609 of them were of working age and living in Finland.

Population per active physician 2008(physicians of working age living in the country):

Denmark 261Finland 295Iceland 268Norway 244Sweden*) 318

*) Only members of the Swedish Medical Association

SNAPS Group 2008

Licensed physician

Independent rights asgeneral practitioner/licensed general practitioner

General practitioner under the national social securitysystem

Licensing of doctors in Finland

Licentiateof medicine6 years

Year - 1984

Licensed physicianPre-

registration period 1 year

Specific training in general medical practice 2 yearsLicensed physician under the guidance and supervision of another doctor

Specific training in general medical practice 2-3 (-5) years

Licensed physician

1984 - 1994 1994 - 2008 -

Licentiate of medicine 6 years

Licentiate of medicine 6 years

Licentiate of medicine 6 years

Proposal from the Finnish Medical Association

Reform of specialist training in Finland in 1999

• Until then Finland had 32 main specialities and 60 sub-specialities

• Number of specialities was cut down to 49 and sub-specialities were ended with a transition period until 2005

• Already in the early 1990’s a working group of surgeons suggested independent specialities into surgery.

Medical specialities 1999 (49)

Training program 5 years (16)

- child neurology - ophthalmology- clinical chemistry -

otorhinolaryngology- clinical microbiology - pathology- clinical neurophysiology - phoniatrics- forensic medicine - physical medicine- geriatrics - public health- medical genetics - radiology- oncology - sports medicine

Training program 6 years (33)- adolescent psychiatry - internal medicine- anaesthesiology and intensive care medicine - nefrology- cardiology - neurology- cardiothoracic surgery - neurosurgery- child psychiatry - obstetrics and gynaecology- clinical pharmacology and pharmacotherapy - occupational medicine- clinical haematology - oral and maxillofacial surgery- clinical physiology and nuclear medicine - orthopaedics and pharmacology- dermatology and allergology - paediatrics- endocrinology - paediatric surgery- forensic psychiatry - plastic surgery- gastroenterological surgery - psychiatry- gastroenterology - respiratory medicine and- general practice allergology- hand surgery - rheumatology- infectious diseases - surgery

- urology- vascular surgery

Structure of training e.g. in surgery(oral- and maxillofacial surgery and

neurosurgery separate):

• Common trunk 3 years (including 9 months in health centres, common to all specialities)

• 3 years of specialized training

• Training and workforce planning policies have been mixed up often in Finland

• As a result of the National Health Project from 2003 the training in health centres for all specialities became 9 months instead of 6 months and the so-called fifty-fifty rule was applied: at least 50 % of the training time (5 or 6 years) has to be spent outside of the university hospitals (some exceptions e.g. neurosurgery).

• After the common trunk the specialized training (3 years) is usually spent in university central hospitals (Helsinki, Kuopio, Oulu, Tampere and Turku)

Theoretical training:

80 hours (20 hours of which training in administration and leadership)

A written anonymous national examination usually during the last year of training

Specialist exam in urology September 21, 2007:

1. Active follow up of prostatic carsinoma2. Surgical treatment of hyperactive bladder3. In situ carsinoma and premalignant skin

leasons of the penis4. Treatment of the renal pelvic stones5. Obstruction of the pyelourethal junction

Two ministries administer specialist training in Finland:

1. Ministry of Education is the central body for universities and gives legislation

2. Ministry of Social Affairs and Health has money that is given to hospitals and health centres as compensation for expenses caused by medical education and research.

Evaluation of the education of specialists in medicine and in dentistry 2006 - 2007

Ministers of Health and Social Affairs and Education appointed to rapporteurs to evaluate:

• How to present training meets the expactations of the service system and the populations health needs

• whether the objectives and implementation of the education are appropriate from the point of view of the universities

• organizing education, the organisations of the health service system and the doctors in specialisation training

• rapporteurs: Professor Anja Tuulonen, Oulu (ophthalmology) and Docent Hannu Puolijoki, Seinäjoki Central Hospital (internal medicine and pulmonary diseases)

Rapporteurs reported problems in diminishing common knowledge in surgery and internal medicine and also problems in organizing on-call work especially outside the university hospitals.

Report given to ministers Sarkomaa and Risikko on September 6, 2007

Proposals in surgery

• New 5 year program in surgery

• After that possibility to take an other degree (3 years) in cardio-thoracic surgery, gastroenterological surgery, hand surgery, paediatric surgery, plastic surgery, urology and vascular surgery

• Of the 3 years one year can already be included in the 5 years training in surgery

• In surgery (and in internal medicine) at least 4,5 years (including the health centre 9 months) should be possible to work in also “central hospitals of big hospital districts”.

Proposals for new specialties: • emergency medicine (also additional degree program during the transition period)• geriatric psychiatry

Future of the proposals

• A very rapid and limited consultation process was organized by the Ministry of Education in September 2007

• Professors in surgery strongly apposed to the proposals

• New consultations going on within surgery (and cardiology)

• Time table for new legislation open, Ministry of Education not willing to pursue proposals, Ministry of Social Affairs and Health more eager.

Special competences

As a supplement to the official system of specialisation, the Finnish Medical Association introduced in 1993 a system of special competences.

Suggestions for the establishment of new areas of special competence usually come from the specialist societies.

There are presently 32 different special competence areas and the number of recognized competences of physicians is over 1700.

Special competences

The FMA has changed the rules for special competences so that now new competences are developed only in areas which are common to at least two specialities (e.g. pain management or insurance medicine, but not any more e.g. cardiac anaesthesia).

Future challenges of specialist training in Finland

1. Increasing retirement of specialists from hospitals, specialist training not sufficient to replace them in some specialities

2. Controversies regarding the proposals from 2007 to reform specialist training

3. Training in leadership and administration

Leadership and administration for specialists

Until 2007 it was possible to gain a competence in administration from the medical faculties for specialist doctors, not anymore.

The Finnish Medical Association strongly supports that in the future (from 2009) all specialist training programmes include 30 credits (20 study weeks) of practical and theoretical training in leadership and administration.

Physician 2003 study

About 1500 young doctors responding.

94 % were satisfied with their choice of speciality.

22 % would not study medicine anymore if they were choosing their career.

BMJ 24-31 December 2005

Choice of speciality according to types of personality

Thank you!

Tack!

Kiitos!