"In many other countries, everyone knows who their doctor is, but in Sweden and in Västerbotten, patients don't know who their doctor is," says district physician Carolina Emdin.
In recent years, Sweden's regions have been working on a transition to what is known as "close care". In this context, primary care is seen as crucial and serves as the hub for the whole healthcare chain. One of the goals for primary care is for all the entire population to have a designated doctor, and by 2022 this should have applied to at least 55 percent of the Swedish population.
However, the current situation is not in line with this goal.
About 30 percent of the population report having a designated doctor, according to the National Board of Health and Welfare (Socialstyrelsen).
In Västerbotten, the figure was just 11 percent.
Carolina Emdin, a general practitioner in Umeå and vice chair of the Swedish District Medical Association (Svenska Läkarsamfundet), is critical of the situation in primary care.
– We're not doing well enough: that's what the numbers show.
According to calculatons by the County Medical Board (Länsmedicinalstyrelsen) there are 85 general practitioners in primary care in Västerbotten, but about three times that many are needed, says Carolina.
– We should have 250 if one full-time doctor is responsible for 1,100 inhabitants, as recommended by the Socialstyrelsen.
For physicians working in primary care, the job is demanding.
– Now we have a system where we're putting out fires. You're already fully booked, and then there are problems that have to be solved that day. You don't know who you're meeting with, you have no control over your schedule, and there's no sick leave system.
The shortage of primary care physicians is not due to a general shortage of physicians, according to Emdin. Doctors are increasingly working in hospitals and at universities, where it's easier for future specialists to get specialist training positions (ST-tjänst).
ST-tjänst positions are allocated by regional managers, and primary care doesn't receive enough funding to train general practitioners, she says.
– Money is allocated for 'close care,' but it's not directed towards creating specialist doctors. We're getting fewer of these ST-tjänst doctors when we should be increasing the numbers.
Sweden's health minister, Acko Ankarberg Johansson (KD), belongs to a party that advocates either full or partial nationalization of health care. However, she does not believe that the state should take responsibility for ST-tjänst placement.
– Some issues are better suited for decisions at national level, while others must remain within the local regions, where they can be better assessed. I prefer to have a better dialogue with the regions to ensure that placements are made in the right places. At the moment, I'm not ready to say that the state would be in a better position to deal with it.
Minister of healthcare Acko Ankarberg Johansson (KD) believes that the most important thing to do to bring more doctors into primary care is to improve the working environment so that more can work full-time.
She recognizes the picture that Cemdin paints of the strained situation in primary care.
–That is why the government allocates three billion a year to expand 'close care'. But the reason we don't have enough general practitioners is sometimes because people can't work full-time due to poor working conditions. If more doctors worked full time, we'd have more staff to support primary care throughout the country.
If all primary care physicians worked full time, it would mean 400 new physician positions, she says.
– What we need to do is improve working conditions to lure more doctors into working full time in primary care.
– It may not solve the whole crisis, and it may not happen as quickly as we'd like, but it's the most important thing to do in the short term.
According to the health minister, regions need to be bolder.
She points to the Jämtland-Härjedalen region as a good example. They set a cap on the number of patients per doctor and started to accept more ST doctors.
– This created an attractive working environment, and more people applied there.
You provide funding, but should the government do more to speed up the process of people getting a designated doctor?
– We already have a law that says people have a right to a designated doctor. Right now we're looking at where it's appropriate to have more legislation or if there are other ways to address it. Because it's important that people have their designated general practitioner and a continuity of care.
