An historical shortage of doctors in Sweden has led to several counties relying on the use of locum physicians. However, this practice has recently been criticised because temporary staff are costly and some believe their frequent use puts patient safety at risk and decreases the quality of Sweden’s healthcare system. This summer, one county council stopped using locum physicians. It has already reversed its decision and has since been criticised by the social partners.
Background
For over a decade, there has been a shortage of doctors throughout Sweden, particularly in the north of the country. According to a Swedish Medical Association survey of staffing needs in primary care (in Swedish, 958KB PDF), an increase of 30% in the current number of doctors, or an extra 1,400, is needed to meet accepted standards of medical care.
To deal with the shortfall, many counties routinely hire locum doctors to care for patients in the region. However, this practice has been strongly criticised in a report on Swedish television (in Swedish) as locum doctors can cost up to 45% more than doctors employed full-time.
Locum doctors are usually hired by agencies and then employed on a temporary basis by hospitals to take on more patient care work, and fewer administrative tasks than full-time doctors. Although salaries are higher for locum doctors, they do not receive any pension contributions from an employer, nor do they receive holiday entitlement or any training, as full-time physicians do.
The Östersund solution
The county council of Jämtland in northern Sweden decided to tackle the problem and, from 1 June 2013, locum doctors ceased to be employed in the city of Östersund. The council claimed that its critical financial situation was the main reason for this, as it would lead to significant improvement in the county’s finances.
However, an analysis of the new policy found that it was likely to put patient safety great risk. Therefore, in its Plan for the settlement of locum primary care physicians (in Swedish, 347KB PDF), the council ended its ban on locum physicians and announced it would work towards a more long-term solution. Agneta Danielsson, Vice Chair of Jämtland County Council, said: ‘Unfortunately there are no other doctors who want to work here, and without locum doctors the county cannot offer appropriate healthcare.’
Social partners’ mixed reactions
Some social partners have been critical of the county’s actions. Despite arguing that the use of locum doctors poses a threat to patient safety in Sweden, the Swedish Association of Health Professionals (Vårdförbundet) opposed the ban in the county. According to Barbro Englesson, Department Chair for Vårdförbundet in Jämtland, the ban was an unsustainable solution.
‘The workload became unbearable for full-time nurses and doctors,’ she said.
Employers’ organisations have also been critical. Håkan Sörman, CEO of the Swedish Association of Local Authorities and Regions (SKL), has argued that standards of care and taxpayers would benefit if locum doctors would instead take employment in the counties in which they operate. However, Sörman has not said how this solution cut be achieved.
David Svaninger, Second Vice-Chair of the Swedish Junior Doctors’ Association (SYLF), said: ‘I don’t think it is all about the money. But I do believe that there is a need for adjusting salaries, especially in areas where there is a greater need for doctors.’ Enhancing the working conditions of full-time doctors would make it a more attractive profession, he argues.
Not everyone agrees that locum doctors pose a problem, however. Marie Wedin, Chair of the Swedish Medical Association (SLF) argues that locum doctors should be seen as a solution to an organisational problem. According to Marie Wedin, it is unsustainable for small county hospitals to employ specialists full-time. It is preferable that doctors, rather than patients, should travel between hospitals, she argues.
Commentary
By 2014 the SKL wants to halve the number of locum doctors compared with 2011, and to minimise dependency on agencies by 2016. Currently, the indication is that the overall cost of using temporary doctors is increasing, as noted in SKL’s statement on agency staff increases in healthcare on its website.
Emilia Johansson and Felicia Giertta, Oxford Research