Українська Медична Рада
Україна, м. Київ
вул.I.Франко 25/40, оф. 2
+38(044) 592-05-75
+38(050) 405-03-47
Opportunities for doctors within the European Economic Area
Working in the EEA
2.4 Working in the Czech Republic
2.19 Working in the Netherlands
The healthcare system
Austria is a federal state divided into nine provinces or Länder. Its healthcare system is highly decentralised with responsibilities split between the federal and provincial authorities. The Ministry of Health formulates policy and licenses drugs while the Länder are responsible for the provision of healthcare. The healthcare system is funded by a mix of taxation, direct charging and compulsory insurance.
The insurance schemes are run by 24 independent ‘sickness funds’. Insurance coverage is compulsory for employees and their dependants and pensioners. Approximately 99 per cent of the population is insured with one of these funds although roughly 40 per cent of the Austrian population have additional private insurance. Patients also contribute directly to the cost of their healthcare through a co-payment system. This accounts for approximately 14 per cent of total health finance. In Austria there is a marked separation between outpatient and inpatient sectors with the public insurance schemes predominantly funding the former and taxation the latter.
Patients are at liberty to choose both their general practitioner and their specialist. Specialists are generally seen following a GP referral but the patient can access them directly. Doctors who are listed on the medical register in Austria are able to set up private practice wherever they want (but no more than two practices). If doctors want to be affiliated to the social healthcare system they have to apply for a contract with the health insurance fund. If they do not have a contract with a health insurance fund, patients have to pay the doctor’s fee themselves and are then reimbursed by social insurance (80 per cent).Decisions relating to the placement of contracts with health insurance funds are made by both the medical associations (each of the nine Länder has its own medical association – see useful addresses section for contact details) and the insurance funds. They also decide which candidate will be awarded contracts in newly created or vacant posts. In nearly all states allocation is based on a points system.Doctors working in hospitals are salaried. EU/EEA nationals do not need work permits, but non-EEA nationals will need their employers to obtain a work permit (Arbeitsbewilligung) on their behalf. Within three months of living in Austria an identity card with photograph must be obtained from the aliens’ police or Bezirkshauptmannschaft, which will entitle the holder to five years’ residence.
Registration
In order to practise in Austria doctors have to be a member of the medical association in the area in which they are resident. This then makes them eligible for inclusion on the medical register and gives them membership of the Austrian Medical Chamber (AMC).
When applying for registration you will need to present the following documents:
• birth certificate
• passport
• marriage certificate (if applicable)
• medical degree certificate
• CCST/VT certificate
• certificate of good standing (issued within the last three months)
• certificate of good health, certifying medical fitness to practise (issued within the last three months)
• employment contract
• two passport photos
• application fee of 53 EUR (approximately £36 at time of writing)
• social insurance number
• notification of the place of residence and of the delivery address (the latter is available to the public).
Doctors who are EEA nationals and who have completed their training in an EEA member state should direct their application for registration to practise to the AMC. Those who have successfully completed a course of study in medicine or specialist training outside the EEA or who are not EEA nationals and are looking for work experience in Austria should also contact the AMC.
Finding a post
If a doctor is interested in a position as a hospital doctor they should apply directly to the owner of the hospital (in most cases the respective government of the province concerned). A list of recognised training hospitals is available at www.aerztekammer.at A limited number of opportunities exist for non-EEA doctors, especially for GPs and specialists. Authorisation must be obtained in advance from the AMC and will only be granted if no EEA doctor has applied for the post. For doctors wishing to obtain training posts, authorisation must be gained in advance, either from the AMC or the university hospital. Doctors should note that this training is not recognised in Austria.
Useful addresses
Federal Ministry for Health and Women
Bundesministerium für
Gesundheit and Frauen
Radetzkystrasse 2, 1030 Wien
Tel: 00 43 1 71100 0
Fax: 00 43 1 71100 14300
Email: buergerservice@bmgf.gv.at
Website: www.bmgf.gv.at
Competent authority & national medical association
Austrian Medical Chamber
Österreichische Ärztekammer
Weihburggasse10-12
1010 Wien Austria
Tel: 00 43 1 51 406 931
Fax: 00 43 1 51 406 933
Email: international@aek.or.at
Regional medical associations
Burgenland Ärztekammer
A 7000 Eisenstadt
Permayerstrasse 3
Tel: 00 43 2 682 625 21
Fax: 00 43 2 682 625 219
Email: office@aekbgld.at
Kärnten Ärztekammer
A 9020 Klagenfurt
St, Veiter Strasse 34
Tel: 00 43 463 5856
Fax: 00 43 463 5142 22
Email: aek@aekktn.at
Niederösterreich Ärztekammer
A 1010 Wien
Wipplingerstrasse 2
Tel: 00 43 1 537 510
Fax: 00 43 1 537 5119
Email: aeknoe@aeknoe.or.at
Oberösterreich Ärztekammer
A 4010 Linz
Dinghoferstrasse 4
Tel: 00 43 732 7783 710
Fax: 00 43 732 7783 71258
Email: aekooe@aekooe.or.at
Salzburg Ärztekammer
A 5020 Salzburg
Bergstrasse 14, Postfach 65
Tel: 00 43 662 871 327
Fax: 00 43 662 871 32710
Email: aeksbg@aeksbg.at
Steiermark Ärztekammer
A 8011 Graz
Kaiserfeldgasse 29
Tel: 00 43 316 80440
Fax: 00 43 316 15671
Email: aek@aekstmk.or.at
Tirol Ärztekammer
A 6020 Innsbruck
Anichstrasse 7/IV
Tel: 00 43 512 52 058
Fax: 00 43 512 52 05830
Email: kammer@aektirol.at
Vorarlberg Ärztekammer
A 6850 Dornbirn
Schulgasse 17 Postfach 206
Tel: 00 43 557 22 19000
Fax: 00 43 557 22 19000 43
Email: aek@aekvbg.or.at
Wien Ärztekammer
A 1010 Wien
Weihburggasse 10-12
Tel: 00 43 1 51 501 0
Fax: 00 43 1 51 501 209
Email: aekwien@aekwien.or.at
Exchange schemes
Universitätkliniken Innsbruck
Anichstrasse 35
A-6020 Innsbruck Austria
Tel: 00 43 512 504 0
Fax: 00 43 5 05 04 22002
Universitätskliniken Graz
Aunbruggerplatz 1
A-8036 Graz Austria
Tel: 00 43 316 385 0
Fax: 00 43 316 385 3062
2.2 Working in Belgium
The healthcare system
The Belgian healthcare system is founded on social health insurance and membership of a sickness insurance fund, a mutuelle, is compulsory. Administration of the insurance fund is split between five non-profit making mutual benefit associations and one public sickness fund. Healthcare provision in Belgium has enjoyed a liberal history and independent medical practice, médicine libérale, has enjoyed considerable freedom. Patients are able to choose their GP and their specialist, as well as having direct access to hospitals. Because of the large numbers of physicians, there are virtually no waiting lists and access to services is universal. The drawbacks of the Belgian system are in its cost and complexity.
Medical education
Undergraduate training lasts for seven years and involves clinical training from the fifth year. General practice training lasts for three years, with the first year taking place during the seventh year of undergraduate training. In contrast, specialist training starts after undergraduate training. During postgraduate training doctors must complete periods – stages – of training of at least six months in either doctors’ surgeries or hospital departments. It is compulsory to complete a stage in a doctors’ surgery to become a GP.
University departments of general practice:
• ULB, Campus Facultaire Erasme, Route de Lennik, 808, Bte 612, 1070, Bruxelles.
Tel: 00 32 2 555 61 67
Fax: 00 32 2 555 6367
• UCL, Avenue Emmanuel Mounier 53, Bte 5360, 1200 Bruxelles.
Tel: 00 32 2 764 5344.
Fax: 00 32 2 764 5327
• ULG, Boulevard de la Constitution 77, 4020 Liege.
Tel: 00 32 43 43 1155.
Fax: 00 32 43 44 0506
Registration
Gaining registration to practise medicine in Belgium is a lengthy process. In the first instance you must contact the Ordre de Médecins and provide the following documents, accompanied by official translations:
• primary medical qualification
• certificate of full registration from the UMC
• certificate of nationality
• certificate of good standing
• CV.
These documents are then forwarded to the Ministry of Health for approval. When you receive notification of this approval, you must contact the Commission Médicale for a visa. This is collected in person and must be taken to a post office to get a timbre fiscal. When you have this stamp, all documentation is submitted to the Conseil Provincial de l’Ordre de Médicins so you can get an INAMI number (Institut National d’Assurance Maladie Invalidité). You need this INAMI number to prescribe, order investigations and charge patients and the number must be noted on all official documents relating to patient care. While you are required to register with the Provincial Medical Council in the area in which you are going to be working, should you change areas, you are not required to re-register with the new Provincial Medical Council.
Finding a post
For general information about applying to practise medicine in Belgium you will need to contact the Fédération Belge des Chambres Syndicales de Médecins. They also provide information about junior doctors’ posts, salaries and specialist training. Hospitals advertise for doctors in one or more of the following weekly medical journals: Syndikale Berichten, Park Pleis 10, B-9820 Sint-Denijs-Westrem Bulletin d’Information, Avenue de la Couronne 13, B1050 Brussels Promotion Médicale, Rue Forgeur 6, Boîte 012, B-4000 Liege
International Department
14 Opportunities for doctors within the European Economic Area
Useful addresses
Fédéderation Belge des Chambres Syndicales de Médecins
ASBL Rue du Château 15 B-1420 Braine-l’Alleud
Tel: 00 32 2 384 3930
Fax: 00 32 2 384 8920
Email: chasyndb@skypro.be
Competent authority
Ordre de Médecins
Conseil National
Place du Jamblinne de Meux 34-35
1040 Bruxelles
Tel: 00 32 2743 0400
Fax: 00 32 2735 3563
Email: ordomedic@skynet.be
www.ordomedic.be
National medical association
Belgium Association of Medical Unions
Association Belge des Syndicats Medicaux Siège
Fédéral Chaussèe de Boondaalsesteenweg 6 b4 B
1050 Bruxelles
Tel: 0032 2 644 1288
Fax: 0032 2 644 1527
Email: absym.bvas@euronet.be
Belgian Specialist Association
Groupement des Unions Professionelles Belges
de Médecins Spécialistes (GBS)/
Verbond der Belgische Beroepsverenigingen van
Geneesheren- Specialisten (VBS)
Avenue de la Couronne 20
B-1050 Bruxelles
Tel: 00 32 2649 2147
Fax: 00 32 2649 2690
Email: jos@gbs-vbs.org
2.3 Working in Cyprus
The healthcare system
The Ministry of Health is responsible for healthcare and the provision of state-financed healthcare services in Cyprus and it is funded by general taxation. Almost two thirds of the population receive state healthcare free of charge. Those individuals in the middle income category (15-20%) receive healthcare at reduced prices. Primary care is freely available to all and is provided by outpatient units as well as urban and rural health centres. Referrals to specialist care are made by GPs. A significant number of individuals have a private family doctor that they pay directly. About 65 per cent of outpatient services are carried out privately. On the other hand, 65 per cent of inpatient care is carried out within the public sector. There are five large public hospitals and three small rural hospitals in Cyprus. In addition, there are a considerable number of private facilities providing care through insurance or on a fee for service basis.
Medical education
A limited number of private colleges offer a pre-medicine course, but Cypriots wishing to study medical degrees must do so abroad.Medical students can undertake their pre-registration year at general public hospitals in Cyprus.
Registration
The Cyprus Medical Council (CMC) is the Competent Authority in Cyprus for the recognition of professional qualifications and the registration of doctors. The following documents and certificates are required by the CMC:
• application form
• certified copy of an identity card or any other proof of nationality
• certified copy of medical diploma
• certified copy of a CCST
• certificate of good standing, issued by the UMC
• the fee of Cyp 20 (approximately £24 at time of writing).
Finding a post
In order to work in the public sector in Cyprus individuals must either be a Cypriot citizen, a ‘first degree’ relation of a Cypriot citizen who usually resides in Cyprus, or a citizen of an EEA member state. Individuals are also required to have, as a minimum, a good knowledge of the Greek language, if one has excellent English. To determine one’s proficiency in the Greek language, written examinations are conducted twice a year by the Public Service Commission. The Public Service Commission also organises examinations for the determination of proficiency in the English language. All vacancies in the public sector, for both permanent and locum posts, are published in the official gazette of the Republic of Cyprus every Friday – www.cygazette.com
Applications for vacancies in the sector must be made to the Public Service Commission. The Public Service Commission then distributes the applications for assessment. The Ministries in turn decide if the applicants for permanent posts should be invited for a written and/or an oral examination. After evaluation, the top scorers are short-listed and the list is passed to the Public Service Commission for final selection. In relation to locum posts, a waiting list of candidates is made according to skills and competencies; the list is used as a guide for employment in cases where shortages in the relevant services need to be addressed immediately. All public sector doctors are salaried employees of the Ministry of Health and belong to a centralised civil service staffing system that allocates them to posts based on specified needs.
Useful addresses
Medical and Public Health Services
Ministry of Health
Markou Drakou Street
Nicosia 1449
Cyprus
Tel: 00 357 22400138
Public Service Commission
Competent authority
Cyprus Medical Council
Email: medicalcouncil@moh.gov.cy
National medical association
Cyprus Medical Association
PO Box 21348
Nicosia 1506
Cyprus.
Tel: 00 357 22316812
Email: cyma@cytanet.com.cy
Hospitals
Nicosia General Hospital: Tel: +357 22801402 Fax: +357 22303471
Makarios III Hospital (Nicosia): Tel: +357 22405000 Fax: +357 22315739
Limassol General Hospital: Tel: +357 25801100 Fax: +357 25305783
Larnaca Hospital: Tel: +357 24800500 Fax: +357 24304298
Paphos Hospital: Tel: +357 26803100 Fax: +357 26306103
Kyperounta Hospital: Tel: +357 25806700 Fax: +357 25532207
Paralimni Hospital: Tel: +357 23821211 Fax: +357 23826322
Polis Chrysochou Hospital: Tel: +357 26322302 Fax: +357 26322303
2.4 Working in the Czech Republic
BACK TO MENU
The healthcare system
In the Czech Republic there is a compulsory health insurance system through which every employed person contributes to his/her healthcare coverage. Health insurance premiums for those in employment constitute 13.5 per cent of an individual’s salary, of which the employer pays two thirds and the employee one third. Health insurance for the unemployed, children, students, women on maternity leave, retired persons, etc is funded by the state. In the Czech Republic there are both state-run and private medical facilities. Most hospitals are state-owned, while most outpatient facilities are privately owned. Healthcare providers sign contracts with insurance companies for five-year periods. On the basis of these contracts, the insurance companies provide remuneration for services rendered, without the individual having to make direct payments. Private GPs are paid under a mixed system combining fee-for-service and per capita fees. Generally speaking patients will first visit their registered GP, who will refer them for further treatment where necessary. Patients are, however, able to access specialist treatment without referrals. Individuals are only able to register with a doctor who has a contract with their health insurer.
Medical education
Undergraduate medical education lasts for six years in the Czech Republic and includes practical training.
Registration
Doctors wishing to practise medicine must first contact the Czech Ministry of Health on +42 22 497 1111. After that they should contact the district branch of the Czech Medical Chamber in the area in which they wish to work.
Useful addresses
Opportunities for doctors within the European Economic Area 17
Competent authority
Czech Medical Chamber
Lékarská 2
150 30 Praha 5
Czech Republic
Tel: +420 257 215 285
Fax: +420 257 220 618
Email: foreign@clkcr.cz
National Medical Association
Czech Medical Association
PO Box 88
Sokolská 31 1
20 26 Praha 2
Czech Republic
Tel: +420 224 266 201
Fax +420 224 266 212
Email: czma@cls.cz
2.5 Working in Denmark
BACK TO MENU
The healthcare system
Government in Denmark is markedly decentralised, with power being devolved through 15 county councils and 275 municipal councils. The responsibility for funding, planning, managing and operating the public healthcare service is allocated to the councils and municipalities. The counties are responsible for running the hospital service and the Healthcare Reimbursement Scheme, which effectively funds the service. The municipalities are largely responsible for home nursing, dental care, and a number of preventive health schemes for children and young people. The current system will change in 2007 when counties will be dissolved and five elected regions established. About 100 larger municipalities will be given responsibility for handling most citizenrelated tasks such as preventive care and rehabilitation. The new structure provides for a new public sector where municipalities, regions and the state each have their own identity in terms of tasks. The state establishes the general framework. The municipalities will be responsible for functions that involve citizens directly and will therefore become the primary access point to the public sector. The five new regions will be responsible for secondary care, including psychiatric treatment and the entire national health insurance service. In Denmark, healthcare is freely available to all irrespective of income and all residents are covered by the Healthcare Reimbursement Scheme. The standard of healthcare is generally very high. The majority – some 85 per cent – of total healthcare expenditure is financed through general taxation. Counties and municipalities are free to levy their own taxes, within a specified limit, which varies according to local needs. Almost all hospitals in Denmark are publicly owned and run, with less than 1 per cent of hospital beds being private. Since the 1980s, Denmark has spent a smaller proportion of GDP on health, but, with an NHS model in mind, has increased spending on primary care and preventive medicine.
Hospitals in Denmark are grouped into three main types:
• university and provincial hospitals, which offer high level specialist treatment
• regional hospitals, which offer some specialist treatment
• county hospitals, which offer general care to local patients.
Broadly speaking, Denmark runs a GP gatekeeper system, similar to the UK, although direct access to ophthalmologists, obstetricians and gynaecologists and ENT specialists is permitted. There are two parts to the Health Reimbursement Scheme and individuals over the age of 16 are able to choose between Group 1 and Group 2 insurance. The main difference is that members of the Group 2 – some 2 per cent – can have direct access to any private specialist, whilst members of Group 1 must choose a GP who will refer them to specialists.
Medical education
Basic medical education in Denmark lasts six and a half years. As in the UK, following graduation, students can call themselves ‘doctor’, but a further 18 months pre-registration training is required before qualifying. This is made up of six months in surgery, six months in medicine both in a hospital and six months in general practice. The doctor can then be registered and practise as a doctor. General practice, however, requires further specialist training. International Department 18 Opportunities for doctors within the European Economic Area
Registration
The competent authority in Denmark is the Danish National Board of Health. Doctors wishing to register will need to submit an application form – available from the Board – along with the following documents (though these may vary depending upon the country of origin):
• primary medical qualification
• certificate of nationality (passport or identity document)
• certificate of good standing, issued by the doctor’s own competent authority within the last three months.
For Swedish nationals, and doctors from English speaking countries, official translations of these documents are not required. The Board aims to respond within three months. Finding a post Posts are advertised in the Danish equivalent of the BMJ, the Ugeskrift For Laeger, which is published by the Danish Medical Association and comes out every Monday. Also the following website contains listings of vacancies: www.laegejob.dk
Useful addresses
The Danish Ministry of Health
Sundhedsministeriet Slotholmsgade 10-12
DK-1216
Copenhagen K
Denmark
Tel: 00 45 72 26 90 00
Email: im@im.dk
The Association of County Councils in Denmark
Amstrådsforeningen
Dampfærgevej 22 Postboks 2593
DK-2100 Copenhagen Ø, Denmark
Tel: 00 45 35 29 81 00
Email: arf@arf.dk
The Copenhagen Hospital Corporation
Hovedstadens Sygehusfællesskab H:S Bredgade 34
DK-1260 Copenhagen K, Denmark
Tel: 00 45 33 48 33 48
Email: hs_direktionen@hsd.hosp.dk
Frederiksberg Hospital
Nordre Fasanjev 57
DK-2000 Frederiksberg
Denmark
Tel: 00 45 38 34 77 11
Fax: 00 45 38 34 77 55
Rigshospitalet
Administrationen, afsnit (section) 5222
Blegdamsvej 9
DK-2100 Copenhagen Ø, Denmark
Tel: 00 45 35 45 35 45
Email: rigshospitalet@rh.dk
Competent authority
Danish National Board of Health
Islands Brygge 67
DK-2300 Copenhagen S, Denmark
Tel: 00 45 72 22 74 00
Email: sst@sst.dk
National medical association
Den Almindelige Danske Lægeforening
Trondhjemsgade 9
DK-2100 Copenhagen Ø
Denmark
Tel: 00 45 35 44 85 00
Fax: 00 45 35 44 85 05
Email: dadl@dadl.dk
2.6 Working in Estonia
BACK TO MENU
The healthcare system
In Estonia the public Health Insurance Fund covers the costs of health service provision and deals with compulsory health insurance. Health service costs for those with no income are covered by social tax contributions. Employers are required by law to pay this social tax for all employees at 33 per cent of the taxable amount, of which 13 per cent is allocated for health insurance. All persons insured under the Health Insurance Fund have a GP. GPs are usually independent contractors and individuals generally need a referral from their GP to visit a specialist, although there are some exceptions eg, patients can self-refer to psychiatrists. There are usually modest additional payments for out-patient visits and hospital treatment. Most specialists work in state run hospitals. There is also a small private healthcare sector which is partly financed by the Health Insurance Fund. The insurance system covers the cost of medicines; the percentage of price compensated depends on the diagnosis.
Medical education
Tartu University is the only medical school in Estonia. Undergraduate study lasts six years and on graduation doctors are eligible to enter specialist training. Specialist training is coordinated by the Medical Faculty of Tartu University. Depending on the specialty, training lasts from four to five years. General practice training takes three years.
Registration
The competent authority is the Health Care Board and in order to be registered, individuals must submit one of the following documents:
• certificate of primary medical qualification,
• CCST, where appropriate
• employment record book, employment contract or any other document certifying employment in a particular specialty. Further details are available from www.tervishoiuamet.ee
Finding a post
Lists of vacant positions are available on the websites of hospitals in Estonia and in local medical journals (e.g., Meditsiiniuudised, www.mu.ee)
Useful addresses
University of Tartu Department of Medicine
Veski 63, Tartu
Tel: +372 737 5326
Fax: +372 737 5320
Email: arst@ut.ee
Ministry of Social
Affairs Gonsiori 29
15027 Tallinn
Tel: +372 626 9301
Fax: +372 699 2209
Email: info@sm.ee
Competent authority
Health Care Board (Tervishoiuamet)
Gonsiori 29 15157 Tallinn
Tel: +372 6 509840
Fax. +372 6 509844
Email: info@tervishoiuamet.ee
National Medical Association
Estonian Medical Association
Pepleri 32 51010 Tartu
Tel: +372 742 0429
Fax: +372 742 0932
E-mail: eal@arstideliit.ee
2.7 Working in Finland
BACK TO MENU
The healthcare system
Finland is divided into five separate provinces or Lääni. The provinces are further divided into around 450 municipalities which are responsible for the healthcare of their inhabitants. Primary healthcare is provided by health centres run either by single municipalities or jointly with neighbouring municipalities. Most Finnish municipalities have switched from a primary healthcare system to a family doctor system. Each family doctor is responsible for about 2,000 patients and the aim is for patients to be able to see their doctor within three days. For the provision of specialist care, Finland is divided into 20 hospital districts. Each district has a central hospital with departments for the majority of specialties. In addition, Finland has five teaching hospitals which provide advanced medical care and are responsible for research and the clinical training of medical students. As with the other Nordic countries, Finland has a highly developed welfare state with health services available to all, regardless of financial status. Public health services are mostly financed from tax revenues; partly municipal, partly state taxes. The public sector finances 76 per cent of total health care expenditure, users of services 20 per cent and others 4 per cent. Other contributors include employers, private insurance and benefit societies.
Medical education
Basic medical training in Finland is available in five universities and lasts six and a half years. Finnish medical students have contact with patients from the beginning of their studies and teaching is via problem based learning. After qualification comes the SHO/SpR equivalent, known as the apulaislääkäri. There are two types of specialist training available, lasting five and six years, depending on the specialty, although as there is a great deal of competition for training places, it can take considerably longer. Training standards are set by the National Board of Medicolegal Affairs, the Terveydenhuollon oikeusturvakeskus or TEO and the five medical faculties. After passing their specialist exams, doctors move on to become either an osastonlääkäri, a ‘full-time’ doctor, or an erikoislääkäri, the equivalent of the UK staff grade. To work as a general practitioner, doctors must complete a total of two years training in basic healthcare and hospital practice, with a minimum of six months in each.
Registration
The TEO is the competent authority in Finland and is responsible for the recognition of all medical qualifications. Healthcare professionals are divided into three groups: those given a licence, those working under permit, and those using a protected title. Doctors moving to Finland from the EU are generally given licences. As training is similar throughout the Nordic countries, anyone licensed in one state can generally move to another. Doctors are not required to show the TEO language proficiency certificates, though potential employers are at liberty to request them.
Doctors wishing to register in Finland will need to submit the following documents:
• passport or other certificate of nationality
• primary medical qualification
• certificate showing UMC registration
• a certificate demonstrating that the doctor’s education is in line with the relevant EU directive.
This is available from the UMC. It must be an original and no more than three months old.
Finding a post
Vacant posts are advertised in the Finnish Medical Association’s journal and on its website – www.laakarilehti.fi Some locum posts are available and it is advisable to contact one of the main teaching hospitals directly.
Useful addresses
Finland Trade Centre
177-179 Hammersmith Road
London, W6 8BS
Tel: 020 8600 7260
Fax: 020 8600 7261
Email: london@finpro.fi
Finnish Institute
35-36 Eagle St
London, WC1R 4AJ
Tel: 020 7404 3309
Fax: 020 7404 8893
Email: info@finnish-institute.org.uk
Competent authority
National Board of Medicolegal Affairs (TEO)
Lintulahdenkatu 10
PO Box 265
FIN-00531 Helsinki, Finland
Tel: 00 358 9 772 920
Fax: 00 358 9 772 921 38
Publishes a useful document, ‘Guide for healthcare professionals coming to Finland from EU member states.’ www.teo.fi/uusi/engl_1.htm
National medical association
Finnish Medical Association
Mäkelänkatu 2,
PO Box 49
FIN-00501 Helsinki, Finland
Tel: 00 358 9 393 091
Fax: 00 358 9 393 0794
Email: laakariliitto@fimnet.fi www.laakariliitto.fi
2.8 Working in France
The healthcare system
The French healthcare system is based on:
• a compulsory national health insurance system, linked to employment and financed by employers and employees. This is complemented by voluntary health insurance
• freedom of access to private and public healthcare services, generally without a referral system.The compulsory insurance system finances a large private sector, which provides most of the outpatient services.
However, most hospital care is still provided in the public sector. The poorest segment of the population can apply for Medical Aid, which entitles them to free healthcare. Private GPs (omnipraticiens/généralistes) provide a large share of outpatient care and house calls. They are paid on a fee-for-service basis and patients are reimbursed by their insurance companies. Patients can bypass GPs and go straight to specialists or hospitals. Since 1997, GPs have been able to opt to become referring GPs. If they wish, patients can conclude a contract with a referring GP of their choice, who will refer them to appropriate specialists. Inpatient care is provided by both public and private hospitals. Public hospitals have a duty to provide emergency treatment. There is no central trade union which speaks for the financial interests of the whole profession. There are a number of different unions (syndicats) all representing different groups. The main grouping is the Paris-based Confédération des Syndicats Médicaux Français, which aims to represent both GPs and specialists. There are also a vast number of professional, academic speciality and disease-specific associations and societies.
Medical education
The French medical education system is firmly rooted in ministerial decrees and orders and is therefore highly regulated. An understanding of the cultural significance of the concours – or competitive exam – is helpful in appreciating how the system works. Access to elite universities and positions in the professions are controlled by gruelling competitive exams. Promising school pupils are prepared for entry exams, and the increasingly competitive exams continue throughout higher education and training, often filtering out the less successful after some years of study. The culture of the concours is also prevalent at all levels of the French public sector, which employs a high percentage of the working population. Medical education is no exception. It takes place in three ‘cycles’, with students being filtered out after the first concours, which takes place one year into undergraduate training.
• 1st cycle (PCEM) of two years
• 2nd cycle (DCEM) of four years divided into two parts:
• 1st part: one year (DCEM1)
• 2nd part: three years (DCEM2, DCEM 3 and DCEM 4))
• 3rd cycle (TCEM), lasting either
• 2.5 years ‘residanat’ to train as a GP or
• 4 to 5 years ‘internat’ to train as a specialist.
General practice training
General practice training (residanat) lasts two and a half years full time. It is organised on a regional basis in ‘subdivisions’ of the health regions (régions sanitaire). The training is usually overseen by the Unités de Formation et Recherche (UFR) of the local medical faculties. GP trainees are allocated to a trainer who is charged with coordinating the theoretical and practical elements of the training.
Specialist training
Access to limited specialist training positions is controlled by a highly competitive exam – the concours d’internat. Successful candidates are ranked in order of the mark they achieve and the allocation of training posts is determined according to one’s mark. This means that you could pass the internat but still not be able to obtain a post in the specialty of your choice. There is only one option for those who cannot pass – to train as a GP. This has created the perception of GP training as a fall back position for failed internat candidates, rather than a career choice in itself. This is justified to some extent because approximately half of the students who enter GP training are failed internat candidates.
The concours d’internat takes place every year in two broad regions – the north (encompassing Ile-de-France, Nord-Est, Nord-Ouest) and south (Rhône-Alpes, Ouest, Sud, Sud-Ouest and departements d’outres mers – overseas departments).
There are three parts to the exam:
• multiple choice questionnaire, which tests factual knowledge and lasts for one hour. It consists of 150 questions.
• clinical scenario multiple choice questionnaire – divided into two parts of one hour 30 minutes each. It consists of 48 questions covering six to 12 clinical scenarios.
• an exam covering 12 diagnostic and therapeutic case studies consisting of two parts of three hours each.
The first two parts are marked by computer, the third by a special panel. When the results are sent to the candidates, they also receive instructions on how to proceed with their choice of post. Doctors from outside France who have enforceable community rights to settle and practise in another EU state may enter the concours d’internat. However, they must be able to show that they have undertaken three years of post-qualification experience as a doctor. Doctors who wish to apply for the concours d’internat must contact the director of the Diplôme d’Études Speciales (DES). These are based at the Unité de Formation et de Recherche (UFR) of the medical faculties. Information can be obtained directly from the Centre National des Concours d’Internat – www.cnci.univ-paris5.fr
BMA members considering undertaking any form of work and training in France are advised to consult this site for further guidance. Doctors in France are subject to a strict ethical code of practice. This code de déontologie médicale can be accessed at the website of the Conseil National de L’Ordre des Médecins.
Registration
All doctors intending to work in France must register with the departmental council of the Ordre Nationale des Médecins – the professional, regulatory and disciplinary body. This is a central and federal body, with headquarters in Paris and local councils in all the French départements. Contact details of departmental councils are available on the website of the Order Nationale des Médecins.
You must provide at least the following documents:
• medical degree certificate, accompanied by a certified translation
• UMC registration certificate
• certificate of good standing (available from the UMC)
• proof of nationality (ie passport)
• copy of birth certificate
• three photographs.
Further documentation may be required. Please check with the local Ordre des Médecins. You will also be required to register your qualifications with the local Direction Departementale des Affaires Sanitaires et Sociales, which is normally based in the main civic administrative buildings – the Cité Administrative. This body can also supply information on local vacancies.
Finding a post
Posts are advertised in the leading medical journals: Le Concours médical, La Revue du practicien and Le Médecin de France. However, not all vacancies are advertised in these medical journals. Contact the local office of Directions régionales des affaires sanitaires et sociales (DRASS) for a list of vacancies in public institutions and for a list of hospitals in general. It is also advisable to contact hospitals or medical institutions in which you would like to work directly, through the head of the relevant department.
International Department
26 Opportunities for doctors within the European Economic Area
Useful addresses
Centre National des concours d’Internat
45 rue des Saints pères
75270 Paris Cedex 6, France
Tel: 00 33 1 44 50 26 76
Competent authority
L’Ordre Nationale des Médicins
Boulevard Haussman 180
75389 Paris Cedex 08
Tel: 00 33 1 53 89 33 33
Fax: 00 33 1 53 89 33 44
Email: conseil-national@cn.medecin.fr
National medical association
Confédération des Syndicats
Médicaux Français
60 boulevard de Latour-Maubourg
75340 Paris Cedex 07
Tel: 00 33 1 4 3 18 88 01
Fax: 00 33 1 4 3 18 88 20
Email: csmf@csmf.org
2.9 Working in Germany
BACK TO MENU
The healthcare system
The Republic of Germany is composed of 16 states or Bundesländer. In 2000, the number of doctors was 359 per 100,000 inhabitants. Healthcare is funded by a statutory contribution system that ensures free healthcare for all via sickness funds. Insurance payments are based on a percentage of income, divided between worker and employer. Healthcare insurance in Germany is divided between statutory and private schemes. The statutory health insurance, Gesetzliche Krankenversicherung (GKV), occupies a central position in the healthcare system in the Federal Republic of Germany. About 90 per cent of the population is covered by the statutory health insurance which is compulsory for all who earn less than a certain amount before tax (3862.50 EUR in 2004, approxmiately £2652.79). Private healthcare schemes can either provide a complete health service for those who opt out of the GKV, or top-up cover for those who remain within it.
In Germany, the provision of healthcare can be broadly separated into outpatient and inpatient sectors. Outpatient services supplied to the public provided by independent doctors practising on a freelance basis under contract to the statutory health insurance. There is no gatekeeper system in Germany and patients are therefore normally free to consult specialists directly. However, each patient has to pay 10 EUR (circa £7) in every quarter for a visit to their GP. Within this quarter they can be transferred to a specialist without further charge, but if the patient goes directly to a specialist they must pay another 10 EUR, even if this is within the same quarter.
Until 2004, Germany operated a system of collective contracts between all statutory health insurances (selfadministration) and the self-administration of office based doctors (Kassenärztliche Bundesvereiningung). Since the 2004 healthcare reforms selective contracts are available.
Hospitals in Germany are grouped into three main types:
• public hospitals (öffentliche Krankenhäuser) run by the local authorities, the towns and the Länder
• voluntary, non-profit making hospitals (freigemeinnützige Krankenhäuser) run by the churches or non-profit making organisations, such as the German Red Cross
• private hospitals (Privatkrankenhäuser), run as free commercial enterprises.
Medical education
Medical studies take a minimum of six years. In the last year, the so-called Praktisches Jahr, the students work in a university or teaching hospital and have four month attachments in medical and surgical specialties and then four months in a specialty of their choice. This is followed by an examination, the Dritter Abschnitt der ärztlichen Prüfung. After graduating, the student can practise medicine but cannot call themselves Doktor. The trainee must work in a pre-registration Arzt im Praktikum post for 18 months before being awarded the Approbation, the equivalent of full registration in the UK. Postgraduate training time lasts four to six years depending on the specialty. Medical education is regulated by the Ärztliche Approbationsordung and was reformed in June 2002. Students who commenced their studies after 1 October 2003 are only required to take two state exams as opposed to the previous three. The first is after two years of study, the second after a further four years including the Praktisches Jahr. This means that medical studies finish after a minimum of six years training on completion of the second exam. For UK-trained doctors, only training completed after the MRCP (UK) can be counted towards training in a medical sub-specialty and prior confirmation needs to be obtained from the relevant royal college.
Registration
Registration in Germany is quite a complicated process. The following steps are a rough guide, though it is probably advisable to contact the German Medical Association, the Bundesärztekammer before starting. Having first located a job, either through the medical press or by contacting hospitals directly, the following steps are needed:
• obtain approbation – or registration – from the regional authority of the Land in which the post is based
• after approbation has been granted it is necessary to register with the German Regional Medical Association, the Landesärztekammer, again situated in the relevant Land
• before practising as a specialist in Germany, the specialist certificate obtained in the UK needs to be examined by the relevant Landesärztekammer. (Recognition of the specialist title is automatic if the title is listed in directive 93/16/EC)
• if wishing to practise independently (and for those who wish to serve patients insured under statutory health insurance), it is necessary to register with one of the 17 Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), and then obtain permission to practise in the social security system from the regional registration committee, the Zulassungsausschuss, which decides if there is a need in the relevant area for this specialist.
Finding a post
Posts are advertised in the journals of the regional Ärztekammer or in the Deutsches Ärzteblatt, a weekly journal published by the Deutscher Ärzteverlag (www.aerzteblatt.de). Usually, you will need to submit your application directly to the department of choice at the hospital of your choice.
Useful addresses
Marburger Bund (German salaried doctors’ trade union)
Reinhardtstrasse 36
10117 Berlin
Tel: 00 49 30 7468460/30
Fax: 00 49 30 74684615
E-mail: bundesverband@marburger-bund.de
Zentralstelle für Arbeitsvermittlung (Central Placement Office)
Villemombler Straße 76
53123 Bonn
Tel: 00 49 228 7130
Fax: 00 49 228 7131aa
Email: bonn-zavauslandsinfo@arbeitsamt.de
Hartmannbund
Schützenstrasse 6a (Ecke Charlottenstr.)
10117 Berlin
Tel: 030 206 208 0
Fax: 030 206 208 29
Email: HB-info@Hartmannbund.de
International Department 28
Opportunities for doctors within the European Economic Area
NAV – Virchow-Bund
(Verband der niedergelassenen Arzte Deutschlands)
e.V. Belfortstr.9 50668 Köln
Tel: 0221 973 0050
Fax: 0221 7391 1239
Deutsches Ärzteblatt
Deutscher Ärzteverlag
Dieselstraße 2, D-50859 Köln
Tel: 00 49 22 34 70110
www.aerzteblatt.de (includes job vacancies)
German Academic Exchange Service (DAAD)
34 Belgrave Square, London
SW1X 8BQ
Tel: 020 7235 1736
Fax: 020 7235 9602
Email: info@daad.org.uk
Kassenärztliche Bundesvereinigung
Employment service of the Federal Government
National medical association
Bundesärztekammer/German Medical Association
Herbert-Lewin PLatz 1
10623 Berlin
Tel: 00 49 30 400456 361
Fax: 00 49 30 400456 384
Email: auslandsdienst@baek.de
2.10 Working in Greece
BACK TO MENU
The healthcare system
Greece introduced its National Health Service, the ESY, in 1983 to improve equality of access to healthcare. It is based on a system of compulsory social insurance and is funded by a combination of taxation and income-related contributions to sickness funds. There is considerable private involvement in both the financing and provision of services. For administrative purposes, Greece is divided into 51 health districts or nomoi and one autonomous region, Ayion Oros. Healthcare is free to the patient because it is paid for out of the insurance funds. In addition to compulsory contributions to the public insurance funds, patients can take out private health insurance. Hospitals in Greece are divided between large general hospitals and smaller district hospitals. Both provide a combination of specialist, outpatient and accident and emergency services.
Medical education
Undergraduate medical training lasts six years and postgraduate training varies from five to seven years duration depending on the specialty. There is no formal assessment during specialist training, but on completion of the training the candidate has to sit a final examination before being awarded specialist status. The number of doctors in training has increased considerably in recent years and Greece enjoys one of the highest doctor-patient ratios in the EU. However, the majority of these doctors are located in Salonika and Greater Athens, with far fewer working in rural areas. The government has attempted to address this problem and training now includes a compulsory period in rural practice.
Registration
Every doctor must register with the local medical association in the area in which they wish to practise. A list of all local medical associations can be viewed at www.pis.gr/medassociationsgr.html
A doctor’s first registration costs 40 EUR per year (approximately £27). Subsequent years cost 75 EUR (approximately £51). Both figures were correct at the time of writing. Doctors do not join the Panhellenic Medical Association (PHMA) directly because the 60 local medical associations of Greece are all PHMA members.
The following documents are required for registration:
• certified copy of degrees, certificates and medical diplomas
• certified copy of the licence for practising medicine in Greece
• proof of ethics and honesty or copy of penal record issued by the competent authority of country of origin or citizenship
• certificate of good standing
• sworn statement in which it is stated that the doctor has the required level of mastery of the Greek language.
• certificate issued by the Greek Medical Welfare scheme stating that the doctor has paid his/her registration fees.
• residence and work permit.
• a photograph
• a detailed record of the applicant’s academic history.
Language testing is not obligatory for licensing, but is nonetheless required for EU doctors wishing to work in the Greek national health service. It is advisable to contact the PHMA for current registration requirements.
International Department 30 Opportunities for doctors within the European Economic Area
Finding a post
Vacancies are advertised in daily newspapers or in the journal of the Panhellenic Medical Association and other Greek medical journals. It is advisable to contact the Panhellenic Medical Association directly to find out when posts are likely to become available.
Useful addresses
Greek Association of General Practitioners
N. Kountourioti 21
5th Floor
546 25 Thessaloniki
Greece
Tel: 00 30 2310 550048
Fax: 00 30 2310 539995
Email: elegeia@otenet.gr
Competent authority and national medical association
Panhellenic Medical Association
3 Ploutarchou str.
106 75 Athens
Greece
Tel: 00 30 210 7258660
Tel: 00 30 210 7258661
Tel: 00 30 210 7258662
Fax: 00 30 210 7258663
Email: pisinter@pis.gr
2.11 Working in Hungary
The healthcare system
Healthcare in Hungary is funded by the state through the Health Insurance Fund (HIF) and is free to all Hungarian nationals. The HIF is controlled by the Ministry of Finance and the Ministry of Health. It was established in 1993 and designed to be self-sustaining through compulsory payroll contributions from both employers and employees. However, over the last few years, contributions have been lower than expenditure leading to Treasury contributions. The Local Government Act (1990) transferred ownership, including management and provision of health and social services to local governments. Individuals are free to choose their own GP (family physician) and this is their first port of call. Family doctors may refer patients to specialists. The Hungarian economy is in transition and while a predominantly publicly funded health system will be retained there are an increasing number of private services becoming available, most notably in relation to pharmaceutical, dental and family physician services. Over 90 per cent of family physicians operate as private entrepreneurs contracted to the local government and the HIF. The remaining 5 to 10 per cent are salaried state employees.
Medical education
There are four medical schools in Hungary and undergraduate medical training lasts for six years (12 semesters). During the first two years the curriculum focuses on theory, the third year explores the theoretical foundations of disease and preliminaries in medicine and surgery, and the fourth and fifth years introduce pharmacology and training in various clinical subjects. During the sixth (final) year students take their final examinations in internal medicine, surgery, gynaecology, neurology and paediatrics. Each final exam is preceded by a two or three month internship period. The final academic year is concluded with a comprehensive state examination which proves competence in the most important practical and theoretical aspects of general medicine.
Registration
Registration is carried out by the Hungarian Medical Chamber.
Useful addresses
Ministry of Health
Arany János u. 6-8,
Budapest H-1051
Hungary
Tel: +36 1 3017800
Fax: +36 1 3020925
www.eum.hu/eum/eum_angol.main.page
Association of Hungarian Hospitals
Fogaskereku utca 4-6
1125 Budapest
Hungary
Tel: +36 1 214 5159
Fax: +36 1 214 9715
Competent authority
International Department
32 Opportunities for doctors within the European Economic Area
Hungarian Medical Chamber (Magyar Orvosi Kamara)
Budapest 1068 Szondi u.100 H-1390
PO Box 175
Hungary
Tel: +36 1 269 43 91/43 92
Fax: +36 1 269 43 91/43 92
Email: podmaniczky@mok.hu
National medical association
MOTESZ: Association of Hungarian Medical Societies
1443 Budapest
PO Box. 145
Hungary
Tel: +36 1 332 45 56/312 38 07/311 66 87
Fax: +36 1 383 79 18
Email: office@motesz.hu; motesz@motesz.hu
Hungarian Medical Association
Balissi Balint u 15
1055 Budapest
Hungary
Tel: +361 269 43 91
Fax: +361 269 4392
2.12 Working in Iceland
The healthcare system
The Icelandic health service is primarily state funded (85 per cent) with the remaining 15 per cent collected through fees for services. The country is divided into healthcare regions. Each region has primary healthcare centres, some of which are run jointly with the local community hospital. Hospitals in Iceland are classified as: specialised teaching hospitals, general hospitals or community hospitals. Hospital care is free of charge.
Medical education
In Iceland basic undergraduate medical education lasts for six years. After graduation individuals must undertake a further 12 months of pre-registration training. Upon completion of this the individual obtains their licence to practise (full registration) from the Ministry of Health. When a doctor has their licence to practise they are entitled to start specialist training which, in a salaried position, lasts a minimum of four and a half years. Most Icelandic doctors undertake specialist training outside the country because there are very few formal specialist training posts.
Registration
The Ministry of Health and Social Security is the competent authority in Iceland. The following documents are required for registration:
• proof of nationality (passport)
• confirmation that the doctor’s education is in line with the relevant EU directive.
• medical qualification
• specialist certification
• certificate of good standing from the UMC.
When the Ministry has formally assessed the application the applicant will become fully registered and be granted a licence to practise.
Finding a job
Doctors considering working in Iceland are advised to contact the Icelandic Medical Association for advice on which hospitals to apply to for salaried posts.
Useful addresses
Directorate of Health
Austurströnd 5 IS – 170 Seltjarnarnes
Iceland
Tel: +354 510 1900
Fax: + 354 510 1919
Email: mottaka@landlaeknir.is
The University Hospital
Landspítali – háskólasjúkrahús Reykjavik
Iceland
The University of Iceland
Haskoli Islands
v/ Sudurgötu
Reykjavik
Iceland
Tel: 354 525 4000
Fax: 354 552 1331
Email: hi@hi.is www.hi.is
Reykjavik Primary Health Care Centre
Heilsugæslan I Reykjavik
Baronsstig 47
101 Reykjavik
Iceland
Tel: +354 585 1300
Fax: +354 585 1313
Email: heilsa@hr.is
Competent authority
Ministry of Health and Social Security
Vegmúla 3 150 Reykjavik
Iceland
Tel: +354 545 8700
Fax: +354 551 9165
eng.heilbrigdisraduneyti.is/ministry/
National medical association
Icelandic Medical Association (Laeknafelag Islands)
Hlidasmari 8 IS 200 Kopavogur
Iceland
Tel: +354 564 4100
Fax: +354 564 4106
Email: lis@lis.is
2.13 Working in Ireland
The healthcare system
Broadly speaking, healthcare in Ireland is provided by a public finance system, but recipients are split into two groups based upon ability to pay. Approximately a third of the population falls within the first group which includes those on a low income, sufferers of certain chronic diseases, and those over 70. They are entitled to the full range of health services free of charge. This group is covered by the General Medical Services Scheme, popularly called the ‘Medical Card’. GPs who are members of this scheme are independent practitioners with a contract for service, not employees. Consultants in the public service see these patients as part of their public service commitments. The government has recently introduced ‘doctor only medical cards’ which are available to an intermediate group of people who just exceed the means test for the full medical card. This card entitles them to free GP consultations but not free prescriptions. Those falling into the second group have to either pay directly for their health services or take out private insurance. Most people pay directly for GP consultations costing 40 EUR (approximately £27) or more. Pharmacy bills are separate. Members of this group see consultants on referral from GPs as private patients and pay the consultant directly or through an insurance policy.
There are three main insurers, the Voluntary Health Insurance Board VHI, a semi-state entity, founded in the 1950s, which operates a community rated insurance system. Members buy a plan at a fixed cost without undergoing a medical test. BUPA and Vivas are also part of this market. The Department of Health and Children regulates the health insurance market to ensure equity. Consultants can opt to become part of the VHI, BUPA, Vivas system. Some other insurers sell cash plans. By the majority of health indicators, the health of the Irish population lags behind that of the rest of the EU, although there are signs of improvement.
There is a small private healthcare sector, which operates independently of the public sector, although there is some tacit support through tax relief on insurance. There are three categories of hospitals in Ireland:
• voluntary hospitals which are run by religious orders or trusts. Although autonomous they are effectively part of the public system because the bulk of their funding comes from the Department of Health and Children.
• Health Service Executive hospitals are state owned and run hospitals
• private hospitals which are entirely run by private organisations.
Since 2004 there have been radical changes in the organisation of healthcare in Ireland. The Health Service Executive has taken over management of the service on a daily basis. The Department of Health and Children develops and funds national health policy.
Medical education Medical
training in Ireland is similar to the UK. There are five medical schools in Ireland of which four are part of the national university sector. One, the Royal College of Surgeons in Ireland, is a private institution with a world class reputation. The University of Limerick is in the process of launching a graduate entry medical school. Undergraduate study lasts for six years and is split between pre-clinical and clinical sections. Postqualification, doctors need to work for a year as an intern, after which they are eligible for full registration and can apply for SHO posts. SHO posts generally last between six months and two years, during which time the doctor can choose a future specialty. Doctors have to sit an examination to obtain membership of the appropriate royal college, after which they apply for specialist registrar posts which replaces the old grading system of registrar and senior registrar which applied to all doctors between SHO and consultant level.
Registration
All doctors are required to register with the competent authority, the Medical Council.
The following information is normally required:
• details of the medical school that awarded the primary medical qualification and of the university to which the medical school was attached
• date of diploma
• proof of nationality.
Non-EU doctors may be required to undergo assessment. Temporary registration is available for up to seven years (2,555 days). Finding a post Vacant posts are advertised in the Irish Medical Organisation’s journal the Irish Medical Journal – www.imj.ie (issued monthly) and some are listed in BMJ Careers. Both the Irish Independent and The Irish Times carry vey detailed health employment listings. It is also a good idea to contact hospitals directly to inquire about vacant posts. Junior doctors should be aware that only posts designated by the Medical Council as training posts are recognised for training purposes. Junior doctors are advised to check first with the Medical Council.
Useful addresses
Royal College of Physicians of Ireland
6 Kildare St
Dublin 2
Tel: +353 1 661 6677
Fax: +353 1 676 3989
Email: iseultmurray@rcpi.ie
Royal College of Surgeons in Ireland
123 St Stephen’s Green
Dublin 2
Tel: +353 1 402 2261
Email: info@rcsi.ie
Irish College of General Practitioners
Corrigan House
Fenian St
Dublin 2
Tel: +353 1 676 3705
Email: info@icgp.ie
Department of Health and Children
Hawkins House
Hawkins Street
Dublin 2
Tel: +353 163 54000
Fax: +353 163 54001
Health Service Executive
Oak House,
Limetree Avenue
Millenium Park Naas Co. Kildare
Tel: +353 45 880400
Fax: +353 1890 200893
E-Mail: info@hse.ie
National medical association
Irish Medical Organization
10 Fitzwilliam Place
Dublin 2
Tel: 00 3531 6767 273
Fax: 00 3531 6612 758
Email: imo@imo.ie
Competent authority
Medical Council
Lynn House, Portobello
Court Lower Rathmines Rd
Dublin 6
Tel: 00 353 1 4983100
Fax: 00 353 1 498 3102
Email: medicalcouncil@mcirl.ie
2.14 Working in Italy
The healthcare system
The Italian national health service (Servizio Sanitario Nazionale, or SSN) has three main administrative levels: central government, regional authorities and local health offices (Aziende Sanitarie Locale, or ASL). The Ministry of Health is responsible for policy decisions, the regional authorities are responsible for providing health services and the daily management of the service, and the provision of primary care is carried out by the ASLs. ASLs and the main hospitals manage their own budgets. The health service is funded partly by employers’ and employees’ contributions, and partly by the government. The regional budgets are determined on the basis of a formula, which includes factors such as population structure and the type of health expenditure. GP services are free at the point of contact, as are most hospital services. Patients pay a proportion of the costs of non-hospital services (eg dental care, drugs, diagnostic examinations). There is a significant private healthcare sector, with approximately 15 per cent of the population having complementary private health insurance. Italy has a GP gatekeeper system, whereby patients must be referred in order to access secondary care. GPs work under contract to the ASL, and although many share clinics with other GPs, most work alone. Out-of-hours service is provided by the Guarda Medica, employed by the ASL, an organisation which mainly employs young doctors wishing to gain experience. Public hospitals are funded on a regional basis and managed by the ASLs. There are many private hospitals, some of which have SSN contracts. Patient choice is important in the Italian healthcare system, and patients are often referred to another region. Outpatient care is provided in public or private hospitals, in polyclinics or in private specialist clinics.
Medical education
There are very few restrictions on entry to university in Italy, and as a result of this, Italian medical schools produce far more medical graduates than the health system can employ. The curriculum of the six-year undergraduate course is often restricted by the size of the classes, and has been criticised for being too theoretical. Not only is postgraduate training highly competitive, but even obtaining a permanent post can be extremely difficult. At the time of writing Italy continues to experience high medical unemployment.
Registration
Although the Italian registration authorities comply with the requirements of directive 93/16/EC, the workforce situation means that it is incredibly difficult to find employment.
In order to register, the following steps must be taken:
• the doctor must have details of his or her qualifications translated into Italian and must submit both originals and Italian sworn translations to the Ministry of Health, which is involved together with the Ministry of Education in evaluating qualifications and the training under directive 93/16/CEE (now Italian law D.Lgvo no 368 – 17/08/1999)
• the Ministry of Health will decide whether or not to recognise the qualification under directive 93/16/CEE and has to evaluate the qualification within three months. If it is recognised, the statutory registration body (one of the 103 Provincial Order of Doctors and Dentists) and the doctor will be notified.
The doctor has to then choose in which province he/she would like to be enrolled. The FNOMCEO (Federazione Nazionale degli Ordini dei Medici Chirurghe e degli Ordontoiatri) holds the database listing all doctors enrolled in Italy and the FNOMCEO International Department can provide a list of provincial addresses on request.
Finding a post
FNOMCEO has some information regarding vacant posts. Due to the great demand for posts and their short supply, it is advisable to contact the relevant department of the main teaching hospitals directly. Please note that junior doctors are regarded as students in Italy, which means they are not covered by the European Working Time Directive, and are not covered by general employee rights. Pay is low – junior doctors receive a grant rather than a salary.
Useful addresses
Ministry of Health
Ministero della Salute
Piazzale dell’Industria, 20
00144 Roma
Tel: +39 06 59941
Fax: +39 06 59945328
Italian Cultural Institute
39 Belgrave Square
London, SW1X 8NX
Tel: 020 7235 1461
Fax: 020 7235 4618
Email: ici@italcultur.org.uk
www.embitaly.org.uk/culture/mainpage.html
Competent authority
Federazione Nazionale degli Ordini dei Medici Chirurghe e degli Odontoiatri (FNOMCEO)
Piazza Cola di Rienzo 80/A
00192 Roma
Tel: +39 06 362 031
Fax: +39 06 322 2429
Email: estero@fnomceo.it
National medical association
La Societa' Italiana di Medicina Generale
Via del Pignoncino, 9-11
50142 Firenze
Italy
Tel. +39 55 700027
Fax +39 55 7130315
Email: simg@dada.it
Associazione Medici Specialisti e Specialisti in Formazione della Communità Europea (AMSCE)
2.15 Working in Latvia
The healthcare system
The State Compulsory Health Insurance Agency (SCHIA) holds the budget for healthcare which it distributes to eight regional funds. It is then allocated between primary and secondary care. Tertiary and special state healthcare projects are directly funded by the SCHIA. A new system of primary heathcare, similar to the UK model, was approved in 1992. However, it has yet to be fully introduced.
Medical education
In Latvia undergraduate medical education lasts six years.
Useful addresses
Ministry of Health
72 Brivibas Str.
LV-1011 Riga
Latvia
Email: vm@vm.gov.lv
Competent authority and national medical association
Latvian Physicians Association
Skolas Str.3
Riga LV-1010
Latvia
Tel: +371 722 0661
Fax: +371 722 0657
Email: lab@parks.lv
2.16 Working in Lithuania
The healthcare system
Lithuania has a compulsory health insurance system which is overseen by the State Sickness Fund. It is funded through employer and employee/self employed contributions with the state covering payments for children, students and those receiving benefits. Lithuania operates a gatekeeper primary care system with the vast majority of specialist consultations originating from GP referrals. There are plans to partially privatise the primary care system, with GPs becoming independent contractors.
Medical education
Undergraduate medical education lasts for six years, including practical training. Registration State accreditation and medical audit agencies license practitioners and deal with medical malpractice.
Useful addresses
National medical association
Lithuanian Medical Association
Liubarto g. 2/15
LT-08118 Vilnius
Lithuania
Tel: +370 5273 1400
Fax: +370 5273 1400
Email: lgs@takas.lt
2.17 Working in Luxembourg
The healthcare system
Luxembourg has a social security based healthcare system, with compulsory contributions to insurance funds. There are nine public and private health funds, membership of which is defined by occupation. Premiums are income related and contributions are paid approximately one third by the employee, one third by the employer and one third by the government. Patients pay for treatment and will be reimbursed by the fund, although there will always be a proportion (the patient’s contribution) which is not reimbursed. The Union des Caisses de Maladie (Union of Sickness Funds) is the umbrella body of all health insurance funds, and negotiates fees and services, ensuring there is comparability between the funds. Approximately 75 per cent of the population purchases complementary health insurance to pay for services that are categorised as non-essential under compulsory schemes. There is no private healthcare in Luxembourg, and all doctors work within the public system. However, each doctor works independently. Primary care is provided by GPs, but they do not have a gatekeeper role, and patients can access specialist care directly. Hospitals do not employ doctors, but have a system whereby the hospital authorities approve a particular doctor and will allocate a certain number of beds for his or her patients’ use. When the doctor wishes to admit a patient, he or she will apply to the hospital for one of his or her allocated beds. This is known as the Belegarztsystem. The doctors’ trade union is the Association des Médecins et Médecins-Dentistes du Grand-Duché de Luxembourg and negotiates with the Union des Caisses de Maladie on fees-for-service. Doctors working under the Belegarztsystem use a fee-for-service system. Some doctors working in certain hospitals are paid a salary, but still charge via fee-for-service billing. The bills are collected by the hospitals and paid into a pool from which doctors salaries are financed.
Registration
Luxembourg does not have its own medical school, so every doctor wishing to practise in Luxembourg will be in a similar position. Registration is the responsibility of the Minister of Health. Applicants who fulfil the requirements of directive 93/16/EC must complete an application form, obtained from the Ministry of Health, and provide their original medical diploma, certificate of nationality and a certificate of good standing. Registration is free. Although there is no facility for language testing, all doctors are required by law to have sufficient linguistic ability to practise safely in Luxembourg. The official language of Luxembourg is Luxembourgish (a dialect of German), but French and German are also widely used, and proficiency in these languages is requisite.
Finding a post
Registration with the Minister of Health automatically allows you to establish your practice wherever you wish, working as an independent practitioner within the social security system. In order to join the Belegarztsystem, you would need to contact individual hospitals. The main medical journal is Le Corps Medical, although this does not carry job advertisements.
Useful addresses
Competent authority
Luxembourg Ministry of Health
Ministère de la Santé
57 boulevard de la Pétrusse
22320 Luxembourg Ville
Email: ministere-sante@ms.etat.lu
National medical association
Association des Médecins et Médecins-Dentistes du Grand Duché de Luxembourg
29 rue de Vianden
2680 Luxembourg-Ville
Tel: 00 352 44 40 33
Fax: 00 352 45 83 49
Email: secretariat@ammd.lu
2.18 Working in Malta
The healthcare system
Malta’s healthcare service is free at the point of delivery. Employers and employees pay national insurance contributions, a proportion of which go towards healthcare. Primary health-care is delivered through eight health centres although a growing number of residents are opting to visit private GPs and specialists working in primary care. Secondary and tertiary care is provided by public hospitals, the main teaching hospital being St Luke’s. There are a small number of private hospitals and a growing number of residents are opting for private health insurance.
Medical education
Undergraduate medical training lasts for five years in Malta and includes practical training. Upon graduation, individuals must undertake two years of internship posts before being awarded full registration. Doctors are required to work in government service for two years after graduation.
Registration
Full registration is granted to those doctors who have qualified in an EEA member state and have full registration in an EEA member state.
The following documents are required:
• passport or identity card (copies certified by a Maltese Embassy/Commission are accepted)
• primary medical qualification (copies certified by a Maltese Embassy/Commission are accepted)
• certificate of good standing
• certificate of compliance (only for those doctors qualifying in Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia or Slovenia before 1 May 2004)
• certificate of specialist training where appropriate.
Useful addresses
Malta Medical Journal
Competent Authority
Medical Council of Malta
181 Melita Street
Valetta CMR02
Malta
Tel: +356 2125 5540
Fax: +356 2125 5541
Email: herbert.guillaumier@gov.mt (Registrar of the Medical Council)
http://www.sahha.gov.mt/pages.aspx?page=87
National medical association
Medical Association of Malta
The Professional Centre
Sliema road Gzira GZR06
Malta
Tel: +356 2137 8851
Fax: +356 2137 6540
Email: mam_secretary@mam.org.mt
2.19 Working in the Netherlands
The healthcare system
The Dutch healthcare system is an insurance-based system which provides three types of care:
• Exceptional Medical Expenses Compensation (AWBZ) – which covers acute and long-term medical expenses eg hospital stays for more than one year, nursing homes and nursing at home. This insurance is compulsory for everyone
• social care – this is government funded and covers non-serious medical risks, such as geriatric care, family health services and health prevention
• general medical insurance – which covers other medical expenses.
As of 1 January, 2006 the population will be covered by one compulsory social insurance scheme that will be operated by private health insurance companies. Primary care is very strong in the Netherlands, with GPs acting as gatekeepers for all patients covered by the social insurance scheme. GPs are paid directly by the insurance fund on a capitation basis (and as of 1 January, 2006 on a (small) fee-for-service basis). There is a significant shortage of GPs, particularly in rural areas. GPs are usually independent contractors, and more than half are in single-handed practices. However, individual GPs work together in small groups to provide out-of-hours services, peer review, training and mutual support. Approximately 50 per cent of medical specialists are self employed, although many work in partnerships and most will have a contract with a particular hospital. Medical specialists are paid on a fee-for-service basis. The Koninklijke Nederlandsche Maatschappij tot Bevordering der Geneeskunst (KNMG – the Royal Dutch Medical Association) is an umbrella organisation of doctors in the Netherlands. Employed doctors, general practitioners and specialists have their own professional associations, which are affiliated to the KNMG: the Landelijke Vereniging van Artsen in Dienstverband (Association of employed doctors), the Landelijke Huisartsen Vereniging (National Association of General Practitioners) and the Orde van Medische Specialisten (Hospital Specialists’ Association).
Medical education
The Netherlands has several medical schools, all of which offer a six-year undergraduate training programme (four years pre-clinical, two years clinical). The clinical training includes rotations in a variety of specialties and at least part of the training will take place in a district general hospital. Medical graduates can specialise immediately after graduation. They are selected for a training programme by interview and will work as an arts-assistant under the supervision of a senior medical specialist. Training programmes last a minimum of five years, and trainees are expected to demonstrate research experience and to have published. The number of training posts for general practitioners is subject to annual negotiations between the Ministry of Health and the LHV. Although there are no formal negotiations regarding the number of training posts for medical specialists, there are practical limits due to the number of available trainers. In general, the Netherlands undergraduate training produces more doctors than there are medical specialist training places, but there are certain shortage specialties. GPs complete a three year programme of specific training, following which they are entered on the Royal Dutch Medical Association’s register of general practitioners. Most registered GPs will then form contracts with health insurers. Renewal of registration as a medical specialist or GP is already required in the Netherlands. Registration as a GP or medical specialist is limited to five years, at which point the doctor must demonstrate continued employment of at least one day a week and participation in accredited CME activities of at least 40 hours each year.
Registration
Doctors wishing to practise in the Netherlands must first register with the BIG-register (Health professionals register).
You will need to show:
• your original diploma
• certificate of nationality
• certificate of good standing and
• certificate of European Equivalency of Training (obtained from the UMC)
• although there is no formal language exam, you may have to demonstrate that you are competent in Dutch.
You will also need to register as a GP or specialist with the KNMG (the Royal Dutch Medical Association), notify the Inspector of Healthcare in the province in which you will work and the burgemeester (mayor) of the area in which you live. You will also need to obtain a residence permit from the local Vreemdelingendienst (foreigner service). The Ministry of Health produces an information booklet on registration in the Netherlands entitled Working in the Dutch Health sector with a foreign certificate, which can be found on its website at www.minvws.nl/images/For_cert_tcm11-45272.pdfb
Finding a post
Vacancies are advertised in the medical journals Nederlands Tjidschrift voor Geneeskunde – www.ntvg.nl and Medisch Contact - www.medischcontact.artsennet.nl
Vacancies can also be foun on:
www.swg.nl (Dutch only, click vacatures);
www.artsennet.nl (Dutch only, click vacatures);
Useful addresses
Ministry of Health
Ministerie voor Volksgezondheid,
Welzijn en Sport Bureau Buitenlandse diplomahouders,
Postbus20350
2500 EJ Den Haag
Tel: 00 31 70 340 6954/7401
Information and Referral Desk Foreign Degree Holders in Health Care (verwijspunt)
PO Box 16.
114 2500 BC The Hague
Tel: 00 31 70 340 6200
Fax: 00 31 70 340 5966
Email: info@verwijspunt.nl
Competent authority
KNMG MSRC (registration body for medical specialists)
Postbus 200 65
3502 LB Utrecht
Tel: 00 31 30 28 23 381
Opportunities for doctors within the European Economic Area 47
KNMG
HVRC (registration body for GPs)
Postbus 200 65
3502 LB Utrecht
Tel: 00 31 30 2823 358
Health Inspectorate
Inspectie voor de Gezondheidszorg
Staatstoezicht op de Volksgezondheid
Postbus 16 119
2500 BC Den Haag
Tel: 00 31 70 340 7911
BIG-register (Register of medical professionals)
Postbus 16114
2500 BC Den Haag
Tel: 00 31 70 340 6600
Fax: 00 31 70 340 5339
Email: info@bigregister.nl
National medical association
Koninklijke Nederlandsche Maatschaapij tot Bevordering der Geneeskunst (KNMG)
Lomanlaan 103
Postbus 20051
3502 LB Utrecht
Tel: 00 31 30 282 3911
Fax: 00 31 30 282 3375
Email: communicatie@fed.knmg.nl
2.20 Working in Norway
The healthcare system
Norway’s healthcare system is mostly publicly-funded. Citizens contribute through general taxation, and the health service is subsidised by the state. Responsibility for healthcare is divided into two tiers: the state, which has overall responsibility for providing and financing services for specialist healthcare, and the 434 municipalities, which take responsibility for primary care.
There are a number of private clinics, usually run by hospital specialists in their spare time, and a few private hospitals. Hospital treatment is free at the point of delivery. There is, however, a charge for visiting the GP, unless the patient is pregnant, under seven or is suffering from an occupational injury. GPs have a gatekeeper role in Norway, referring patients for specialist treatment as necessary. GPs are organised into polyclinics to provide health care, including out-of-hours services, for the community where they are based. The municipality either employs the GP directly (if the GP is working in the public sector) or will have a contract with a private GP. If you are a private GP, you will be paid on a fee-for-service basis, but will have to cover all other expenses. All out-of-hours work is on a fee-for-service basis.
One of the biggest problems facing the Norwegian healthcare system is providing adequate services to the small percentage of the population living in the far north, where population density is as low as two per km2.
Medical education
Norway has four medical schools. A six-and-a-half year medical degree is followed by 18 months of supervised residencies: 12 months hospital-based and six months with a GP. Once this is completed, the doctor is fully registered and can begin specialist training. Specialist training programmes take a minimum of five to six years, although doctors usually gain specialist approval after nine years, with which they can apply for consultant (overlege) posts. Specialist training for general practice lasts for five years, with one year in a hospital and four years of general practice, including a two-year vocational training programme.
Registration
Norway is a member of the EEA, and therefore complies with the requirements of directive 93/16/EC. Registration of medical qualifications is carried out by the Norwegian Registration Authority for Health Personnel, but registration of specialist medical qualifications is the responsibility of Den norske Lægerforening (the Norwegian Medical Association). The relevant application forms are on its website. Doctors who wish to work in the social security system need to seek permission from the municipality or state. Further information can be obtained from the Norwegian Medical Association. Although doctors from within the EEA cannot be asked to complete a language exam, the Norwegian Medical Association emphasises the importance of learning Norwegian before applying for employment.
Finding a post
Vacancies are advertised in Tidsskrift for Den norske Lægeforening (the Norwegian Medical Journal) which is published three times a month: www.tidsskriftet.com
Useful addresses
Norwegian Tourist Board
Charles House
5-11 Lower Regent Street
London, SW1Y 4LR
Tel: 0906 302 2003 (50p per minute)
Fax: 020 7839 6014
Email: infouk@ntr.no
Norwegian Ministry of Health
Helsetilsynet Postboks 8128
Dep N-0032
Oslo
Tel: 00 47 22 24 88 88
Fax: 00 47 22 24 95 90
Email: postmottak@safh.stat.no
http://www.helsetilsynet.no/
Competent authority
SAFH
PO Box 8053
Dep NO-0031
Oslo, Norway
Tel: 00 47 21 52 9700
Fax: 00 47 21 52 9703
Email: postmottak@safh.stat.no
National medical association
Den norske Lægersforening
Postboks 1152 Sentrum
N-0107 Oslo
Tel: 00 47 23 10 90 00
Fax: 00 47 23 10 90 10
Email: legeforeningen@legeforeningen.no
2.21 Working in Poland
The healthcare system
The National Health Fund Act 2003 introduced a compulsory health insurance scheme. Citizens are currently required to contribute eight per cent of their income to the scheme. An increase to nine per cent is scheduled for 2007. In addition, people can purchase ‘health packages’ from private clinics and insurance companies to boost their statutory coverage. Poland operates a GP gatekeeper system and local government authorities (gminas) are responsible for primary care units. Outpatient services are usually available with a GP referral. However, some specialists can be accessed directly, for example, ophthalmologists and psychiatrists. The majority of hospitals are publicly owned, although they are self-governing and self-financing administrative units.
Medical education
Medical education in Poland takes four to six years and includes practical training.
Registration
Registration is through the Polish Medical Chamber with a licence to practise medicine being granted to individuals who have completed a one year internship. For up-to-date information about which documentation you need to provide contact the Chamber directly.
Useful addresses
Ministry of Health
ul. Miodowa 15
00-952 Warsaw , Poland
Tel: +48 22 634 9600
Email: kancelaria@mz.gov.pl
Competent authority
Polish Chamber of Physicians and Dentists (Naczelna Izba Lekarska Rzeczypospolitej Polskiej)
Ul.Jana Sobieskiego 110
00-764 Warsaw, Poland
Tel: +48 22 851 5115
Fax: +48 22 851 7136/7142
National medical association
Polskie Towarzystwo Lekarskie (Polish Medical Association)
Al. Ujazdowskie 24
00-478 Warszawa, Poland
Tel: +48 22 628 86 99
Fax: +48 22 628 86 99
2.22 Working in Portugal
The healthcare system
Portugal’s National Health Service (Serviço Nacional de Saúde – SNS) was established in 1979. It is financed by taxes and most care is free at the point of delivery. Due to a lack of resources in the public system, particularly in secondary care, there is a small but increasing interest in the private sector. Doctors employed in the SNS are also able to work in the private sector on a fee-for-service basis. Working exclusively in private practice is unusual, although there are some opportunities in tourist areas. Organisation and management of the health system is the responsibility of the five regional authorities. In recent years, Portugal has made primary care a priority. GPs work in health centres, with lists of 1,500 patients. They are salaried and employed by the state. In theory, GPs operate a gatekeeper system, but in reality many patients side-step this by attending emergency departments with nonurgent matters.
Medical education
Undergraduate medical courses last six years, followed by a pre-registration internship. Once they have obtained full registration, doctors choose their career: hospital medicine, general practice or public health. Specialising in general practice requires a three-year vocational training scheme, leading to a ‘generalist’ diploma. The Ordem dos Medicos (Portuguese Medical Association) has recently called for this training scheme to be increased to four years. Entry to specialist training is very competitive. The Regional Health Administrations declare the number of vacancies, and posts are offered to the best qualified applicants.
Registration
The competent authority in Portugal is the Ordem dos Medicos (Ordem), which is also the national medical association. In addition it registers specialist qualifications. Membership is compulsory for all practising doctors.
Doctors wishing to work in Portugal have to register with the regional branch of the Ordem, submitting:
• an application form
• proof of nationality
• certificate of primary qualification and
• current certificate of registration.
All doctors, including Portuguese nationals, are required to take a medical communication test which assesses their understanding of Portuguese.
Finding a post
Finding a job can be quite difficult, due to the strict rules for applications and selection procedures. Vacancies for salaried posts in the SNS are advertised in the official journal, Diario da Republica, or can be obtained directly from the regional health administrations.
Useful addresses
Ministry of Health (Ministério da Saúde)
Avenida João Crisóstomo 9
P-1200 Lisboa
Tel: 00 351 21 354 4560
Fax: 00 351 21 314 2861
www.dmrs.min-saude.pt/novidades.asp
Competent authority & national medical association
Ordem dos Médicos
Avenida Gago Coutinho 151
1749 084 Lisboa
Tel.: 00 351 21 8427 100/11
Fax: 00 351 21 8427 101/99
Email: ordemmedicos@omsul.com
2.23 Working in Slovakia
The healthcare system
The first port of call for healthcare in Slovakia is the primary care doctor of which there are three types: GP, paediatrician and gynaecologist. Primary care doctors work in multi disciplinary teams with nurses and para-medical staff and they operate primarily within the private sector, receiving payments directly from insurance companies. Citizens may choose which primary care provider they visit. There are three types of hospital in Slovakia: regional, district and highly specialised. The latter are generally affiliated to medical schools and are state owned. Regional and district hospitals are owned regionally. Healthcare in Slovakia is funded both publicly and privately and all citizens are covered by mandatory health insurance. Employees and self-employed individuals pay 14 per cent of their salary towards statutory health insurance premiums.
Medical Education
There are three medical schools in Slovakia. The basic medical degree takes six years. On completion of medical studies individuals apply for residency programmes to undertake specialist training.
Registration
Details about the registration process are available from the Slovak Medical Board, which is the competent authority in Slovakia.
Useful addresses
Ministry of Health
Limbová 2,
PO Box 52
837 52 Bratislava Slovakia
Tel: +421 2 593 73 111
Fax: +421 2 547 77 983
Email: office@health.gov.sk
Slovak Medical Chamber
Dobsinského 12
811 05 Bratislava Slovakia
Tel: +421 7 5244 2010
Fax: +421 7 5244 2011
Email: sekretariat@lekom.sk
Competent authority
Slovak Medical Board
26 Lazaretská 811 09
Bratislava Slovakia
National medical association
Slovak Medical Association
Legionárska 4 813 22
Bratislava Slovakia
Tel: +421 2 5542 2424
Fax: +421 2 5542 2363
Email: secretarysma@ba.telecom.sk
2.24 Working in Slovenia
The healthcare system
Primary care is available from healthcare facilities that are state-owned, but managed by municipalities. Secondary care is provided by a number of public general and specialist hospitals. All Slovenians are entitled to compulsory health insurance benefits with employees and employers each paying contributions. In 2002, 84 per cent of health expenditure was covered by the health insurance fund. Voluntary health insurance was introduced in 1993 and around 98 per cent of Slovenes are subscribers.
Medical education
The basic medical degree course takes six years. However, doctors must undertake a further two years supervised practice before their degree is awarded.
Registration
The Medical Chamber of Slovenia is the regulatory body. Graduates must complete two years as an intern and pass a licensure examination before being granted a licence to practice medicine.
Useful addresses
Slovenian Ministry of Health
Stefanova ulica 5
1000 Ljubljana
Tel: +386 1 478 60 19,
Fax: +386 1 478 60 58
Email: ministrstvo.zdravje@gov.si
Competent authority
Zdravniska Zbornica Slovenije (Medical Chamber of Slovenia)
Dalmatinova 10 p.p. 1630
1001 Ljubljana, Slovenia
Tel: +386 1 30 72 100
Fax: +386 1 30 72 109
Email: zdravniska.zbornica@zzs-mcs.si
National medical association
Slovenian Medical Association
Dalmatinova 10
1000 Ljubljana Slovenia
Tel: +386 1 4342 580
Fax: +386 1 4342 584
Email: zdravnisko-drustvo@bit.si
2.25 Working in Spain
The healthcare system
Spain is divided into 17 autonomous regions, seven of which have full responsibility for health services in their area (Andalucia, the Basque Country, the Canary Islands, Catalonia, Galicia, Navarra, and Valencia). Public sector healthcare in the remaining 10 regions is the responsibility of the National Institute of Health (INSALUD). The public healthcare system is financed by general taxation and regional taxes, and approximately 20 per cent of the population is covered by additional private health insurance. In recent years the Spanish government has encouraged the growth of the private sector. GPs are usually salaried, and often work in large primary healthcare centres, alongside paediatricians, nurses, and sometimes dentists and social workers. As in the UK, healthcare is free at the point of delivery, and GPs act as gatekeepers to secondary care. Private GPs are also available, and are paid on a fee-for-service basis. The Spanish health system centres around hospitals and public sector hospitals are managed by INSALUD, or by the regional governments in the seven areas with devolved health services. There are also private hospitals run either for profit or by charitable organisations. Although access to secondary care should be through GP referral, many people avoid long waiting lists by using accident and emergency departments. Most doctors are employed by the pubic sector and receive fixed salaries. Health sector reforms have been introduced to a greater or lesser extent by each regional authority. In some of the regions, such as Catalonia, this has resulted in a purchaser-provider split, and a closer relationship between the private and public sector.
Medical education
Undergraduate medical training in Spain lasts six years – three of which are pre-clinical and three clinical. Upon successful completion of the six years individuals are awarded the Licenciado en Medicina y Cirugia. Access to specialist training in Spain is controlled by a competitive examination – the medico interno residente system (sistema MIR), which is open to Spanish citizens and to citizens of other EEA states who also obtained their primary medical qualifications from an EEA state. There are usually a few places open to doctors from non-EEA states. The exam is organised annually by the Ministry of Education and Science. Candidates are ranked in order of the mark they achieve. They are then allowed to choose their specialty and location according to their rank. Those near the bottom generally have very limited choices. To pass the exam, candidates need to have an extremely high level of medical knowledge and the exam is conducted in Spanish only. The residency programme for successful candidates lasts three or four years, sometimes longer depending on the specialty. GPs, for whom there is a separate MIR exam, spend their final year in a training practice. For details of employment procedures in a specific area, you should contact the regional health authority.
Registration
In order to practise in Spain (including privately), doctors must be fully registered with the appropriate provincial medical college (Colegio de Medicos de la Provincia). Doctors must also have their qualifications officially recognised by the Ministry of Education and Science.
You will need originals and translated and certified copies of the following documents at least:
• your UMC registration certificate
• your medical degree certificate
• your CCST/VT certificate
• birth certificate
• identity card (which must be obtained from the local police on arrival).
You may also be asked for certificates for which there are no direct equivalent in the UK, such as proof that you have no criminal record. The registration process can be long and complicated.
Finding a post
Appointment procedures vary by region. Some operate a system whereby permanent posts (plazas en propiedad) are offered on the basis of the results of assessment exams called oposiciones. These exams are only held when a large number of vacancies in a certain specialty exist, and can be used for GPs or hospital-based specialists. Oposiciones are run on a regional basis. Every year, there is a system of transfers of permanent posts – traslados – when the first choices go to those with the best oposiciones scores. Employing long-term locums – interinidades – is a common method of filling temporary vacancies in permanent posts before new oposiciones are held. Short-term locum posts are known as sustituciones and cover sickness, holidays and maternity leave.
Setting up in private practice
Many UK doctors are interested in working in private practice in British expatriate communities. Any doctor registered with the provincial Colegios de Médicos can set up a private practice in that particular area, subject to compliance with ethical standards and tax laws. Appropriate professional advice should be taken.
Useful addresses
Ministry of Health
Ministerio de Sanidad y Consumo
Paseo del Prado 18-20
28071 Madrid
Spain
Tel: +34 1 596 1000
Fax: +34 1 596 1547
Competent authority and national medical association
Consejo General de Colegios de Médicos de España
Plaza de las Cortes
11- 28014 Madrid
Tel: +34 901 400 100
Fax: +34 91 596 4480
www.cgcom.org/
Registration body
Ministério de Educación y Ciencia
Alcalá, 34, Madrid 28014
Tel: +34 91 701 80 00
www.mec.es
The healthcare system
Sweden has a publicly-funded healthcare system, which is funded mainly through taxation at national, regional and local level. Healthcare is available to all throughout the country. Patients pay a small fee for GP and specialist visits, prescriptions and outpatient care, but inpatient hospital treatment is free, with the exception of some limited accommodation costs per night. Responsibility for the provision of health services lies with 18 county and 289 municipal councils, known as healthcare ‘principles’. The 18 county councils are responsible for the majority of healthcare services which are provided at three levels: primary/outpatient, county health services and regional health services. The role of the national Ministry of Health and Social Affairs is limited compared to that of the regional county councils. It focuses on drafting new legislation in the area and also awards some national grants to the heath-care sector. Local municipal authorities have responsibility for long-term care. Sweden has traditionally had a strong focus on hospital care, although primary care is growing in importance. Most GPs work in salaried posts in health centres and are employees of the county council. Patients have free choice of GP and of hospital within their county, and can access hospital care without GP referral.
Medical education
The Swedish medical undergraduate course lasts five and a half years, followed by an internship of 18 months, comprising six months in family medicine and one year in a rotation of various major specialties. Once the internship is completed and full registration obtained, the doctor can enter specialist training. Specialist training lasts at least five years and is assessed by the head of department, who, once the training is completed, will recommend that the doctor is granted formal qualification as a specialist by the Board of Health and Welfare. General practitioners are required to complete a five-year programme, leading to qualification as a specialist in family medicine.
Registration
Registration of basic and specialist qualifications is carried out by the National Board of Health and Welfare. Applicants must supply evidence that their qualification complies with directive 93/16/EEC and a certificate of good standing that is not more than three months old. It is also helpful to submit a CV. The National Board of Health and Welfare emphasises the importance of Swedish language proficiency and a knowledge of Swedish medical legislation. Although these are not prerequisites for registration, employers many to ask for them as a condition of employment. The Swedish Medical Association publishes a booklet which includes details on registration requirements for international doctors: www.lakarforbundet.se/upload/Lakarforbundet/In%20English/rekrytfolder_eng_2005.pdf
Finding a post
Most vacancies are advertised in the Swedish Medical Journal (Läkartidningen) which is published weekly. There have been recent fluctuations in medical workforce which have led to considerable competition for some specialties. There may also be bureaucratic hurdles for a GP to register as a specialist in family medicine due to the longer training period in Sweden. Posts are also advertised on the hospital and county council websites.
Useful addresses
Competent authority
National Board of Health and Welfare (Socialstyrelsen )
S-106 30 Stockholm
Tel: 00 46 8 555 530 00
Fax: 00 46 8 555 532 52
National medical association
Sveriges läkarförbund
Box 5610 S-114 86 Stockholm
Tel: 00 46 8 790 33 00
Fax: 00 46 8 20 57 18
Email: info@slf.se
2.27 Working in Switzerland
The healthcare system
Healthcare in Switzerland is based on a compulsory insurance system. Switzerland has a good quality healthcare system, but it comes at a price. Recent statistics show that health spending accounts for about 10 per cent of GDP, making Swiss health costs the second highest in the world. Moves are under way to reduce healthcare costs. These include limiting the number of doctors, increasing the range of non-brand medications on the market, as well as changing the system of health premiums. The Swiss have no public, state-run health service, and also no reciprocal arrangements for healthcare with other countries. Virtually every hospital (Spital, hôpital, ospedale) has some kind of 24-hour service. Every district has a rota system whereby one local pharmacy (Apotheke, pharmacie, farmacia) stays open outside normal shopping hours.
Medical education
Undergraduate training in Switzerland lasts for six years, followed by general then specialist training. After graduation, medical students become junior doctors or ‘Assistantarzt/assistante’. After completing specialist training, a doctor becomes an ‘Oberarzt’. Medical education is under the authority of the Federatio Medicorum Helveticorum (FMH) which awards specialist certification.
Registration
Switzerland has 26 cantons and doctors must register with the health authority within the canton in which they will be practising. An arrangement between Switzerland, the European Union and its member states on the mutual recognition of professional qualifications came into force on 1 June 2002.
This means that doctors are entitled to full registration in Switzerland if they fulfil both of the following criteria:
• they are citizens of a EU member state
• they have completed primary training in a member state and hold a recognised qualification.
Finding a post
Vacant posts are advertised weekly in the Bulletin of Swiss Physicians or in the Swiss Medical Journal Schweizerische Ärztezeitung. It is also worth looking at the following website: www.jobmed.ch/index.php?lang=2
Useful addresses
Swiss Federal Office of Public Health
Bundesamt für Gesundheit
Seilerstrasse 8
CH-3003 Bern
Switzerland
Tel: +41 31 3229505/10
Fax: +41 31 3249033
Association of Swiss Assistant Doctors and Chief Physicians (VSAO)
Verband schweizerishcher Assistenz – und Oberärzte
Dählhözliweg 3
Postfach 229
CH-3000
Bern 6
Tel: 00 41 31 351 1573/74
Fax: 00 41 31 352 9008
Health Info Net AG
Pflanzschulstrasse 3
CH-8411
Winterthur
Tel: 00 41 522 350 270
Fax: 00 41 522 350 272
Email: info@hin.ch www.hin.ch
Canton medical societies
http://www.fmh.ch/ww/fr/pub/organisations/cantons.htm
Competent authority
Swiss Medical Association (FMH)
Federation des Medecins Suisse/Verbindung der Schweizer Arztinnen und Arzte
Elfenstrasse18
3000 Bern 16 Switzerland
Tel: 00 41 31 359 1111
Fax: 00 41 31 359 1112
Email: fmh@hin.ch