How is that >98% of Danes have a GP? Part of the answer lies in their approach to training physicians. Here's a summary of some of what I've learned on my trip to Denmark 🇩🇰 After high school, most Danes take a gap year where they typically work and travel (the average is 2 gap years but several take even more). They would then apply and gain admission to medical school which is 6 years in total. After graduating from medical school, every new doctor does a one year "internship" of sorts, 6 months of which is in a GP practice and the other 6 months in a hospital. Where they do this internship is based on luck. They draw numbers and choose the location based on numerical order. If you draw 10, you pretty much have your pick of spots. If you're 450, you'll have pretty limited choices left. Following the internship, they apply and get selected into an orientation for a specialty program. This orientation is 6 months for GPs (remember they already did 6 months in their internship) and 1 year for other specialties. It's a time for residents to assess whether the specialty is the right fit for them and vice versa. When they complete the orientation, residents can apply for an orientation to another specialty area if they choose. On average, most residents do two orientations. When they are sure which specialty they want to pursue, they apply and are selected to a residency program. Residency training is 4.5 years for GPs and 5 years for other specialties. In the GP residency, trainees spend 30 months on hospital rotations and a 6 month, 6 month and 12 month block in 3 different general practices. Notably, the GP residency increased from 3.5 years to 5 years in 2003. I've been told that this change actually made it easier to recruit trainees to become GPs and that following the change, GP incomes increased. GPs now, on average, make about the same or more than colleagues in other specialties. There are a few interesting features of the physician training pathway in Denmark: -all specialists gain a foundation in family medicine through the internship year -the location of the internship year is based on a lottery, exposing trainees to communities across the country and likely increasing the chances of them settling in a more rural area -trainees have a chance to try out different specialties with the orientation year -GP training is about the same length as other specialty training I think elements of this training pathway are part of the reason why general practice is highly respected in Denmark and paid as well as other specialties. Pay and respect in turn influence recruitment and retention of the GP workforce. PS. the photo here is a wall of some of the 170+ residents trained at the practice I visited (more on that later!)
Matthew Evans
7mo
Some really interesting information on physician training in Denmark. I find it interesting that career thing to medicine starts right out of high school. The Canadian system currently has a full (and expensive) 4-year undergraduate’s degree with no guarantee of medical program admission in the way. Thinking of better ways to build capacity could be a plus for our system.
Tazim Virani
7mo
Thank you Tara from the "on the ground" facts. Your last comment on respect is foundational to what we believe is important for our health and well-being.
It sounds like it was an enlightening visit Tara Kiran! I am interested in learning more about the Danish health care system and will DM you. Thank you for sharing your summary
Milena Forte
7mo
Fascinating
primary care physician, digital health researcher, imaginator, breaker of the status quo
7moInteresting. Sounds like a healthier training environment. Once in the workforce I wonder if they practice in teams and what their relationship is to other members of the team. If they don't practice in teams I wonder if they have the fragmentation of care that we have in Canada. I wonder how much admin work they have that can't be delegated. I wonder what their medical education costs them and what their typical debt load (if any) is after training.