Hej! Greetings from Sweden! I’m an American physician who has been living in Stockholm, Sweden for the past 4 years. My residency in Pediatrics took place at Children’s Hospital Oakland (California) and my fellowship in Pediatric Endocrinology at University of California San Francisco. All of my formal training finished in 2015 and I subsequently worked full-time in a pediatric urgent care and part-time in an outpatient pediatric endocrinology practice.
Things Took a Turn 3 Years Into My Career
Things took a turn 3 years into my career when my husband decided to fulfill a long-held wish. He had lived in Sweden twice in the past. He spoke fluent Swedish and had always dreamed of living there again for a short time. I was pregnant with our first child and we realized it would be best to do this while our child was small.
The decision to move was difficult – my career had just started and I was also recently offered two dream positions. But my husband promised our adventure would be just 2 years long and after I agreed, he put in a request for transfer at his company (an international tech giant). His company took care of everything – visas, housing, moving expenses – and in the summer of 2018 we were off.
I did everything “just in case“
When we moved, I did not expect we would be in Sweden long enough for me to even think about a Swedish Medical license, but I did everything “just in case“. This was lucky, as the COVID-19 pandemic completely changed our plans about going home. I spent 2 years studying Swedish, basically starting from scratch (save for a few Duolingo sessions), in order to fulfill the C1 language level requirement for getting the medical license. There is no point in trying to find quick shortcuts here – you really need to have a good grasp of the language in order to practice.
Then came the Theoretical Test for Foreign Doctors, which had a pass rate of 17% when I took it. This test can best be described as a hybrid of the USMLE Step 1 and 2 – that is, basic science and clinical medicine from all specialities rolled into one 8-hour, multiple choice exam. The fact that I had only worked in pediatrics since medical school meant I had to relearn an enormous amount of information, all in a foreign language, in addition to puzzling out European protocols and algorithms and learning non-generic names of medications.
A second, practical, test took place over 2 days. I was prepared to show a panel of physicians everything from how to do a skin biopsy to how to do an eye exam with a slit lamp (having never seen a slit lamp in real life). After that came 6 months of residency in a pediatric endocrinology clinic, followed by a course in Swedish medical law. Finally, after a little more than 4 years of effort, I had my medical license – this put me at the level of a second-year resident in the US.
After this, I technically need to do 6 more years of residency and 3 years of fellowship training to get back to the career status I had before we moved. Because of my prior training it is possible to get up to 4.5 years of that waived. So, the whole process will likely take me 8.5 years.
There Were Marked Differences
Residency gave me insight into the healthcare system in Sweden and there were marked differences. Residency in Sweden does not entail the extended-hour shifts we require in America, but the salary is not great during this time. You start at about $2,500 a month after taxes, which can be difficult if you live in an expensive capital city with a family. Eventually you can earn about $7,500 a month as a senior attending subspecialist. The flipside is that healthcare and education costs are cheap (or non-existent, for children) and childcare is typically around $200 a month, full-time.
Swedish pediatric endocrinologists have the same dedication and drive as doctors in America, but they, unlike in America, recognize that your job is only part of your life. So, a full-time endocrinologist would expect to see 25 patients a week and use the rest of the time for charting and meetings/planning. Being on-call (in this specific subspeciality) means holding a phone from 8 am till 4 pm, with no call overnight or on the weekends.
This life-work philosophy extends to parenting. If your child is sick, not only do you have literally more than a hundred possible sick days a year, but your legal right to take care of your child means that no one will complain or question you. Parental leave after the birth of a child usually extends 1.5 years. Another interesting factor is the absence of medical insurance. My colleagues did not have to send in reams of paperwork for medication authorization. Instead, they sat down in a meeting, came to a consensus about whether a specific patient needed the medicine, documented this meeting formally and then simply ordered the medicine.
Immigrating is Hard
It is important to know that you need to have another reason for moving to Sweden other than your medical profession in order to be granted a residency permit – for example, your spouse is Swedish, or your spouse obtains a work visa. This is because you will not be allowed to work in medicine until you have gone through the lengthy process of obtaining your Swedish license. In Sweden, if your spouse receives a work visa, you automatically receive a visa that allows you to work as well.
Immigrating is very hard. You lose a lot – connection with your fellow citizens, the pride your work status gave you, the ability to communicate easily. Expect that it might be really difficult and that it will take you several years to feel comfortable. If you know this, it will be easier to clear the hurdles and eventually get to the place where you feel that you can both really make a life in this new country and also appreciate the new things the country has given to you
For those interested in learning more about getting a medical lcensed in Sweden read the Ultimate Guide to Practicing Medicine in Sweden. Also, if you’re ready to learn Swedish or another language, use the exclusive Hippocratic Adventures discount and sign up for Babbel!
Dr. Paula Jossan is an American physician double-boarded in Pediatrics and Pediatric Endocrinology. She lives in Sweden with her family and recently received her Swedish medical license. She looks forward to continuing to improve her Swedish and experience everything her new country offers.