On our third date, my now fiance casually dropped into the conversation that someday he wanted to live in Sweden. Seeing as this was still very early in our relationship, I didn’t think too much of it. Sure, he spent some time in Stockholm in college, but we didn’t even know each other’s middle names yet, so planning a life together in Sweden was not something I thought I had to consider.
Flash forward three years. Victor and I are living together in San Francisco with our one year old Corgi puppy named Ruth. Over a delicious dinner of takeout dumplings, Victor casually mentions that he has a job opportunity with an incredible company in – you guessed it – Sweden.
Trading California for Sweden
At first, I was adamantly opposed to the idea. While I had lived abroad before, that had been as a student, a Fulbright fellow, or a medical student. It had all been temporary stays of a year or less. This was a permanent move away from our friends, great careers, and the warmth and sun of California to the arctic cold and darkness of the Nordics.
Also, I had spent the better part of a decade finishing medical school, residency, and endocrinology fellowship, and I had recently established a Bay Area career in digital therapeutics. There was a lot to leave behind. However, as we discussed it more, I realized this was an adventure that we had talked about a great deal.
We both wanted to learn another language, live in Europe, and experience a different style of work/life balance. I just didn’t think it would happen like this and so suddenly, but life rarely goes according to plan. So, in late 2019, we decided to take the leap and move to Stockholm, making the announcement on Instagram, of course.
COVID-19 Changed Our Plans
Speaking of life not going to plan, the COVID-19 pandemic shut the world down just as we were planning our departure. We had given up our apartment and jobs in San Francisco and were living in Airbnbs week-to-week in San Francisco, waiting for the travel restrictions to lift so we could get into Europe.
We had originally planned to be in Sweden in March 2020, but it wasn’t until the end of June 2020 that we were able to touch down in Europe. Arriving during Swedish summer where the sun almost never sets was a warm welcome to our new home. Ruth adapted brilliantly to her new city full of nature, and being able to spend time outdoors during the pandemic was one way of making the best of a less-than-ideal situation.
Moving with Ruth, Our Corgi
The Swedish veterinarians were also incredibly helpful at getting Ruth an EU Pet Passport, which she needed shortly upon arrival to document her in Sweden and allow her to travel freely throughout Europe.
Getting an EU Pet Passport was fairly straightforward as the US Department of Agriculture has a strict set of requirements for exporting your pet from the US to the EU. The main parts of the process are:
- Getting an EU-compliant chip, which is straightforward at any vet’s office.
- Having a USDA certified vet complete an EU Health Certificate within 30 days of arrival in the EU.
- Have the USDA sign off on the completed EU Health Certificate within 10 days of arrival in the EU at a USDA endorsement office.
Given our travel during the pandemic, the coordination of appointments with the USDA certified vet and USDA endorsement office was the most challenging, but everyone was really great in allowing us to reschedule.
Lastly, I will say that not all airlines are created equal when it comes to transporting a pet in the cabin or in the hold. I would recommend US carriers as they are much more accommodating when it comes to pets traveling in the cabin, and it is advisable that your flight from the US goes directly to your final destination in Europe.
Travel within Europe with pets is more strict and less easy to navigate than a transatlantic flight. It’s definitely do-able to connect, but it requires more coordination with the airline. However, I think many people will agree that these logistics are a small price to pay to bring our furry family members with us on our adventures abroad.
Getting a Job
After settling in, I got down to the business of getting a job. This turned out to be a much more challenging process than I had anticipated. Sweden is known for having thriving digital therapeutics and biotech scenes. However, I had not considered the fact that despite having similar companies to those in San Francisco, the size and population of the country made such opportunities much more limited.
With about 1 million people in Stockholm and about 10 million in all of Sweden, the population of the entire country is smaller than the Bay Area. Also, the majority of biotech work in Stockholm was not in research and development (R&D), which was my background and area of interest. Most R&D work is located further south in the Skåne region of Sweden.
Stockholm has primarily industry jobs in the function of medical affairs. In the US, I would be interested in medical affairs roles as they involve aspects of attending conferences, interacting with key opinion leaders, and publication planning. However, in Sweden – or frankly any country – these are localized roles that focus on a specialty of medicine in the country. Therefore, they usually mandate local language fluency and knowledge of the national healthcare system, two things I had yet to learn.
While re-evaluating my job prospects, I had some extra time to apply and coordinate for Victor, Ruth, and I to be on one of our favorite American reality TV shows, House Hunters International. You can laugh at our ‘amazing’ acting skills and download our episode here: Coupling Up in Stockholm. This was a fun distraction, but as someone who thrives on work, I was desperate to find a job.
After about 4 months in Sweden, I was able to secure a position as a medical advisor to a healthtech startup, Holo Health. This was a great segway from my previous work in San Francisco, but it was an equity-only position, which didn’t help with our living expenses or my mountain of student debt in the US.
Given the remote-work possibilities during the pandemic, I leveraged this opportunity to apply for jobs all over Sweden, focusing on the R&D-rich Skåne region. I also focused my search on US-owned biotech and pharmaceutical companies in Sweden, seeing as the cultural fit and my background would translate more easily. This turned out to be the best avenue for success, and I was soon hired as a fully-remote employee of Johnson & Johnson in Helsingborg, Sweden, focusing on clinical research and digital therapeutics development.
This would be my main advice for anyone looking for work in industry outside the US. If you don’t move with a job – which is much more common – definitely focus on US-owned companies, as the hiring process and culture will be an easier fit. Also, the opportunities for remote work in industry have largely continued post-pandemic, so where you live should not limit your search for jobs throughout the country.
From a financial perspective, the pay in Sweden is about one third of what it is in the US. However, we have found that this has been enough to enjoy our lives, travel widely, pay back student loans, and even save up to buy a Stockholm apartment – a process in Sweden that is extremely streamlined and done largely through text/app-based bidding.
Rediscovering Clinical Medicine
As we approach the 3 year mark for living in Sweden, I have found that I am beginning to rediscover my interest in clinical medicine. I had left clinical practice after fellowship, as I felt mentally and emotionally drained from training and the US healthcare system. However, being in a country with a functioning national healthcare system has made me think that I would enjoy practicing medicine when everyone has access to care.
I have recently started volunteering at Läkare i Världen (Doctors of the World) to further explore this and also help with healthcare for refugees. While I cannot yet volunteer as a licensed physician, it is still great to be back in a clinic and learn more about the healthcare system in Sweden.
Practicing Medicine in Sweden
In terms of eventually practicing medicine in Sweden, there are several hurdles that I am in the process of going through. The process is outlined clearly by Socialstyrelsen, or Sweden’s National Board of Health and Welfare: Obtaining a Medical License for Training Outside the EU.
The biggest challenge in this process is learning Swedish, but there are several ways to go about this. All foreign residents in Sweden have access to free Swedish lessons through Svenska för Invandrare (SFI or Swedish for Immigrants). I completed these courses during my first year in Sweden. They provide a good foundation, and they offer night classes so you can do them while working full time.
After SFI, you can continue free lessons offered by the city, or you can take paid classes at Folksuniversitet, which offers both in person and distance learning. Sweden also has dedicated courses for medical professionals, called SFX for Medical Personnel. However, SFX requires a full-time commitment, something I cannot do with student loans and life expenses.
The other thing to consider with learning Swedish is it is very challenging to actually practice it. English proficiency in Sweden, especially the urban areas like Stockholm, is incredible. It is possible to navigate banks, grocery stores, sports, clubs, friends, and pretty much everything in English. Also, when Swedes hear you struggling in Swedish, they kindly and very quickly switch to English, as it’s easier for both parties. Easier to communicate, yes, but very hard to actually practice and learn Swedish.
With this realization over the last year, I have come to the conclusion that I have to force myself to work in Swedish if I have any hopes of becoming fluent. I believe that this will only happen if I focus on passing the required Swedish medical exams (think of the equivalent of USMLE Step 1 and Step 2, but in Swedish) and then practice in a clinic. My goal is to embark fully on this process in 2023 through private tutoring, with the hope of being able to get my licensing and certification by 2024.
It’s by no means an easy process practicing as a US-trained physician in Sweden. While I eventually plan to continue my industry work and practice part time, I feel that working in Swedish will allow me to more fully integrate into the society and country I now call home.
Also, while the finances are not nearly as beneficial in Sweden as they are in the US – either in industry or as a clinician – I did not become a doctor to make a lot of money, and very few of us actually did. I enjoy the challenge of learning the language and practicing in a healthcare system that is very different from the US.
No healthcare system is perfect, but I hope what I can learn in Sweden and what I have learned in the US can help me continue to develop digital therapeutics and innovations that make lives better and healthier for all people. A lofty goal, I know, but I think that moving abroad and starting a new life leads to dreaming again. You feel like a new person when you live in another country, and this process has made me both excited and happy to become the doctor I always wanted to be.
Dr. Bryan McColgan is an endocrinologist with a passion for digital therapeutics research and development. He has lived abroad in Zimbabwe, the United Kingdom, Israel, and Switzerland, but Sweden is the first country outside the US that he has lived in since becoming a physician. In his free time, he enjoys exploring nature with his fiance, Victor, and dog, Ruth (who you can follow on Instagram @corgiruth). He also is an avid science fiction reader and enjoys all things Harry Potter and Disney. More info available at https://www.bryanmccolgan.com.
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