Norway is a country with midnight sun, stunning landscapes with fjords, mountains, glaciers, inland forests and lakes, and the happiest people in the world. Understandably, many American doctors would love to move and practice medicine in Norway. Here is a guide to practicing medicine in Norway covering the healthcare system, medical registration, finding a job, and immigration.
Norwegian Healthcare System
Norway has a population of 5.4 million and a gross domestic product of approximately $400 billion (or $75,000 per capita), making it one of the wealthiest countries in the world. It has universal health coverage funded by taxes and payroll contributions and enrollment is automatic. Norway spends about 10% of its GDP on healthcare.
National health care covers outpatient care, hospital care, mental health treatment, rehabilitation, preventive services, select prescription drugs, maternity care, home based and palliative care, and medical equipment, all with a minimal co-pay. About ten percent of the population also has supplementary private insurance typically paid for by the employer, which provides quicker access to private specialists and services.
Each municipality provides primary care to their residents and the general practitioner functions as a gatekeeper to specialty care. Specialty care is provided both in the outpatient and inpatient setting. If a patient is too sick to be treated as an outpatient, the primary care doctor (or legevakt, which means “doctor on call”) refers them to a specialty service at the hospital, such as medicine, surgery, orthopedics, neurology, gynecology, psychiatry, or pediatrics.
Norwegian Medical Education
Norwegian students enter medical school after graduating high school and attend one of 4 public medical schools paying an annual tuition of 1200 NOK (118 US dollars)! Norwegian students, like the rest of Europeans, attend medical school for 6 years. There are, however, not enough medical school spots in Norway for Norwegians, so around 40% study medicine abroad, typically in Poland, Hungary, Slovakia, Denmark and the Czech Republic. After medical school, an 18-month internship (or turnus, which means rotation) is then required. This includes six months in medicine, surgery, and primary care. One then typically completes specialty training in Norway or sometimes in another EU country.
Evolution of Emergency Medicine in Norway
In 2012, when I moved to Norway, the specialty of emergency medicine did not exist. Patients who required inpatient treatment were referred to the hospital’s emergency room (actually akuttmottak which means “acute receiving area”). There, they would be admitted by an intern, on average only 6 months out of medical school, without attending supervision. Approximately 30 percent of patients arrived by ambulance without first being evaluated by a PCP.
Problems arose when patients were referred to the wrong specialty – for example, a patient with back pain referred to orthopedics when the real diagnosis was an abdominal aortic aneurysm. Caring for patients with multiple co-morbidities was difficult, such as a patient with chronic obstructive pulmonary disease and amyotrophic lateral sclerosis with respiratory distress referred to surgery for a bowel obstruction. The surgeons were tied up in the operating room and did not consider the bowel obstruction emergent, and the medicine physicians did not want to treat a patient registered to the surgical service.
In the emergency department, there was no “ownership” as care was provided in silos, with no one looking out for the whole patient. It was also challenging to care for patients presenting with symptoms, such as weakness, rather than with a specific diagnosis, since the most appropriate service was unclear. The nursing staff were often left to fill the void until the proper physician could be located. There were bad outcomes, and politicians and the media began to notice.
In 2013, I was part of a pilot project to staff the emergency room with 24/7 attending level supervision of the interns and residents. This pilot project resulted in decreased wait times, decreased patient complaints, and no unexpected deaths, and was a stepping stone to creating an Emergency Medicine Specialty in Norway.
The Norwegian Directorate of Health is in charge of medical licensure and specialty approval. For an American physician wanting to practice medicine in Norway, the entire process from learning the language, taking the medical exams, gathering and submitting documentation, and obtaining the general medical license can take about six years.
Steps to Medical Registration
- Gather Documentation. You will need ECFMG Verification of your medical school diploma and medical school transcript. You will also need to include a very detailed syllabus from medical school as well as documentation from residency and any other work experience.
- Pass a Norwegian Language test. Medical care is provided in Norwegian, hence you must have at least college entry-level knowledge of Norwegian, both written and verbal. If you are a complete beginner to Norwegian, attaining this level of proficiency can take about three years.
- Pass the Medical Proficiency Test. This two-day test is a practical and oral test assessing your medical knowledge and skills.
- Complete a Course on the Norwegian Health Services. This four-month course provides “knowledge on Norwegian health and care services, health, social security and social rights, cultural understanding, and national focus areas.” This course is conducted at college level Norwegian and the majority of students have been in Norway for at least three years to master the language.
- Complete a course in handling medications safely.
- Apply for a Medical License Online. You can expect an answer within approximately seven months. You will then be informed of any further requirements.
After obtaining a medical license in Norway, one can then apply for turnus. Once you have completed this, you can apply for specialty training (if needed) or apply for a job as a specialist if you have training from elsewhere that is approved.
Finding a Job and Salary
You can find a job by querying the Norwegian national job bank for physicians which lists all available positions.
General practitioners in Norway are mostly self-employed and contract with their local municipality where they provide care. Their annual income is 804,000 NOK (78,824 USD): 35% coming from the municipalities, 35% via fee-for-service, and 30% out of pocket payment from patients. Their patient panel on average consists of 1120 patients. One can make more money by having more patients assigned to them as GPs are primarily paid according to the number of patients on their list.
Hospital-based specialist are salaried, the average salary is approximately 1,032,000 NOK (101,176 USD). They can have a private practice outside of their hospital hours. Private practice specialists can generate income by contracting with a regional health authority, charging fee for service, and out-of-pocket payment from patients.
Taxes are high in Norway, but cover healthcare, education, retirement, and a guaranteed three-week summer vacation, in addition to another week of vacation, holidays, sick time, and time off to care for sick children.
Malpractice insurance is provided by the Norwegian Medical Association for all members. Most physicians typically do not carry additional malpractice insurance. Malpractice cases are virtually unheard of in Norway. If there is a bad outcome, it typically plays out in the media against the hospital or system, rather than against the individual physician. In addition, patients who have bad outcomes, whether preventable or not, are supported or compensated by the Norwegian Patient Injury Compensation, a government fund.
My husband and children had no problem moving to Norway since they are citizens. I needed a visa, however, and Bjørn could not be my sponsor since he had no earned income in Norway. Proving that we had enough money in the bank to live off did not suffice.
I therefore applied for a study permit and enrolled in language classes for immigrants. My classmates, who came from around the world, could not understand why I was working so hard to master the language when I was planning on moving back to the US in one year. I explained that this was my only opportunity and that it may come in handy someday.
The Bottom Line
Transitioning to practicing medicine in Norway involves learning the language, taking exams, and completing clinical rotations. It is possible if you are committed and if you see yourself living in Norway for the long term. Curious what it was like to transition to working in Norway, check out How I took the leap and moved to Norway.
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Dr. Gayle Galletta attended medical school at Georgetown University and Emergency Medicine Residency at Henry Ford in Detroit. Most of her two decades as an attending have been spent at the University of Massachusetts and its affiliate community hospitals. From 2012-2014, Gayle took sabbatical and moved to Norway with her husband and three children – she reflects on this in her piece How I took the leap and moved to Norway . While there she was unexpectedly recruited to help establish Norway’s first emergency department, paving the way for emergency medicine specialty recognition by the Minister of Health in 2017.
In the summer of 2012, I left my job as an emergency medicine physician at an academic center and moved with my family to Norway. My colleagues told me I would be risking my career. As it turned out, this courageous step and a fortuitous opportunity changed my career...
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