The training of specialists in occupational medicine in Finland, and European perspectives
The occupational health service (OHS) system of Finland is considered, both in Europe and in other parts of the world, to be exemplary in several respects, not least because the system has been developed and is being developed systematically to serve the changing needs of work life. The high standard of occupational health and safety in Finland has been achieved through systematic and continuous cooperation between the social partners and the government, especially with the Ministry of Social Affairs and Health. This can be seen in the amendments to the Act on Occupational Health Services (2001) and the Occupational Safety and Health Act (2002) which have taken into account the requirements of EU directives.
The Act on OHS emphasizes the need for OHS to be preventive, proficient, of a high standard and effective. A multiprofessional occupational health service team must be able to apply the most recent scientific evidence in practice. This requires well trained staff and high-quality, cost-effective operating systems. Internal cooperation and management, together with cooperation with the management of client organizations and employees are key issues in the development of occupational health services in Finland. The service must be professional, flexible and achievable.
The training of occupational health service professionals has been the focus of interest for a long time. The decision was taken to pay special attention to the professional qualifications deemed important for occupational health. The complementary and further education of OHS professionals was ensured by raising the training requirements for occupational health staff, as well as by developing the educational structures and content of the training. A Government Decree (1484/2001) on the principles of good occupational health practice (GOHP), the content of OHS, and the qualifications of professionals and experts, stipulates that a licensed physician working primarily in occupational health services must be a specialist in occupational health.
In 2001, only 38 % of Finland's about 1,000 occupational health service centres employed a physician specialized in occupational medicine (OM). Of the full-time OM specialists 72 % work in the private sector. There is a shortage of about 300 OM specialist physicians. Over the next five years, 30 % or so of the current 600 working-aged OM physicians will retire. In order to satisfy the growing need for OM specialists, we need to have at least 50 new specialist degrees annually. If this target is reached, it will be possible to fulfil the shortage in about 10–15 years.
The government decided in 2004 to give a special training benefit for specialist training in occupational medicine. This has been paid since the beginning of 2005 to universities and the Finnish Institute of Occupational Health (FIOH), and since the beginning of 2006 to private providers of occupational health services. Thus far only municipal employers have received compensation for the training arranged for specializing doctors at occupational health care centres. This benefit for specialist medical training in OM would guarantee the sufficient content, quality and quantity of training for specialist physicians in the sector well into the future on an equal footing with other specialist fields.
Growing interest in occupational health
The field is increasingly attracting newcomers; the registered number of physicians specializing in OM makes the sector the second largest of all medical specialities. At the end of 2005, about 600 students were completing specialist training in OM at five universities.
The universities are responsible for guiding, coordinating and arranging training in conjunction with the Finnish Institute of Occupational Health and medical teaching staff working at OHS training centres.
The training consists of a two-year basic course and four years of specialist training. The specialist training is divided up into a two-year service in OHS supervised by a specialist at an OHS training centre approved by the university, one year at the FIOH, and one year of clinical duty in some other specialist field that supports the training. The physicians participating in specialist training in OM must receive at least two hours of tuition a week, take part in 160 hours of in-service training, and take a total of 120 hours of course-form theoretical training, of which a minimum of 20 hours must be management education. In order to qualify as a specialist in occupational health, the students must pass the national examination for a Specialist Degree in Medicine.
More physicians are taking the degree – the quality of training is being raised
In 2004, a virtual university in occupational medicine was started with support from the Ministry of Education. In 2005 the portal of the virtual university was made accessible. The portal provides information and enables contacts between specializing physicians, lecturing doctors and the departments providing training. More information about this is available at: http://www.tthvyo.fi.
The virtual university in OM is engaged in producing the contents for the training modules. The training is carried out in the form of web-based learning, and video-conferencing connections are made use of. Training and collaborative events will be arranged jointly for the physicians who are specializing, and those who are supervising them, and web-based training follow-up and assessment will be developed.
European perspectives in OM specialist training
The Union of European Medical Specialists (UEMS) has a wide spectrum of objectives. They include the promotion and harmonization of top-level training for medical specialists, focussing on high-quality medical practice and health care in the European Union; the promotion of free movement of medical specialists within the EU; ensuring that the EU authorities and/or organizations dealing with questions directly or indirectly concerning the medical profession in the Member States of the EU include representation of the medical specialist profession; and upholding the professional interests of European medical specialists.
The UEMS has a Section of Occupational Medicine (OM) which was founded in 1997. At present it includes as members specialist representatives from most UEMS member and associate countries, altogether 19 countries. The mission of the OM Section is to promote the development of the speciality of occupational medicine in Europe with the aim to improve the health of workers throughout Europe.
Since 1997 the Section has been increasingly active, and is involved in a variety of projects. The topics that are being tackled are basically related to specialist training, professional practice, and research. Action is taken by publishing articles, conducting and contributing to surveys, lobbying and working in partnership with other influencial groups in Europe, such as EASOM, and developing tools to assess the quality of training and practice. The Section has actively informed about its activities and has engaged in discussion with other European professionals on important issues. It has organized workshops, symposia, and sessions in connection with international conferences, distributed documents at both national and international level, and has established the Section's own website (www.uems.net).
Finland has participated in the activities of the UEMS and has used the European experience effectively when amending the Act on Occupational Health Services and developing specialist training in occupational medicine.
A new, ongoing activity in Europe to develop OM specialist training is ATOME (Assessment Tool for OM in Europe). It is being led by Dr. Ewan Macdonald from Glasgow. Its objective is to develop common assessment methodologies, which EU countries could choose to use as part of the assessment of physicians completing the four-year training programme, before being recognised specialists in occupational medicine.
1) Finnish Institute of Occupational Health
2) Kuopio University, School of Medicine