The Swedish Agency for Public Management

Central government commitment for courses in doctors' further training (2016:14)

The responsibility for doctors' basic and further training is shared between central government and county administration boards. The central government has responsibility for the basic education of doctors at universities. County administration boards provide specialist on the job training for at least five years which most doctors undergo after their initial qualification. A smaller proportion of the specialist courses­ are nationally financed and are provided by the National Board of Health and Welfare. These courses are called specialist competence courses (SC courses).

Statskontoret's commission

Statskontoret has been given the task of analysing the governmental responsibility and control of the supply of SC courses and submitting a proposal for how the government commitment to SC courses should be formed in relation to other actors’ undertakings, in order to secure the long-term supply of specialised doctors.

Statskontoret's overall assessment

Statskontoret can state that the system of SC courses is well reputed among the actors involved. There is nothing to suggest that the task could be carried out more efficiently by any other actor in the present situation. Statskontoret therefore takes the view that the National Board of Health and Welfare should continue to have the commission of running SC courses.

SC courses in demand and well-reputed

SC courses are in demand by specialist trainee doctors and they are generally considered to be of high quality. Statskontoret can also state that SC courses are well-reputed among principals and within the profession. The majority of actors that Statskontoret has interviewed have underlined the need for continued central government commitment to specialist training courses for doctors.

Arguments for continued central government commitment

Statskontoret has weighed up principles regarding the allocation of responsibility for doctors' specialist training. Statskontoret considers that there are three main reasons for continued government commitment to SC courses.

Firstly, the system of nationally administrated SC courses is probably a more cost-effective solution than funds for SC courses being allocated to principals. National management of the courses makes it possible to have more participants per course at lower costs.

Secondly, SC courses help to counteract regional differences between small and large county councils. Since SC courses are offered to all doctors on specialist training, regardless of which county council they belong to, they can help to equalise the quality of specialist training over the whole country.

Thirdly, SC courses allow central government to exercise a strategic influence on specialist training, such as filling a possible shortage of specialist doctors in certain areas, or drawing attention to certain health policy issues.

The risks of central government commitment

There are also potential risks involved in central government commitment. The system of SC courses could be considered as possible interference in local autonomy. Since SC courses are voluntary, however, Statskontoret does not consider that there is any risk of interference from central government. Another risk is that SC courses may have a displacement effect, since the incentive for county councils to organise courses decreases when central government provides national courses, which are also free of charge. One further risk is that a shortage of information may hamper planning of SC courses by the National Board of Health and Welfare, and thus reduce the efficiency aspect of a central governmental commitment.

Proposals and recommendations by Statskontoret

Statskontoret considers that a number of prerequisites need to be met for the National Board of Health and Welfare to carry out the administration of SC courses more efficiently and thereby help to secure the long-term supply of specialised doctors.

Statskontoret makes the following proposals and recommendations:

Statskontoret's proposal to the government

  • The government should specify the commission of the National Board of Health and Welfare in respect of SC courses. After checking with the other actors concerned, the National Board of Health and Welfare should have the opportunity of making clearer priorities in the range of SC courses offered. The National Board of Health and Welfare should also be entrusted to continually analyse and submit proposals on the need for special schemes,
  • The government should consider allowing the National Board of Health and Welfare to charge an administrative fee in the event of late drop-outs from the SC courses.
  • The government should consider whether information on medical specialisation for doctors could be entered in the National Board of Health and Welfare's healthcare staff register.
  • The government should consider making a review of specialist training for doctors.

Statskontoret's recommendations to the National Board of Health and Welfare

The National Board of Health and Welfare has high administrative costs for the SC courses as well as long lead times in the procurement process. Statskontoret recommends that the National Board of Health and Welfare reviews and streamlines the administration of the SC courses.

Statskontoret's other considerations

Statskontoret notes that there are a number of initiatives for greater coordination between central government and principals regarding the supply of skills. Statskontoret will therefore not make any further proposals in this case.