Position papers: Clear quality criteria instead of administrative machinery
A new regulation of admissions must ensure high-quality medical care for the population. The quality criteria proposed by the FMH lead us to expect a reduction in admissions in a qualitatively desirable manner. At the same time, they act in the sense of a demand-oriented distribution of medical disciplines.
As the current regulation on the authorisation of doctors working in outpatient practices expires in 2019, various models for a follow-up regulation are currently being discussed. According to the FMH, the position paper introduced into this discussion by the Swiss Academy of Medical Sciences (SAMS) is not helpful because it is limited to the demand for a comprehensive control system with "little evidence".
Many foreign specialists
In 2015, for example, 1744 specialist titles were awarded in Switzerland, of which 741 (41%) were awarded to doctors with a foreign diploma. In addition to these 1744 specialist titles, 1677 foreign specialist titles were recognised. Almost half of the new specialists therefore already brought their further training with them from abroad.
In a country where a total of 70% of the new generation of specialists comes from abroad, there is probably little left for a new control apparatus to do - especially since, according to an analysis by the BASS office, interest in specialist training in primary care disciplines has been constant for decades anyway. This fact is ignored, as is the fact that regional differences in the density of doctors have been documented by the Federal Statistical Office since 1890 to a similar extent - only with less mobility in the past.
The main contents of the steering concept remained open on the basis of the SAMS position paper, since, according to the SAMS, further discussion of this would hardly make sense due to the lack of data. However, a clear recommendation was made as to where the new national steering committee should be located: The "Dialogue on National Health Policy", the permanent platform of the Confederation and the cantons. A proposal that would exacerbate the already pronounced conflicts of interest between the cantons.
It can only be guessed how high the effort for the envisaged control would be, as so far only headcounts have been used instead of full-time equivalents. At the same time, the FMH stresses, it is questionable what successes a new national control body could be expected to have. According to the OECD, Germany, for example, has a higher physician density than Switzerland despite controlling the number of physicians, but still has problems with care in rural regions.
Switzerland-wide quality criteria for doctors
The FMH calls for an authorisation system that guarantees high-quality medical care. The FMH therefore proposes easily applicable and demonstrably effective quality criteria for the admission of physicians, which must be met cumulatively:
- Proof of sufficient language competence: Experience in Germany shows that a good 40% of applicants fail a language test with simulated doctor interviews at B2 level.
- A training period of six years of full-time study or at least 5500 hours of theoretical and practical instruction.
- At least three years of clinical medical activity at a recognised training centre in the specialist discipline applied for admission: In this way, excessive admissions of individual specialist disciplines would be limited by the lack of availability of posts with specialist activity. In addition, knowledge of the health care system, the insurance system and the social system acquired during these years, as well as networking in the targeted speciality, have a quality-assuring effect.
- Up-to-date certificate of continuing education: Continuing education throughout the professional life is essential for a qualitatively impeccable practice of the profession and can be easily verified in all 46 specialties.
