Professional esteem, good pay and integrated digital health records are key factors making Denmark’s doctors smile.
When a doctor says being a GP is the “best job in the world” it’s no small statement.
Professor Jens Søndergaard is a GP and, among other research affiliations, leads the General Practice Research Unit at the University of Southern Denmark. He caused quite a stir at last year’s RACGP national conference with enticing tales of a national healthcare system that significantly elevates and rewards GPs.
The Medical Republic spoke with Professor Søndergaard last week about the Danish model of primary care for our podcast The Tea Room. He was joined by GP and colleague Professor Janus Laust Thomsen, clinical professor and leader of Center for General Practice at Aalborg University.
Professor Søndergaard and Professor Thomsen outlined the key factors that make general practice a sought after profession in Denmark.
1. The pay is great
Professor Søndergaard said it’s “rather attractive” to become a GP in Denmark.
“You get a high salary. It’s far better than being a hospital specialist,” he said.
In Denmark GPs run their own clinics and have a trade union that negotiates funding contracts on their behalf. Most other non-GP specialists have salaried roles in hospitals. Some non-GP specialists also practice privately and negotiate an agreement with the regional authority for funding.
Professor Thomsen agreed that good remuneration was key to a successful primary care model.
“If you want a very efficient healthcare system, you need very good doctors who would see the role as both interesting and financially rewarding,” he said.
GPs are paid through a combination of capitation and fee-for-service, Professor Thomsen said.
“We have around 30% reimbursement on listed patients and 70% reimbursement on activities. This structure for reimbursement is negotiated each four years and that gives room for fast implementation for new additions to our national funding contract,” he said.
Funding for primary care is largely provided by Denmark’s national government. Funding targets national health indicators including fewer hospital admissions, less in-hospital treatment for chronic care patients, increased use of telemedicine and better integration of IT across regional and municipal sectors.
2. Collaboration and respect from peers
Danish GPs are regarded as highly trained specialists. according to Professor Thomsen, strong connections between primary care and secondary (hospital) care are forged during medical training. These connections are leveraged throughout a GP’s career.
“The young doctors who are becoming GPs are actually very highly thought of in the hospital department. So, doctors in secondary care are not so nervous to let the patient go back to primary care after hospitalisation,” Professor Thomsen said.
3. Mature digital health ecosystem
Denmark’s digital health model seamlessly connects all health software and enables fast data sharing. Professor Søndergaard said that primary and secondary care doctors have access to all the patient’s data regarding medicine and treatment strategies.
“We have a common digital communication standard that makes it possible to exchange information between all the different heath systems. If a patient changes doctors, you almost don’t notice that they are a new patient from what you can read in the patient’s electronic health journal,” he said.
Professor Søndergaard says another key part of Denmark’s digital health success is every person in Denmark having a personal registration number which links all health records. The number enables cradle-to-grave management of patients who are listed with a GP as soon as they are born.
4. Strong research and improvement focus
Regions negotiate funding for primary care which includes 10 paid days each year for GPs to upskill, undertake research and contribute to quality development projects.
Professor Søndergaard is currently collaborating on a quality development project that aims to decrease antibiotic consumption in many European Union countries. He’s also working on a project to decrease waiting time for cancer diagnosis.
Professor Thomsen’s current project looks at polypharmacy.
“We send out pharmaceutical experts from the quality development unit to train GPs and nurses. They’ll they sit in on some consultations and help the practitioners react effectively to polypharmacy in their patients,” he said.
5. High educational standards
All students get free education at Danish universities. Professor Søndergaard said that students also receive financial support for up to six years for food, rent and books, and that the entrance score for medical school is very high.
Professor Thomsen said the way Denmark organised its medical educational system was also important as it elevated GPs to being the “gatekeepers” of healthcare.
“Every physician has been through general practice sometime during their education. So, we know how it is to work in different places,” he said.
6. The government listens to GPs
Professor Thomsen said that their research verified the very high quality of care delivered by Danish general practitioners. The research, backed by an effective union, has influenced government policy.
“The government have now decided to move more tasks from the hospitals to the general practice; for instance, diabetes, COPD and other chronic diseases. It makes it a very efficient, cost-effective system. And patients appreciate that they can have the diseases controlled by their GP instead of going to the hospital,” Professor Thomsen said.
