Swedish health care delivery system and its effects on surgical education

Sweden, with a small, decentralized population, has a similarly decentralized network of hospitals that comprise the national health care system, which is nonetheless highly regulated by the national government. Medical education and graduate training in surgery are likewise regulated. Reforms implemented in 1992 made a 21-month general rotating internship mandatory for all medical graduates, after which they enter specialty training. The training, which lasts a minimum of 5 years, is done under the tutelage of a Board-certified practitioner in the field. During the trainee and program contract for the amount of time spent in clinical and didactic experiences, the trainee is personally responsible for ensuring that much of his or her individual program is accomplished. Rising health care costs have spurred increased rationalization of resources and are expected to constrict training opportunities for future surgeons.