Response to interpellation 2025/26:440 on the training for occupational physicians
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the education for occupational physicians and the role of occupational health care. L argues that occupational health care is an important expert resource for preventing ill health and rehabilitating those on sick leave 1. L emphasizes that the government takes competence supply seriously through investments in state governance 2 and that Karolinska Institutet shall promote competence supply 3 4. L also argues that grants for rehabilitation support have been developed and increased 4, as well as that Försäkringskassan and Arbetsmiljöverket shall develop their cooperation 4. S argues that the shortage of occupational physicians is acute and that the government is not taking responsibility for the education issue 5, as the measures L highlights do not affect the ST education 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Arbetsmarknadsminister och vikarierande klimat- och miljöministern Johan Britz (L)
Mr. Speaker! Johanna Haraldsson has asked me what concrete measures I intend to take to ensure a long-term sustainable supply of competence for occupational physicians in Sweden, if the government intends to appoint an authority with clear responsibility for the funding and organization of education in occupational medicine, including the ST training for occupational physicians, when the government intends to make decisions on the ownership of the education for occupational physicians, and what assessment the government makes of what consequences a lack of decision will have for the future availability of occupational health care and the possibility of maintaining the level of protection for employees in Sweden.
I would like to begin by thanking the member for the questions.
A prerequisite for the work of occupational health care is a robust supply of competence of doctors with specialist training in occupational medicine. At the current state, as Johanna Haraldsson mentions, there is no specific principal with a designated responsibility to ensure the possibility of carrying out all steps up to specialist competence in occupational medicine. According to the Health and Medical Services Act (2017:30), there shall be an opportunity for employment of doctors' specialist service, including basic service, in the regions in a scope that corresponds to the planned future need for doctors with specialist competence in clinical operations.
The government has taken several initiatives to strengthen the health-promoting and preventive work that occupational health care performs. Among other things, Karolinska Institutet has taken over the task of monitoring and promoting the supply of competence within occupational health care from and including January 1, 2026 (A2025/00104).
To facilitate for employers to take their rehabilitation responsibility and take advantage of the occupational health care's expert resources, the grant for workplace-oriented rehabilitation support has also been developed. Försäkringskassan and Arbetsmiljöverket have additionally been tasked by the government to develop their cooperation and supervision of employers' work environment and rehabilitation responsibility (S2024/02157 and A2024/01446). The government intends to submit a communication to the Riksdag during May with a new work environment strategy.
Johanna Haraldsson (S)
Mr. Speaker! Ever since the Institute for Work Life was abolished by the right-wing government in 2007, no one has had the mandate and the responsibility for the ST-training in occupational medicine. This has led to a steady decrease in the number of company doctors, and the shortage is now acute. A majority of those working as company doctors are over 65 years old, and all supervisors and study directors are over 70 years old. They are the ones required to carry out the training.
The Office for Sustainable Working Life has warned that the shortage of occupational physicians could be a systemic risk. In a report to the government in February 2024, the Agency for Occupational Health Knowledge stated that one of the most important measures to meet the competence supply is to ensure that there is a principal responsible for the training. They also pointed out the need for a unified responsibility for the financing.
When Sveriges Företagshälsor and Svenska Företagsläkarföreningen have turned to the government with questions, proposals, and a desire for dialogue and solutions to the problems, they have been sent between the Ministry of Employment, the Ministry of Health and Social Affairs, and the Ministry of Education. Due to the confusion that seems to prevail within the government regarding who has the real responsibility for the issue, I submitted a written question to the Prime Minister to clarify which department or which minister in the government has the responsibility for the training of occupational physicians. The question was then referred to the Minister for Health and Social Affairs. But during the interpellation debate that I later had with the Minister for Health and Social Affairs, it became clear that she did not consider herself to have the responsibility but referred back to the Minister for Employment.
We thus have a situation where there is a serious problem, but no one in the government seems to want to take responsibility for solving it. The questions I have asked here today are therefore the same as those I asked the Minister for Health and Social Affairs. I am receiving the same non-answer today as I received from the Minister for Health and Social Affairs in the autumn.
In written questions and in interpellations, different ministers have stated the same thing. Exactly the same wording appears in several answers: In the current situation, there is no specific principal with a designated responsibility to ensure the possibility of executing all steps up to specialist competence in occupational medicine.
The government thus has the ability to identify the problem but obviously not the ability to make the necessary decisions. What is the problem? What is it that actually prevents the government from acting? Why has one not proceeded with the proposals that Mynak has put forward regarding appointing a head for the ST-training in occupational medicine and securing the funding? The government has had the proposals on its table for approximately two years.
One also begins to wonder – if it really is the case that the Minister for Employment has the responsibility, why does the Minister not even make an attempt to answer the four very concrete questions that I have posed in my interpellation?
I have repeatedly raised this in the chamber, in written questions and motions. But the answers and initiatives from the government are missing. I truly hope that the minister, in his upcoming remarks here today, provides an announcement. The future of occupational health care is extremely uncertain if nothing is done regarding the issue of competence supply when it comes to occupational physicians.
Arbetsmarknadsminister och vikarierande klimat- och miljöministern Johan Britz (L)
Mr. Speaker! I am very grateful that Johanna Haraldsson is raising the important issue of competence supply in occupational healthcare. Let us begin by establishing that we agree on the importance of having a well-functioning occupational healthcare system. For this, trained occupational physicians are also, of course, required.
Occupational health care is an important support to counteract, among other things, ill health and sickness absence in working life. But the foundation for a long-term good working environment is created at the workplace through a systematic preventive work environment effort in a well-functioning cooperation between employer and employee.
Occupational health care is an important expert resource that can be engaged by the employer as needed to prevent and eliminate health risks in the workplace. It has the competence to identify and describe the connections between the work environment, organization, productivity, and health.
Another task for occupational health care is to prevent sick leave and rehabilitate those on sick leave back to the workplace. Additionally, doctors within occupational health care perform medical examinations, and they issue certificates of fitness for work.
Johanna Haraldsson (S)
Mr. Speaker! Yes, it is an important support, but that support risks being completely eroded given that the number of occupational health physicians who are to carry out the assignment is constantly decreasing.
One must take the measures required in the workplace, but one also has an obligation to hire occupational health care or equivalent expert resources if needed. If these are not available, it becomes an enormous problem; it becomes difficult to succeed in fulfilling the obligations that one actually has as an employer.
I can state that the answer to my questions is still missing. Particularly concerning is that the minister has no answer to my question regarding what assessment the government makes concerning the consequences of not making this decision, which has not been made so far. What consequences does it have for occupational health care and for the working environment as a whole?
It is serious that the minister has not even considered what consequences this has. But we can look at how things look today. Then we can quite quickly state what a missing decision has entailed so far. It has led to fewer occupational health physicians and thus poorer access to occupational health care at our Swedish workplaces.
Occupational physicians are needed to carry out statutory medical examinations and to issue, among other things, certificates of fitness for work. Without that competence, it becomes difficult for employers to comply with the work environment legislation. In the long run, there are actually only two alternatives. Either one is forced to lower the requirements regarding medical examinations and that companies should hire occupational health services, i.e., lower the protection for the employees, or operations risk being stopped because employers cannot fulfill basic safety requirements.
I wonder if the minister thinks it is a desirable development.
Mr. Speaker! The Minister refers in his answer to the new work environment strategy, but in the joint referral response from the labor market parties, there is a clear criticism linked to this issue. Svenskt Näringsliv writes, together with LO and PTK, that occupational health care for many employers is a necessary resource to be able to conduct a functioning work environment effort, just as is stated here today. They are clear that the shortage of occupational physicians is particularly acute. But perhaps the most interesting thing is that the parties also write that the issue is not raised in the work environment strategy that the Minister here refers to. It needs to be described to a greater extent for us to get closer to a solution.
So, both employer organizations and trade union organizations say that the government is not taking the issue seriously enough. One wonders if the minister has read this referral response. Will he ensure that the problems with the competence supply in occupational health care are highlighted better in the strategy? But the most important thing is: When does the minister intend to take responsibility for the issue and make the necessary decisions?
What is being requested is quite clear and quite concrete. The industry, authorities, investigators, and labor market parties are requesting a state coordination and a long-term financing model for the training of occupational physicians.
As said: Everyone seems to know what needs to be done, but no one understands why nothing is happening. Why does the minister not have the ability to issue any announcements?
Arbetsmarknadsminister och vikarierande klimat- och miljöministern Johan Britz (L)
Mr. Speaker! I thank Johanna Haraldsson again for this important discussion.
The Government takes the issue of competence supply within health and medical care very seriously. On 1 June 2023, the Government decided to appoint a parliamentarily composed committee to produce a decision basis that enables a gradual and long-term introduction of a full or partial state ownership for health and medical care. According to the final report, which was presented on 2 June 2025, the committee assesses that the state should take increased responsibility for a number of areas, of which competence supply is one area, in order to create better conditions to meet the care needs. These proposals are currently being prepared in the Government Offices.
Let me nevertheless take up two examples of initiatives from the government to strengthen state governance, with implications for competence supply.
On 1 January 2026, the government announced a continued commitment to skills supply based on the National Council for Health Care Competence's national plan for skills supply in health and medical care. Within this framework, the National Board of Health and Welfare has been tasked with paying out approximately 1 billion kronor to municipalities and regions for the purpose of strengthening the skills supply within health and medical care. The measures implemented shall, among other things, be based on the national plan to improve the skills supply in health and medical care.
Furthermore, municipalities and regions can take part in two government grant regulations when implementing measures concerning competence supply and the work environment in specialized care and primary care, respectively. Through a transition from agreements to regulation-based government grants, a long-term perspective in the state governance is also clarified in areas bearing on the competence supply.
Johanna Haraldsson (S)
Mr. Speaker! All the measures that the Minister here raises do not concern the issue that we are debating today. The healthcare responsibility committee, which he raises, does not at all concern the issue of ST-training in occupational medicine or the competence supply of occupational health care. It becomes directly misleading to raise those measures when they de facto do not concern this area.
The Minister is talking about the regions' responsibility for health and medical care. It really says something about the level of understanding from the Minister's side regarding the problems. The regions are not responsible for occupational health care. They do not organize it. They are not the principals. Occupational health physicians are generally not employed by the regions. This is one of the reasons why we are standing here today. Occupational health physicians are in practice the only medical specialty where there is a lack of a clearly publicly funded and coordinated educational structure.
I return to this: All the measures that the minister here raises do not concern just this specialty.
But the minister perhaps means that the regions should take responsibility for the training of company doctors. In that case, I wonder how that is going to work. Or is this just something the minister says to make his answers here today a bit more substantial?
The Minister pointed out in a previous post that Karolinska Institutet has taken over a task that another agency previously had. It is not so much a reinforcement of measures; it is just a transfer of a responsibility to another agency.
What is being requested are decisions on financing, organization, and clear responsibility for the education. The problem has been identified. The needs are known. The proposals exist. Now the government needs to make decisions.
When does the government intend to take responsibility and act? Does one intend to do it before the situation becomes even worse?
Arbetsmarknadsminister och vikarierande klimat- och miljöministern Johan Britz (L)
Mr. Speaker! Johanna Haraldsson mentioned Karolinska Institutet. Within Karolinska Institutet, there is research, education, and other expertise in the area of occupational health care. That was why the government, in connection with the decommissioning of the Agency for Occupational Health Knowledge, tasked Karolinska Institutet with monitoring and promoting occupational health care when it comes to competence supply.
To facilitate employers in taking their rehabilitation responsibility and utilizing the expert resources of occupational health services, the grant for workplace-oriented rehabilitation support has been developed. The allocated funds have increased by 20 million kronor, from 114 to 134 million kronor. The amount that can be paid out to an employer has doubled from 10,000 kronor to 20,000 kronor per employee per year.
Försäkringskassan and Arbetsmiljöverket have further been tasked by the government to develop their cooperation and supervision of employers' work environment and rehabilitation responsibilities. The assignment has been reported back, and in the reporting, the agencies have, among other things, updated their routines for how tips are submitted and followed up and worked on communication efforts aimed at employers.
The questions that Johanna Haraldsson raises are very important and relevant. The assessment is that the government will need to return during the autumn with further measures.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.