Response to interpellation 2025/26:46 on the shortage of occupational physicians and responsibility for education
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that the regions are responsible for planning healthcare 1 and that the government has taken initiatives to strengthen occupational health care 1. KD points out that they are working on mapping the distribution of competence and that the responsibility for occupational health care is shared among several cabinet ministers 2. KD argues that investigations are being prepared and that decisions have been made regarding the supply of competence 3. S argues that the state must take responsibility for the financing and organization of the education since the number of doctors is decreasing 4. S claims that the government is not making the necessary decisions despite the situation being a systemic risk 5. S argues that the government is passing the question around between departments 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.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! Johanna Haraldsson has asked me what concrete measures I intend to take to ensure a sustainable supply of competence for occupational health care and whether the government plans to proceed with the proposals and give an authority the responsibility for the training of occupational physicians. Johanna Haraldsson has also asked me when the government intends to make a decision on the responsibility for the training of occupational physicians and what assessment the government makes of what consequences a lack of a decision will have for the future availability of occupational health care in Sweden.
Initially, I would like to emphasize that it is the regions that, according to the Health and Medical Services Act (2017:30), are responsible for planning health and medical care based on the need for care among those covered by the region's responsibility.
A prerequisite for the work of occupational health care is a robust supply of competence when it comes to doctors with specialist training in occupational medicine. Specialist residency (ST) takes place today mainly through additional specialization in occupational medicine, through the occupational health care services that are responsible for meeting the requirements according to current regulations. In the current situation, as Johanna Haraldsson herself mentions, there is no specific principal with a designated responsibility to ensure the possibility of executing all steps up to a certificate of specialist competence in occupational medicine.
The Government has taken several initiatives to strengthen the health-promoting and preventive work that occupational health care performs. Among other things, the Government has tasked Karolinska Institutet with preparing the incorporation of the part of the Agency for Occupational Health Knowledge's (Mynak) task to monitor and promote occupational health care regarding competence supply into the agency from January 1, 2026 (A2025/00104). To facilitate for employers to take their rehabilitation responsibility and utilize the expert resources of occupational health care, 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 responsibilities (S2024/02157 and A2024/01446 respectively). The Government has also tasked a special investigator to produce a proposal for a new work environment strategy for the period 2026–2030 (dir. 2024:56).
In June 2025, the Healthcare Responsibility Committee submitted the report Responsibility for Health and Medical Care (SOU 2025:62). It appears from the report that the committee sees a need for increased national coordination and dimensioning in the education of healthcare personnel, where each principal needs to contribute more clearly to the collective national need for healthcare personnel. The committee proposes, among other things, that the state shall take an increased responsibility for the competence supply of healthcare and that the government shall review the specific forms for this. The report has been referred for consultation. The consultation period expired on 31 October 2025.
In conclusion, I would like to thank Johanna Haraldsson for the questions. I look forward to the debate.
Johanna Haraldsson (S)
Madam Speaker! The supply of competence regarding occupational physicians has for a long time been a well-known and growing challenge. Both in government investigations and regarding the government's own work environment strategy, the need for more occupational physicians and that the state takes responsibility for ensuring the financing and organization of education in occupational medicine has been clearly pointed out.
Since the Swedish Work Life Institute was abolished in 2007, no authority has had a clear responsibility for the training. The number of occupational physicians is steadily decreasing, and a majority of those who still work as occupational physicians are over 65 years old. This means that Sweden soon risks being left without sufficient medical competence in occupational health care.
In 2021, the Swedish Work Environment Authority was tasked with coordinating efforts for skills supply within occupational health care. In its final report in 2024, the Authority concluded that Försäkringskassan should be suitable as the primary body for the ST training in occupational medicine.
Mynak will be shut down from the turn of the year, and the tasks have been moved to Arbetsmiljöverket and Karolinska Institutet. Karolinska has, however, stated that the responsibility for the ST training is not included in their mandate. They have also not received budget funds for it. No agency has, therefore, received the responsibility for the financing and organization of the training after this reorganization.
Sveriges Företagshälsor has long been engaged in the issue, and when they have asked questions to government representatives, they have been bounced around between different departments. The Ministry of Employment has referred to the Ministry of Social Affairs, which in turn has referred further to the Ministry of Education. When the Swedish Association of Occupational Physicians turned to the Ministry of Education with a letter in the matter, they were informed that this is primarily an employer issue and therefore should be handled by the Ministry of Employment.
Not even the government seems to know who is responsible for making these decisions. When I, against that background, asked the Prime Minister who has the responsibility to make decisions on the issue, he let the Minister for Health and Social Affairs answer. I then drew the conclusion that it is she and the Ministry of Health and Social Affairs who are responsible for ensuring the financing and organization of education for occupational health physicians.
That is why I submitted this interpellation to the Minister for Health and Social Affairs to get answers to the questions I have now posed. However, in the Minister's first contribution, I do not receive answers to my questions, and now I am no longer quite sure if I have posed the questions to the right minister.
What I asked was what concrete measures are intended to be taken to ensure a sustainable supply of skills. Are there plans to proceed with the proposals to appoint an authority responsible for the financing and organization of the education? When do you intend to make that decision? I also asked what assessment is made regarding what consequences it will have if these decisions are not made.
Instead of answering my questions, the minister talks about the regions' responsibility for health and medical care, but the point is that the regions do not organize or are the principal for specifically occupational health care. It is the only additional specialty that is not publicly funded or coordinated.
The Minister also refers to the Vårdansvarskommittén, but that is actually directly misleading. That investigation does not even concern education in occupational medicine or occupational health care. I therefore hope that the Minister will answer my questions in the upcoming contribution.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! Just as the interpellator points out, this is an area of shared responsibility, and it is not entirely clear where the boundaries of the distribution of responsibility lie. It is also not entirely clear what is the best solution moving forward. That is why this issue is being investigated in stages.
Just as was mentioned, the Swedish Work Environment Authority (Myndigheten för arbetsmiljökunskap) has looked into the issue and proposes that Försäkringskassan is the agency best suited to serve as the principal for the educational issues concerning occupational health physicians. The Office for Sustainable Working Life (Kansliet för hållbart arbetsliv) has in its final report "A more sustainable and longer working life" identified Arbetsmiljöverket as the agency that is most readily available to be given the assignment to coordinate the state commitment regarding occupational health care.
Occupational physician is not a protected professional title, so there is no formal state regulation or any requirement for specific education. Many are general specialists at the core, and then they take additional supplementary training. The path to becoming an occupational physician is therefore somewhat winding and varies.
We have today a great shortage in very many areas when it comes to specialist doctors, and it is difficult with the availability of training positions for specialist residency. This is something that we are now trying to take a collective grip on, and therefore it is difficult for the government to specifically prioritize one direction. It is therefore why I refer to both the Vårdansvarskommittén and the Nationella vårdkompetensrådets recommendations on 25 measures to secure the competence supply.
This is something that we are trying to take a more unified grip on. The National Board of Health and Welfare is also producing key figures on what the shortage looks like and what the regions' assessments look like regarding future needs in order to dimension the training and the training places.
Johanna Haraldsson (S)
Madam Speaker! For the government, it is not obvious which is the best solution, and I understand that, because this is a particular specialty that does not have a clear mandate – the only specialty that neither the state nor the regions take responsibility for.
That is why the question needs to be solved, and that is also why I am asking these questions in the chamber today.
When I debated the same issue with the then deputy Minister for Employment approximately exactly one year ago, she argued that the work to solve this problem was in full swing. Now we stand here one year later, and the work that according to her was then in full swing has yielded no result. We stand at exactly the same point: the Government refrains from making necessary decisions, and the number of occupational health physicians is decreasing.
Mynak established that today's situation is unsustainable. There is no head of agency, no funding, and no national planning. At the same time, we have a growing skills shortage. Just as the minister mentioned, it was suggested that Försäkringskassan should take the head of agency role – a concrete proposal that the government has not taken a position on, as I understand it.
The Office for Sustainable Working Life warned in 2023 that the shortage of occupational physicians is a systemic risk, that the work environment work and the sick leave process are being weakened, and that the state must therefore take greater responsibility.
Sveriges Företagshälsor, which represents the majority of all occupational health services in Sweden, demand a state coordination and a long-term financing model. They have proposed that Karolinska Institutet be tasked with responsibility for the ST-training in occupational medicine.
The parties – LO, TCO, Saco, Svenskt Näringsliv, SKR – are in complete agreement: The State must take responsibility for and appoint a principal for the education in occupational medicine.
All authorities, occupational health services, investigators, union people and employers say the same thing, namely that we have an acute shortage of occupational health physicians and that we need a clear ownership of the education as well as secure funding.
I also asked the minister what assessment the government makes of the consequences of not moving forward and ensuring the supply of competence. What consequences will it have for the availability of occupational health care in Sweden?
To create healthy workplaces, expert knowledge is needed that companies and public employers do not always possess themselves. That is where occupational health care plays an important role. In a time where sick leaves are increasing and high workload is one of the biggest work environment challenges, occupational health care can contribute with the knowledge needed for employers to be able to prevent the problems. Therefore, it is so serious that the competence shortage now reduces the availability of just that knowledge which is so central in preventive work environment efforts.
Occupational physicians are also required for employers to be able to fulfill basic legal requirements in work with asbestos, lead, certain chemicals, night work, and other high-risk environments. All of these require medical examinations and certificates of fitness for work issued by occupational physicians, and even today, employers report that they do not find doctors who can perform these assessments quickly enough.
The government can thus, through its passivity, create a situation where the protection of workers cannot be maintained in practice. If there are no occupational health physicians who can perform the medical examinations in a timely manner, it will indeed be impossible to continue to uphold the requirements.
The question therefore becomes: Which protective rules does the government want to remove?
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! As I have mentioned, this issue spans several ministers' areas of responsibility. This makes it difficult to discuss the issue as a whole. I am responsible for health and medical care issues, and therefore I am taking the debate today. But at the same time, the responsibility in the government is distributed such that it is Minister Johan Britz who has the task of monitoring and promoting occupational health care. This means that the questions that more specifically concern those aspects of occupational health care may be addressed to Minister Johan Britz.
When it comes to the shortage of specialist doctors in all areas, it is something we are working very intensively to address. Part of that involves mapping out what the availability looks like today, how many doctors there are, and what the distribution of expertise looks like around the country. There has not been a clear picture of this previously.
In order to know which specific measures we need to take to meet the competence needs ahead, we need to start by getting a clear picture of how many doctors there are within different specialist areas across the country. We have given a number of assignments to Socialstyrelsen during the parliamentary term to get a clearer picture, help the regions dimension training places and so on. That work will continue forward, and we are also making additional investments to finance training places.
Johanna Haraldsson (S)
Madam Speaker! Now the Minister for Health and Care continued to do what I previously highlighted as one of the major problems with this issue. The ministers pass it around among themselves, and no one takes clear responsibility. I understand that several can have responsibility, but somewhere one must also ensure to coordinate and, jointly in the government, take the necessary decisions. Sooner or later, the government will need to take responsibility, not only for the decisions that were not made but for the consequences of letting them be.
When companies can no longer get hold of occupational physicians, when statutory medical examinations cannot be performed, when workplace environment risks are not detected in time, then it is the employees who pay the price. It is about people who get longer sick leaves, poorer rehabilitation and, in the worst case, injuries and illnesses that could have been prevented.
The government has had the underlying material on the table for a number of years. Authorities, trade unions, employers, investigators, and occupational health services have pointed out the same thing. A clear ownership of the education in occupational medicine is needed. But the government chooses to pass the question around between departments instead of jointly making the decisions that are required.
I mean that it is high time for the minister to answer the questions. When will the government take responsibility for the acute situation and make the necessary decisions? Which agency will be given the mandate to secure the education in occupational medicine? Occupational health care is not a side issue. It is part of the safety net that allows people to work an entire professional life without being worn out or becoming ill from their work.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! I already mentioned earlier that there are a number of investigations being prepared. They are not being prepared at my department. Questions about them may be addressed to the responsible minister. I have answered the questions for which I am responsible in my role as Minister for Health and Care. They concerned the supply of competence, where we have made a number of decisions and where work is ongoing.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.