Working as a doctor in rural Northern Norway: Gry Bernzten

Working as a doctor in rural Northern Norway

By pure chance and circumstance I ended up working as a doctor in a small fishing village in Northern Norway. I am Norwegian, and after medical school I worked at the local university hospital for five years. But the environment in my departement was cut-throat, and demanded time sacrifices that I was not willing to give. A friend of mine offered me a job as a GP, and I though sod it- why not try? This was 24 years ago.

My practice is the only practice in the county, covering several inhabited island 24/7 365 days a year. There are three GPs and an intern that changes every 6 months as a part of certification of medical training. we also have two locus that come and do most of our weekend on calls . We travel around the islands by boat and ferry. Three days a week we have an outpatient office at the largest neighbouring island. Norway has universal health care coverage, meaning patients pay a small fee to see the doctor and the total per year is capped at around 280 US $. Children up to 16 and pregnant women are treated for free.

 In Norway you cannot go straight to the ER , you have to see an on call GP first and 95% of cases are handled outside of hospitals. We also do a lot of practical procedures, like suturing, IUD insertions, nail removals, skin biopsies and similar procedures that can be done with local anaesthetic. We do check ups on diabetes, heard disease, cancer controls and a lot of simple psychiatry. It makes for a very varied day, and personally I like doing lots of different things. Our older patients do not want to travel much, and especially during the winter we do a lot of the standard controls for chronic diseases that otherwise would be taken care of by the hospital. We have a very well- stocked lab, and can do a lot of on site testing getting immediate full blood count, CRP, urine stix, hbaic and glucose. It gives us a better standing in deciding if we can treat the patients at home or if they have to go to the local hospital.

The main difference in between working as a GP and working in the hospital is the large degree of personal autonomy we have. We are partially salaried to cover things like nursing homes, public health and children’s controls, but for four days a week we are privately employed meaning we get to organise our own days. As long as there is cover we can take time off when we want, do courses and research. Naturally , if you don’t work you don’t get paid but the base line salary is good enough to allow for a lot of flexibility. In the summer the office shuts at 3pm, in the winter at 4pm so work life balance is good. We do quite a bit of on call, but as the population is small it is usually quiet and we can sleep most nights.

My county is not too far from the nearest university hospital, a couple of hours by ambulance and boat and helicopter if the weather permits. However, many other counties are further away and especially during the winter roads can be closed for extended periods of time if there is lots of snow and wind. For doctors working here, it is necessary to be able not only to stabilise patients for quick air lifts but to be able to treat life threatening conditions for many hours. Also, they have the same problems with older patients with complicated, multiple chronic diseases not being able to travel to the hospital for check ups. We have just had a workshop that is supposed to be the first in a series of workshops especially tailored to rural and island medicine. We need more knowledge than what is provided in regular medical education, and in the courses offered to GPs. This is a work in progress, we look to Canada where they already have a good program in rural medicine and hope to be able to get something similar in Norway.

 In the office we do full blood count, ESR, CRP, troponin test, d- dimer, hcg, hbai1c, blood glucose, urine stix, spirometry and ECG.

I have stayed in this community a long time. The children who were born when I started are now adults, and when they come to see me I remember being there in the boat and the ambulance accompanying their mother to the hospital hoping to make it in time. I know what kind of people their parents are, and how much resources the family has. Some children are dandelions that prosper despite a less than ideal upbringing while others are delicate flowers that will never live a regular life despite having all the backing anyone could dream of. I know which families hide dark secrets behind well-manicured lawns , and which will come together and pull through adversity. This is a privilege , and makes me a better doctor for the people I am here to serve. But it also makes my job more interesting, and more fulfilling. I am seeing not only the snapshots of peoples lives but the film of continuity in society.