Swiss Medical Specialty Training System: How to Apply and Life as a Doctor in Switzerland.

It’s no secret that the UK no longer has the greenest pastures for doctors or those considering a career in medicine. Applications to UK medical schools keep falling year on year and more doctors drop out of medicine entirely or leave the UK during or after foundation training.

If you’re one such dispairing junior doctor then you’re not alone:

During my F2 (PGY2) year I decided to quit and apply to continue my training in German-speaking Europe. A couple of months (and a few much needed holidays) later I got a great training job in a Swiss university teaching hospital. Since then I’ve received endless questions from friends and colleages on how to do the same. Whether you’ve made a decision to go abroad or are just curious about what it’s like, I break it down for you here:

 

Swiss Medical System & Training pathway: Cross-recognition in the UK

After medical school, graduates can apply directly to the specialty of choice for training, which lasts on average 6 years, after which one becomes “Facharzt” or a Specialist. For most specialties the training is cross-recognized between UK and Switzerland, (you can check with the individual Royal Colleges in the UK if you want to be 100% certain it also applies to your specialty) and after attaining Facharzt in Switzerland one would be elgible for CCT in the UK and could theoretically then work directly as a consultant:

If your chosen specialty is a surgical or medical one, it is often desireable to have a year’s experience in General Surgery or General Medicine respectively, before applying to the specialty of choice. This is particularly true for competitive and specific specialties. For instance if you aspire to become an ENT / Plastic/ or Neuro surgeon, your training pathway may look so:

Medical School -> Assistenzarzt in General Surgery (1 year) -> Assistenzarzt in ENT / Plastics / Neurosurgery (5 years) -> Facharzt in ENT / Plastics / Neurosurgery

It’s of course possible to skip the year of general surgery and go straight into your surgical specialty. Vis-a-vis skip general medicine and go straight into medical specialty. But for competitive specialties this is difficult and rare, and you’ll have to impress the Chief doctor with your CV.

However:

Most medical graduates straight out of medical school in europe DO NOT have any publications. By this I include even international poster presentations and small abstract publications. So coming from the UK, where most medical students already have a handful of publications/posters/etc by the time they graduate – it looks pretty impressive in comparison.

Duration of Specialty Training in Swizterland:

Specialty training lasts between 5-6 years for a single specialisation, of which 2 years have to be spent a category A hospital:

Hospitals are categorised into A, B, or C depending on size/caseload and academia. You can do most or all of your training at a single large teaching hospital (category A), but the maximum time that can be spent at a category B and C hospitals is 3 and 1 years respectively. This is to ensure that all trainees spend at least a portion of their training in a large teaching hospital as well as a smaller hospital. You can find a list of which hospital is which category in the SIWF-register I link to below. It also has information on how each department within a hospital is categorised.

Having said this, Switzerland is so small that you will have at least one category A, B, and C hospital within 30 min of each other, so you can very easily and realistically NEVER MOVE HOUSE THROUGHOUT YOUR ENTIRE TRAINING even if you switch hospitals. I think that’s a pretty big deal that needs to be emphasised.

Flexibility of Speciality Training in Switzerland:

Dual-Specialisation

In Swizterland it’s not uncommon to be dual-qualified in two related specialities and receive two “Facharzt” or specialist titles.  Usually the duration for dual-specialisation is full training time + 3 years. For instance if one does 5 years of internal medicine and qualifies as Facharzt in Internal Medicine, a further title of Facharzt in Gastroenterology can be obtained by only 3 more years in Gastroenterology specialty training.

For certain specialties with more niche-procedures, the list of surgical competencies can be difficult to complete (most commonly due to rarity), sometimes requiring prolongation of training time until you complete all the required competencies. I’ve heard that for very very rare procedures that you have to complete in Neurosurgery some surgeons wait a few years (at smaller hospitals) for them to come around.

Time-Flexibility

Training can be interrupted and resumed at any point, unlike in the UK. If you start at a hospital and don’t like the town or the hospital after a few months – you can quit, and there’s nothing wrong with that. (But it’s advised to apply for another position first if you don’t want a break in between, obviously.)

If you want a sabbatical or even just a few months of unpaid leave, this is certainly possible too, you just need to ask your own department chief for their approval. For instance a colleague in my ENT department now is taking 4 months unpaid leave in the summer for a very long honeymoon. Chief said okay no probs.

The reason this is possible is because in Swizterland training doesn’t happen in fixed year blocks. The year doesn’t start and end at the same time for all trainees in the country like in the UK. You can start and stop anytime anywhere, and all the time worked just accumulates in your own personal portfolio (which is free by the way) until you’ve done the required time and competencies.

You have complete control over your own training in Swizterland, Austria, and Germany. This is in my opinion the most attractive feature of specialty training in German-speaking Europe. Nobody asks questions about taking up to 6 months off between posts – that’s considered a perfectly reasonable break time. Interruption in training of more than 6 months you’d probably need to explain in interview, but that’s about it.

Entry after Foundation training (F1 & F2) or Core Training in the UK:

You can likely enter straight into the specialty of your choice as “Assistenzarzt” straight out of foundation training in the UK. You’ll have likely done enough of other specialties in your F1 and F2 rotations, and certainly after core training to satisfy departmental Chiefs that you have enough general experience.

Once you’ve entered the system here it’s advisable to complete all of your specialty training in Europe (non-UK) as the pathways within non-UK Europe are similar and largely interchangeable.

UPDATE: I’ve received a lot of emails and questions regarding entering into Swiss specialty training straight out of medical school like Swiss graduates. Just to clarify, this is not possible if you’re a UK medical school graduate: FY1 is considered an extension of the UK medical school system as it’s a form of internship, equivalent to internships incorporated into medical school in Switzerland and other countries. You must complete FY1 to be at an equivalent standing to Swiss medical school graduates. Without FY1 you’re not eligible for full registration with the GMC or MEBEKO, or any other european regulator.

Entry at SpR / registrar levels:

The FMH publishes details on each specialty and on how to get training from abroad recognized. You’ll be credited to your level and complete specialty training in the appropriately reduced time.

How each specialty is credited is different, but likely involves matching the competencies you’ve completed in the UK to the competencies required for completeion of specialty training in Switzerland and then taking the equivalent time and competencies off what is remaining.

Medical Hierarchy and Equivalent nomenclature:

Assistenzarzt/in = aka. Resident, a doctor in Training for specialty
Facharzt = Specialist
Oberarzt = Consultant like in the UK
Chefarzt = Departmental Chief doctor. He or she is 100% in charge of everything in the department. They do the hiring and firing, they set the policies, etc. Their word is final in everything.

Working as a doctor in Switzerland: The every day life of an Assistenzarzt

Hours worked per week in Switzerland can be roughly the same as in the UK, and similarly will vary by specialty and hospital. The website SIWF-Register surveys all the trainees in each hospital annually and produces excellent charts rating each Hospital department on various criteria ranging from learning experience and research opportunities to hospital Culture. It’s an excellent tool to help decide which hospitals to apply to.

Salary:

There is slight variation between individual Hospitals and different parts of the country, but each hospital has fixed salary bands for all doctors of the same level, and these are often published on their website.

Example monthly salary of doctor in 1st year of specialty training:

Basic Salary                      CHF 6,981.00
Per sat/sun on-call           CHF 47.501
Per Nightshift (midweek)  CHF 47.50
Total                                   CHF 7,076.10

According to the swiss medical regulator, the average salary of trainees (across all years of training) is CHF 8.416 per month, or CHF 100,000 annually. Towards the end of your specialty training you can expect to earn approx. CHF 10,000 per month.

On-calls and overtime are paid separately on top, and each hospital will have a different policy on how overtime is compensated. Apparently there can be quite a variation:

Some pay all overtime fairly as recorded and some don’t pay but give time in lieu. There are stories of some departments erasing overtime records to avoid giving extra payments. Presumably, however, these hospitals will be rated poorly in their SIWF surveys. At my current hospital we are given a chart every month with our scheduled working hours where we can indicate day by day any extra hours we worked or lunch breaks we missed. These are then compensated.

 

Application Process

Unlike in the UK where all applications are standardised and condensed into a single number by which you are ranked against your peers nationally, in the rest of Europe applications are much more old-fashioned:

Each doctor is responsible for their own application “portfolio” entirely and makes direct applications to heads of departments in their target specialty and hospital.

Your application should include:

• Cover/Motivation letter – this is the most important part of your application. Ideally written as a one-page formal letter explaining your motivations to work at that hospital/in that specialty and why they should hire you.
• CV/Resume (more on Medical CVs for Europe here)
• Copy of your medical degree/other degrees (English original is fine)

Send that to the “Chefarzt” or departmental lead of your desired workplace, and with any luck that will land you an interview.

My interview was short and conversational:

They know your background and academic achievements from your application. The interview will largely be to gague you as a person, and whether they want you on the team. Remember, in Europe doctors can stay at one hospital/team for several years.

Once you’ve secured a job, or simultaneously as you apply, you’ll want to get on the Swiss Medical Register, known as “Nostrifikation”:

The swiss medical regulator is known as the MEBEKO, and is where you apply to enter the register. The swiss medical association is called the FMH.

UPDATE: Since 01.01.2018 it’s compulsory for all doctors working in Switzerland to have full MEBEKO registration. Previously there may have been some flexibility for EU-trained doctors with equivalent registrations, but no longer.

General Requirements for medical registration:

• Medical Diploma attained within the EU/ECC
• Citizenship of an EU/ECC nation
• Proof of German ability to B2 level through either Matura (high shool diploma) from a german-speaking institution or work-experience in a german-speaking country. Those who attained their Medical Diploma in a Germany, Austria, France, Belgium, or Italy are exempt.

That’s it! Good luck!

Feel free to post questions below for anything I haven’t covered and I’ll do my best to answer them.