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Why does Denmark take so long to authorise foreign medical professionals?

Denmark on Monday announced funding to speed up processing times for authorising the qualifications of foreign health professionals. But how long do authorisations actually take, and why is the process so slow?

Aalborg University Hospital. Denmark has announced spending to speed up the glacial speed of authorisation for foreign health professionals who apply to work in Denmark.
Aalborg University Hospital. Denmark has announced spending to speed up the glacial speed of authorisation for foreign health professionals who apply to work in Denmark. Photo: Henning Bagger/Ritzau Scanpix

With Covid-19 case counts and hospitalisations on the climb, Danish healthcare workers have issued a call for reinforcements from foreign doctors and nurses.

But there are hundreds to thousands of qualified healthcare professionals already in Denmark, unable to practise due to long waiting times for the Danish Patient Safety Authority (Styrelsen for Patientsikkerhed, STPS) to certify their qualifications.

On Sunday, political parties agreed on a “winter package” for next year’s budget that includes 11.3 million kroner in 2022 and 11.8 million in 2023 to bring the processing times down.

This is a dramatic step up from the figure of 1.5 million kroner proposed by health minister Magnus Heunicke on November 23rd.

“We think it is reasonable that there are language requirements, and it must be determined whether they are skilled enough to be doctors in Denmark, but it makes no sense that people should wait for one to two years to get their case decided,” Andreas Steenberg, finance spokesperson for the Social Liberals (Radikale Venstre), one of the parties behind the budget, told news agency Ritzau in early December.


Applicants from outside the EU and EEA

Currently, it takes an average of 33 months for STPS to review the qualifications of doctors or dentists from outside the EU, the agency told The Local in written responses and over the phone. Even after those 33 months, they can’t practise—the rubber stamp from STPS is the first step in a long process that involves specialised Danish language courses, medical tests, and courses in Danish health law.  

STPS is currently processing applications submitted in February 2019—since then, the agency has received an estimated 1,184 applications from doctors outside the EU and EEA.

For nurses, currently in high demand in Denmark, the waiting time is 19 months, meaning STPS is now processing applications from April 2020. 

STPS confirmed to The Local that the agency has received approximately 1,780 applications from nurses from outside the EU or EEA since April 2020, but said it can’t determine how many have been processed.

Applicants from inside the EU or EEA

The Patient Safety Authority told The Local via written responses and on telephone calls that it “cannot” share average processing times or the number of applications from EU citizens in the backlog because it did not have a record of how many there are.

A communications officer from the agency did, however, say they expect to find 60-70 EU/EEA nurses whose applications have not yet been reviewed, but did not speak to the total number of open cases. The agency did not provide an estimate of the number of EU/EEA doctor applications that have yet to be processed.

STPS also told The Local that it prioritises applications from EU and EEA applicants who can provide proof of a job offer in Denmark. According to applicants, job offers to practice medicine in Denmark are difficult to obtain without a permit to practice medicine in Denmark.

STPS told The Local that, in the month of October, it issued final decisions on the following number of applicants from EU/EEA countries: 19 medical doctors, two dentists, seven nurses and 17 other healthcare professionals. STPS certifies qualifications for a wide variety of professions, including radiographers, physical therapists, and dental hygienists.

From January to October, final decisions were issued to 150 medical doctors, 29 dentists, and 82 nurses.

Why is processing so slow?

What’s the reason for the glacial pace?

In its responses to The Local’s information requests, STPS pointed towards deficient funding and other responsibilities for the five examiners that typically make up the medical qualifications review team—“registration of Danish paramedics, and issuing Certificates of Current Professional Status (CCPS) and Certificates of Good Standing (CGS)”.

The latter two are documents that people with professional qualifications issued in Denmark can submit to gain work authorisation in other EU/EEA countries.

As of December 2nd, three additional examiners have been added to the team in an effort to reduce the backlog, the agency also said.

In a November 11th phone call, a communications officer from the agency also attributed the longer processing times to a relatively high proportion of applications from Asian countries.


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Denmark to test 10 kindergartens and playgrounds for ‘forever chemical’ PFAS

Ten kindergartens and public playgrounds in the South Denmark region are to be tested for the pollutant chemical PFAS.

Denmark to test 10 kindergartens and playgrounds for ‘forever chemical’ PFAS

Five kindergartens and public playgrounds on Funen and five kindergartens and public playgrounds in Southern Jutland are to be tested for presence of the chemical, the South Denmark regional health authority said in a statement on Thursday.

The locations are to be tested because the authority does not know with certainty that they are not contaminated with PFAS, the health authority said.

“I want to stress that the Region does not expect in advance that PFAS chemicals will be found in the ground in amounts that can constitute a risk to children,” Poul Erik Jensen, head of the Region’s environment board, said in the statement.

“But a review of a number of different kindergartens, creches and playgrounds has identified 10 locations in the region where the risk of PFAS pollution cannot be dismissed,” he said.

“That should naturally be looked into so we are on the safe side,” he said.

The kindergartens and playgrounds to be tested are located in the municipalities of Assens, Faaborg-Midtfyn, Middelfart, Svendborg, Sønderborg, Varde, Fredericia and Vejle.

Local authorities have been advised of the decision to test the areas and issued advice related to necessary precautions.

Despite the decision to conduct the tests, the South Denmark Region does not consider any PFAS presence that might be detected to constitute an acute risk to children. This means the areas do not need to be closed off, Jensen said.

The tests will primarily take place during the upcoming Easter holidays to minimise disruption, he also said.

“Our experts’ assessment is that PFAS does not constitute a risk for children’s play with the soil. The playgrounds can therefore be used as they have been up to now until we have received the results of the investigations,” he said.

A common factor for each of the locations is that they are close to a former factory or waste disposal site. For this reason, they have already been tested for pollution, but PFAS testing did not form part of the standard testing at the time.

The results of the tests are expected to be available in May.

What are PFAS? 

PFAS (per- and polyfluoroalkyl substances) are a large group of synthetic chemicals used in various products since the early 1950s. Their past uses include foam in fire extinguishers, food packaging and in textiles, carpets and paints. Also known as ‘forever chemicals’, they persist in water and soil and can cause harm to human health. 

Due to their chemical properties, they take a long time to break down and can be found in very low concentrations in blood samples from populations all over the world.

They are, however, unwanted in the environment because they have been found to have concerning links to health complications. Their use in materials which come into contact with foods, like paper and card, has been banned in Denmark since 2020.

PFAS have been linked to a series of health complications and, if ingested in high enough amounts, are suspected of causing liver damage, kidney damage, elevated cholesterol levels, reduced fertility, hormonal disturbances, weaker immune systems, negatively affecting foetal development and being carcinogenic.

READ ALSO: PFAS pollution: What do people living in Denmark need to know?