Revolutionising Veterinary Practice: Does Sweden have the Answers?

When I arrived in Sweden to begin work as a locum veterinarian, I was mentally prepared to face some new challenges. I knew that the language and the cultural expectations of clients would differ from those at my usual UK-based clinics. I expected to see some differences in case load, and I wasn’t at all surprised by the immaculately clean and well-designed hospital facilities.

But what I wasn’t prepared for was the many small, but significant differences in how a Swedish vet practice operated. Some differences were cultural, some were legal, but on the whole, the Swedish approach reflected a society that was more conscious of doing its best for its people, the animals, and humanity itself.

These small variations added up to an approach that was nothing short of revolutionary. If UK-based practices were to implement more of these strategies, it would go a long way towards tackling some of the greatest challenges facing western veterinary medicine, including poor mental health, low practice profitability and dwindling permanent staff retention.

So after 5 weeks of full-time work, here are the ten take-home lessons I picked up during my time locuming as a vet in Sweden that I’d like to bring home to the UK.

1. Work Less, Enjoy Life More

In Sweden, standards of living are high. Houses are relatively inexpensive, health and social care is great, and the countryside is beautiful. So, why work all the time?

Many of the veterinary staff that I met chose not to work full-time- even those that were young, fit and didn’t have children. The clinic where I worked had no after-hours cover, and it wasn’t because they relied on the local emergency centre (there wasn’t one). People just didn’t want to work those shifts, so the clinic stopped offering them. The clinic opened and closed at the same time each day (a strict 4:30pm finish), and there was no pressure from clients to keep the doors open late.

My colleagues really valued their evenings and weekends with their families, and no one was shamed for that. In addition, Swedes receive generous maternity and paternity leave (16 months paid per child), sick leave and family leave, and were expected to take it.

Imagine being a vet and having a life that didn’t revolve around work! For the first time, Sweden showed me it really was possible!

2. We must Utilise our Vet Nurses Better

While practicing in the UK and Australia, I’ve worked with dozens of incredible Vet Nurses and Vet Techs. Without them, I wouldn’t have survived my first year in practice, let alone become a confident vet. But unfortunately, vet nurses are not always treated as the indispensable, skilled professionals that they truly are.

My time in Sweden really highlighted how the industry could be utilizing vet nurses to the full extent of their abilities. Nurses in Sweden were trained to do many more routine procedures than in the UK. This gave them space to grow and be more professionally challenged as their careers progressed, and in addition, it gave the vets more time to focus on the non-routine cases.

Just some of the tasks that I was impressed to see vet nurses performing unassisted included:

• Cat and rabbit castrations
• Routine Euthenasias
• Planning and induction of anaesthetics
• Solo blood draws and catheter placements (usually observed by the client)
• Obtaining full sets of radiographs
• Full dental scale and polishes, including basic extractions
• Plating-up and interpreting in-house culture and sensitivity profiles

These are all tasks that, with the proper training and experience, my vet nurse colleagues in the UK and Australia are capable of undertaking. Some procedures are already legal for RVNs to perform.

Now, not every RVN may necessarily want to perform minor surgeries or euthenasias. But for those that want to take on more clinical responsibility, shouldn’t that be an option? Shouldn’t they have a chance to progress their skills, careers and earnings like veterinary surgeons and human nurses do?

The other interesting thing about working with vet nurses in Sweden was their uniforms. In our clinic uniforms were EXACTLY the same for the veterinary surgeons, vet nurses, receptionists and assistants. Each person’s role was indistinguishable until you read their name badge. When I asked why, I was told the reason was simple- we were all equals in the veterinary team. Each person played a different, but equally vital role and they were treated with the same level of respect. And that is something we definitely can learn from.

3) Take Anti-biotic Resistance Seriously

The World Health Organisation describes anti-biotic resistance as “one of the biggest threats to global health, food security, and development today”. So why don’t most veterinary clinics take it as seriously as they should?

We’re all guilty of it- giving a cat shot of convenia or re-prescribing a short course of amoxy-clav to a feverish dog. But we need to remember that these drugs may not be around forever (or for very long at all). We need to use them sparingly while we’re privileged enough to have them.

In Sweden, everything gets cultured. The owners don’t get a choice, if there’s an infection- even one of obvious origin like a cat bite- that wound gets cultured. Owners might get a short course of penicillin to tide them over until the culture results come back, but otherwise no antibiotics are prescribed until it has been proven that there is an infection present that will respond to them.

Simple wounds and abscesses are also much more likely to be managed surgically. The attitude is that’s its better to anaesthetise an animal to fully explore the wound, flush it thoroughly and place a drain than to chuck it on anti-biotics and see what happens.

Likewise, surgical sterility is taken very seriously- full gowns and gloves for every procedure, face-masks, hair-nets, the lot. And as a consequence, injectable amoxicillins (betamox and synulox for example) aren’t even stocked, because they are never needed.

Any inconvenience that I experienced by culturing so many infections was far out-weighed by the knowledge that I was making a positive contribution to human health. And the most surprising thing is that the owners were on-board with it too! They came in asking for cultures, and refused offers of anti-biotics if they weren’t convinced that their animals needed them. And that’s important too, because this issue will affect us all.

Speaking of which…

4) Start doing more Lab Work In-house

I mean we all learnt how to plate up a bacterial culture in pathology class, right?

Its not exactly complicated- sure it take a few extra minutes and some dedicated equipment (like an incubator), but being able to perform a bacterial culture and sensitivity isn’t a specialised procedure. If more practices did this in house it would:

a) Encourage us to take more responsibility for our antimicrobial use.

b) Give us faster results (no postage delays)

c) Keep the profits in-house by avoiding third-party lab fees and postage

d) Up-skill our veterinary staff

Its a win-win! And again, its something that vet nurses or support staff could be trained to do if they wanted to progress their careers, so there’s no reason to fear that it would be putting more pressure on the vets.

5) Maintain Proper Isolation Facilities

Not many clinics in the UK have a dedicated isolation consult room, treatment room and ward area. But they do in Sweden!

This means animals with nasty coughs and bloody diarrhoea can be managed completely separately to the rest of the clinic, which once again, reduces the risk of infection and the need for treatment with anti-biotics. Clients even enter from a separate door, directly from the car park, and receptionists are trained to recognise which cases need to go to the isolation consult room from the moment they make the booking.

We all know its easier to prevent problems before they arise, so proper isolation facilities should be a priority in all vet clinics.

6) Encourage Pet Insurance

Sweden has hands-down the highest rate of pet insurance that I’ve experienced of any country I’ve worked in so far. Even the feral rescue cats from the local shelter were insured! I only met a couple of clients that were not insured, or expressed any concerns about cost.

The biggest upshot of this is that if a patient was unwell, we could actually investigate straight away. If a cat was a little off-colour, there was no hesitation to run bloods. If a Labrador came in with a limp, we would sedate it then and there, and take x-rays, and have a diagnosis the same day. Every dental case had x-rays taken. Cost was simply not a factor.

This had a lot of advantages- it meant that the animals received the gold-standard care every time- there was no expectation to wait and see if things got better with an injection or two! It also meant the vets had the opportunity to diagnose a wider range of illnesses, and had a better chance to increase their own skills by performing those procedures that would be too expensive in a general practice in the UK.

The other amazing thing about the insurance in Sweden is that claims for treatment were submitted and paid on the spot! The reception staff would be able to tell an owner while they were still in the clinic how much their insurance would cover, and how much would need to be paid before they left. This meant that all bills were settled in full on the day of treatment before the client left the building! So there was no friction with the owner waiting to be reimbursed weeks later, and no bad debtors.

And this in turn, allows you to:

7. Make the experience about the client

As veterinarians, its easy to make the mistake of focusing our attention entirely on the patient. In many practices, we admit the pet, get some paperwork signed, and then try to direct the client out the front door as quickly (and politely) as we can manage.

But the dynamic was different in Sweden. The diagnostics were very much a collaborative effort, often times with the owner beside you every step of the way. For example, more procedures were done in front of the owner than what I was used to- bloods taken, catheters placed, sedation given- the owners were even invited into the x-ray room to don lead gowns while radiographs were taken of their sedated dog. With owners present for simple procedures, communication was easier than ever, and clients could see the lengths we went to caring for their pet. But the downside was the extra-pressure it put on younger staff to get a blood sample the first time, or to interpret x-rays on the spot with an audience.

There were also some little touches to help clients feel comfortable in practice- including separate and spacious cat and dog waiting areas with free tea, coffee and biscuits.

At the end of the day, the clients are the ones who decide what veterinary care is worth. If we can make the experience more positive, comfortable, and collaborative for clients, perhaps we would have fewer issues with compliance and poor debtors after all.

8. Don’t rely on Drugs for Income

Swedish vet clinics do not rely on income from selling or prescribing medications. In fact, apart from anaesthetics and emergency drugs, Swedish vet clinics barely stock any medications!

So where do owners get medications for their pets?

All medications are prescribed on-line through the vet-clinic’s patient management soft-ware. The software sends an e-prescription to an online national database in the owner’s name. The client just needs to visit a pharmacy of their choice to pick up the drugs.

This is all done at no extra cost to the client, and no profit to the clinic.

Instead, the clinic makes its profit through other means, such as higher relative costs of treatment, which isn’t an issue for most clients because they are (almost always) insured! And not having to dispense medications constantly takes one extra load off the clinic staff.

9. Train your Staff and your Clients

The Swedes take their CPD seriously- no compulsory lunchtime lectures over soggy sandwiches here. When an important talk or meeting was going on, it was no big deal to close the clinic for an hour or two, giving every member of the team the freedom to attend.

The clinic also made the most of their staff’s knowledge- after a vet had attended a conference, they would present what they’d learnt to the rest of their colleagues so everyone could share the benefit.

The clients were also much more ‘well-trained’ than average. They arrived on-time, every time, with all the appropriate paperwork in-hand. They knew the opening and closing hours, and never showed up unexpectedly. In over a month of working in Sweden, I never had a single no-show appointment or raised voice.

The clients didn’t even complain when the whole clinic closed for 2 weeks of holidays every summer, despite it being the only veterinary clinic in town- allowing all 20 staff members to take a well-earned break.

With the amount of stress vets and vet nurses face in the average clinic on a day-to-day basis, having well-behaved and organised clients was a god-send which allowed me to do my job more effectively than ever before.

10. Fika is Holy

We all know that veterinary medicine is unpredictable- the most mundane work morning can turn into hours of chaos in the time it takes someone to yell “bulldog dystocia”.

But one thing that Swedes really do value is their mental health, and their mid-morning “fika” break was absolutely compulsory. At around 10am each day, I had “fika” scheduled into my work diary- and not for writing notes or making phone calls- for actually sitting down with a cup of coffee and a cinnamon roll and relaxing. The practice even supplied the coffee and occasionally the pastries, as well as a beautiful, sunlight-filled break-room with space for everyone to sit and chat.

Encouraging staff to take this mid-morning break, as well as an entire hour off for lunch, really broke up the day nicely, and gave you a little breathing space between cases. It was just another welcomed example of how the business valued their staff and their mental health.

The Downsides of the Swedish Vet Practice Model

My time working as a locum vet in Sweden has definitely changed the way that I look at veterinary medicine for the better.

However, while I loved working in Sweden, there were definitely a few disadvantages related to the different style of practice.

One of the most apparent downsides of the Swedish model was that the majority of cats and dogs in the country are not neutered! Spey and castration surgeries are much less common and generally performed only if there is a problem. This results in a much higher rate of hormone-linked diseases such as pyometra, mammary cancer, cysts and prostatic disease.

And while I loved that over 90% of my patients were insured, I did feel for the minority of clients who did not have pet insurance. The insurance rates had allowed prices for diagnostics and procedures to rise much faster than in the UK, meaning that if you didn’t have insurance, you could easily be priced out of treatment.

The high uptake of insurance and availability of high-end equipment also meant that, in my humble rural-Australian opinion, there was a tendency to over-treat. Expensive diagnostics were sometimes used before they were called for, rather than trialling a conservative approach first. This is something that comes down to opinion, but sometimes I do think less is more in nervous or vulnerable patients.

Finally, Sweden, like most western nations at the moment, is experiencing a shortage of veterinarians. Swedes are very focused on work-life balance, which meant that there were few staff that wanted to work full-time in my clinic. But this is an industry problem that has a long way to go before being resolved!

Conclusion

So does the Swedish approach to veterinary medicine hold the key to better outcomes for our patients, our staff and the longevity of our profession?

There may never be a simple answer to this question, but with a healthier work-life balance, superior respect of vet nurses, fewer client finance issues and more responsible use of antibiotics, I certainly think they are a few steps ahead of us in the UK and Australia- and that means there is plenty more than we can learn.

If you want to hear more about what its like to work as a vet in Sweden, check out my Interview with Magda about her Swedish experience.

If you’d like to learn more about vets in other parts of the world, check out the Veterinary Work Overseas page or head over to Global Vet Interviews to hear fascinating stories from vets from Sri Lanka, Dubai, Finland, and many more.