Vet in Sweden: Interview with Magda

Known for its efficient design, environmental consciousness, gender equality and social care, Sweden is a country that has a lot going for it. But have you ever wondered how these factors translate into the veterinary hospital environment?

I met Magda when I began to work as a locum at her clinic in rural Sweden. Originally from Poland, Magda moved to the UK following her veterinary studies, before eventually settling in Sweden with her family. We sat down together to discuss the difference in attitudes, culture and laws which make a Swedish vet clinic a fascinating place to work.

Tell me about your background. When did you first become interested in veterinary medicine, and where has your career has taken you so far?

It was spontaneous decision [to study veterinary medicine] based, in a way, on a process of elimination. I wanted to study something about animals without mathematics and statistics. [The vet course] seemed suitable, so I ended up doing that. I studied for six years, well seven, but during the studies, I actually never wanted to be a practicing vet.

As I started to study, I ended going to England for completely different reasons. I was going for the whole summer every single year to work with people with special needs. It was in a community called Camphill Village Trust- its a series of little communities in towns and villages where volunteers live and work together with people who need some assistance. So we lived, worked, laughed, travelled. We did things together and we all had an equal place in the community. When I finished uni [my husband and I] wanted to move there. And so we did. We lived there for the first 3 years after uni, and I worked there just part time for free at the vet clinic nearby and my kids were born.

And that’s when I actually fell in love with veterinary, because I met this old-fashioned vet, who was just so good with people. It was at that point that I realised, I may have studied to do veterinary medicine, but actually veterinary medicine was about the people who come with those animals. And I thought, actually I can do it!

He was a great mentor. When my son was about 6 months old, we decided to move out of that community and then I started to work part-time paid, and built it up from there.

And I believe you did some further following that?

Yeah. As I got more engaged in what I was doing, I started a certificate in small animal general practice, primary care. So that’s a bit unconventional as a specialism, as its specialising to be a small animal general practitioner. Its not maybe as appreciated as some of the other pathways because some people think that you’re just a GP, when actually, you do things that specialists are not able to do.

What was it that made you decide to move to Sweden?

Well, with the family we moved between North Yorkshire to Northern Ireland, and then back to North-West England. We worked [in the UK] for 13 years. By that stage, we’d been coming on holiday to Sweden for seven years after we met a Swedish family with children the same age as ours. So two years ago we thought “why do we keep coming to Sweden on holidays? Lets just move here”.

So I applied for a job here in English, not knowing any Swedish basically. And we ended up here.

It has been a really rocky road though I think. I did experience burn-out at least twice when I was in England because of how the workload is. The more I understand how it works here in Sweden, I think “how do people continue to cope in England?”

In the job interview here in Sweden, the previous clinical directors asked me, “how many [animals] on average do you see a day?”

And I said, “well on an open clinic day, it would be 60”.

He almost had a heart attack! He said he wouldn’t see that many in a week! So that is a completely different perspective.

So that’s what I moved away from. Going part time [in the UK] didn’t really sort it out because even having that intense, 10 minute consult time-limit- its too much.

So it sounds like one of the things that attracted you to work in Sweden was a better work-life balance?

Well, that’s something that we only discovered once we’d moved. We kind of knew that there was an environment in which people lived and were happier.

It just always felt like holidays, which is because we always used to come here only for holidays. So there was a danger that the feeling would disappear when we actually moved here. But its been exactly the same.

Was it difficult to become registered as a vet in Sweden?

No. To register I needed to produce all my relevant diplomas [and] pay the equivalent of £300 in registration fees. I had to have a letter from my employer to say they’ll look after my Swedish [language skills] as at that stage my Swedish was at a very low level. I mean I’ve been here 14 months and I still don’t speak so much. But I understand more and more. I’d prefer to speak better but people really love to speak English! So the language is getting slowly better. But because there’s such a need for vets here they don’t make it too difficult.

Once you are actually working here, you should really make sure you write your notes in Swedish. But I think the most important thing for Sweden is that there are professionals physically here to look after the animals, even if their Swedish is not the best. When we get clinical notes from other clinics, its a lot of ‘Swinglish’. So the regulatory body understands.

The clinic helps me too, they pay for my Swedish [language] training. Some clinics down south employ so many foreign vets that they get their own teacher coming in to the clinic to teach the vets. But that’s a much bigger hospital.

What are some of the most common types of emergency cases you might see in small animal practice here?

So snake bites in the summer- from April until September. We get three or five a day. Our clinic is a day clinic so we only really have them initially. We do have anti-toxin, but we don’t usually do more than the initial treatment.

Then in September the hunting season starts, and hunters here in Sweden are serious. The most common emergency is due to wild boar attack, and that was a shock for me as I’d never had one before. I [used to] stay around Manchester so that is very different, its more like dog attack wounds around there. I respect [wild boars] so much more with how precise they are when they attack with their tusks. So dogs here must wear a protective vest to hunt, and if they don’t, then the insurance doesn’t cover them. So we don’t have any thorax emergencies thanks to [the vests].

Otherwise, the big difference is the culture around neutering, so we have pyometras come in daily, as well as other problems that correlate with not being neutered, like mammary masses, polyps [and] prolapses. And with the cats, they are on the [contraceptive] pill for life here. Even though you’ve seen we do a lot of cat spays, there are many prescription requests for the pill.

Wow, really? Why do you think they prefer to medicate their cats, rather than neuter them?

Well, people don’t want to modify the body of their cats, they think that’s wrong. But at the same time they stuff them with medication. Its called Provera. You often run out, especially in January and February.

The other disease that is different is nose mites, which is unheard of in the UK. Here, the theory behind it is that the hunters want something to blame for why the quality of their dog’s hunting is not so good- they say nose mites. None of the vets I have worked with here have seen them!

What kind of cultural challenges have you found working in Sweden?

I think that the challenge is around treatment, and it is very Scandinavian, its around antibiotics. I will be challenged by owners on why I want to prescribe antibiotics.

Someone challenged me on that in the clinic today actually!

Yeah. They’ll say you’ve already put a drain in the wound, why would you want to give antibiotics as well? So its something that’s very different after almost routinely giving antibiotics in the UK. I have to think a little bit more- what is the reason that I would have given more antibiotics in the UK? The reason actually doesn’t exist.

The other point is being upset if I recommend neutering. But then you kind of change that into a little joke or try to make it a little less awkward. It was almost offensive to some people to suggest that I wanted to neuter a healthy pet. It’s [an attitude] that’s different. And I do think that its changing now, because there is only one veterinary school in Sweden so lots of young people are having to go to other countries to study, where they do neuter.

But neutering here as a preventative is also difficult because people pay [the full price] for what we actually do. So, many people openly say they will prefer to wait until their bitch has an actual pyometra, and then we can fix it [because they can then claim it on insurance]. But to be honest, even with insurance, when you have to pay your excess then the insurance fees, its probably a similar cost. It is around £800-1000 for a routine dog spay. Pyometra would cost 3 times more.

And speaking of pet insurance, it seems like its a lot more common here.

Yes, 95% of owners in the clinic where I work have insurance. And that is really crazy because your clinical reasoning is so used to looking at what option is the cheapest, and suddenly that’s not such an issue any more. Owners want the best and while price of course matters, yet it is pushed to the second row.

Yes, I’ve struggled with that in Sweden as well. I’ll tell the owner what is the cheapest option, and they’ll say to me, yes but what is the BEST option! I’m not used to that.

And that’s something that’s really crazy! I think the way that the insurance operates too is very different. The reception staff will send the details of the consult to the insurance company immediately, the client will just sit in the waiting room while [the record] is sent.

Then she can tell the owner how much they have to pay, and they pay on the spot. And that also makes a big difference, especially with bad debtors.

Thats amazing! In the UK it often takes months for a claim to come through!

Yeah, I think normally [in a UK practice] they say about a month of your clinic’s income is what you have in debt. Whereas here, bad debt just doesn’t seem to exist. So that makes a huge difference for the practice.

Do you think that Sweden has quite a good standard of welfare compared to the UK?

Yes and no. I think it depends on what you say welfare is in the UK.

I think I haven’t experienced such a double standard in society when it comes to animal welfare [as in the UK]. You sometimes see people with multiple obese pets, and how is that any different to the ones that are starved or not looked after? So you have this double standard – dogs living in the conditions they are not meant to. Too many border collie owners who live in a flat in the city. Or people who just don’t know anything about the breed. Or take on animals when they are not able to pay for that. So where is the welfare there?

There’s a large amount of shelters in the UK, and here in Sweden [I know of] only two shelters within 250km of where I live. So you actually don’t have that issue [of having many unwanted pets].

There is the cat [rescuer] that comes to our clinic, but she keeps everything at home, she’s actually just re-homing cats.

So people are taking more responsibility for their pets in Sweden?

Yeah, there is more responsibility and the owners understand the breed.

But then, a hunter will just shoot their dog when its not up to working any more. So this is where there’s no clear answer to that. You could say, is it really a welfare issue [to shoot a dog] if the dog is not being used any more? It might be ill, how is that better? I think that is the culture, and you have to respect that.

And its the same thing for example, here you have clients who have pet dogs that live in the house, but then they have a hunting dog which lives in a kennel outside. And the choices made for what you do for each dog for treatment is different. But overall, I think that’s better, because the animals are better understood. Pet ownership is taken more seriously here.

And compliance is amazing, people do what you tell them to do. They come back! I’ve had only one no show recently- that’s all I’ve had in the last 13 months- one no show! So from that point of view, people do what you tell them.

Are there any laws that affect your work here that you didn’t deal with in the UK?

Yes, I think around antibiotic use, that’s for sure.

And perhaps the fact that we are not able to keep drugs [in the clinic] to sell them. So I don’t have to worry about [the mark-up costs on drugs], however I don’t want necessarily to have to write a prescription for a box with 100 tramadol tablets in it [because the pharmacy only dispenses whole boxes]. So there are medications that I’d love to be able to keep in the clinic, but we’re supposed to keep them for an emergency only. Plus insurance in many cases doesn’t cover the drugs- that’s another difference.

The UK is also more strict with methadone [than in Sweden]. Here it stands in a box in the middle of the room, and we use it as we [need] it. We used to have all the medications for sedation in each [consult] room in a little basket. And then we removed that so there is no access to the clients. Because you know, it is an opioid, and it creates and opportunity.

What is the biggest struggle or frustration that you face as a vet?

At the moment, nothing really that’s to do with veterinary side. I don’t really have any issues with my work, I think I really started to love it again here.

And that’s because I actually can be a vet in Sweden. Because in the 10 minute appointments [in the UK], there is no space to breathe, and there’s high demands from the clients. And here, you don’t feel it. You are a vet, you can be a vet. So I don’t have any struggles now.

What part of being a vet do you enjoy the most?

I think all of it. That’s the thing, I like the challenge of when a routine thing actually turns out not to be a routine, its the surprise element.

I think its kinda good that I’m at the level now where I’m not afraid to just open the dog, and just go for it. I think before [I moved to Sweden] the frustrations would overgrow everything else, but now its just fun, its cool. And now I do much more operating and dentistry than I ever imagined I would.

But I have always liked the human element- so whether it is trying to look after your colleagues, or training younger members of staff, or looking after the client. I think that is what has been more satisfying.

What advice would you give to a young vet in starting out now about how to enjoy and make the most of their career?

Come to Sweden!

I’m serious! I think that’s the most important advice!

I think the problem with the market in the UK is the turnover of vets in the clinic is so high because they can be [replaced]. You will find another inexperienced vet that will really need a job, and I think what I have been always trying to look at is that when [a vet] goes for an interview, they must interview the clinic as well. So many times we just don’t do it. So you must go and almost demand that you get a trial, and you must see how its going to work for you.

But don’t sign the opt-out [of the European Working Time Directive, which states employees cannot work more than 48hrs per week].

Thats great advice, I made that mistake in my first job! [Laughing]

But then again, I had to go through quite a lot of pretty horrible stuff before I got the guts to say to my employer, “I’m not going to stand this. And I don’t agree with the contract where it says, in a matter of business, you may be required to work for free an extra 100hrs per week if its needed”.

And now, you know, I’ve stopped signing it, I say no. But I think because I’ve got to the position in the UK where they needed me more than I needed them, I was able to do that. I could afford it. It feels wrong that your requirements are respected only because you have got the experience needed to add to the clinic. So many vets struggle with that.

Whereas here, you are protected by the unions. They won’t allow you to sign any shit basically, and they negotiate your wages as well. Its fantastic.

In Sweden, the role of the vet nurse is very different to that in the UK. Do you think vet nurses are utilised better here than in the UK?

They are. They have similar training as in UK, yet they actually are allowed to do everything that professional conduct says.. I think it reflects in the salary in a way, because its not much lower than the vet salary. So head nurse would earn more than a three year vet graduate. Because we are doing different roles, and we cannot work without each other.

I think RVNs tend to be very undervalued in the UK for the training they go through.

Yeah, but the (veterinary nurse) title is not protected in the UK. How can you do that when the title is not protected? Whereas here, it is.

And the interesting thing is that as a vet in Sweden, I can also do what we call a delegation, so I can delegate tasks to an individual nurse.

So with each of the nurses here, once a year we sit down and we say, what can you do more than what you did in your basic training? Then I sign it that I’m comfortable that I delegated [a certain task]. So they have those extra responsibilities as well. So in this clinic, all the nurses have propofol induction signed off. They have rabbit castration. Cat castration. They do all the abscesses in cats as well. A lot of things. And euthanasias as well.

And if you look at the professional conduct in the UK, vet nurses can do euthanasias, but traditionally they don’t. They are allowed, but they don’t do it. Whereas in Sweden, nurses do it, but its the vet who has to come and pronounce death.

And vet nurses do know so much- they are not worse or better than vets, they just do a different job. So its really difficult to compare what they do in relationship to a vet, because we compliment each other. In the UK, I think its such a class society that you do have that feeling to it, the ladder is going up. Whereas here, the society and work hierarchy is flat. So in our set-up, and it is very Scandinavian, the structure is as flat as possible. So you don’t have many people at the top or bottom.

I did notice that all the staff uniforms at the clinic are exactly the same. Most clinics in the UK have different colours for different roles.

Yes, because in the UK, I think, you have to show your class. It is the class system, and it goes deep into the society as well.

Whereas in Sweden, its like- what should I do? I prefer being a nurse or a vet, so I’ll just do that, you know? And again, the issue is, I think, there is only one uni for vets and one for vet nurses for the whole country. So that’s what the struggle is- its not about grades or about how good you are, but also the fact that there’s not many places.

And finally, how many rectal examinations have you done this week?

Hmm, none. None! Two weeks ago, I had a prostate week, but this week, zero! But we’ll see what comes tomorrow!

A huge thanks to Magda for sharing her fascinating experiences of life as a vet in Sweden.

Further Information

If you’re interested in hearing more about what its like to work as a vet in Sweden, you can read about the things I learned during my Swedish experience in my recent article, Revolutionising Veterinary Practice- Does Sweden have the answers?. Or if you’re thinking of working in Sweden as a veterinary professional, get in touch with the Swedish regulatory body, Jordbruksverket, to find out exactly what you’ll need to do.

Want to read more interviews with vets who work in fascinating parts of the world? Check out the Global Vet Interviews page.

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