The idea is intended to help combat the shortage of medical professionals.
It takes years before young doctors have anything to do with patients. In the nursing internship they should gain their first experience before starting their studies.
Gaëtan Bally / Keystone
Switzerland trains too few doctors. The local healthcare system is therefore increasingly dependent on foreign countries. From 2012 to 2021, Switzerland recognized almost 30,000 diplomas from foreign doctors. During the same period, only 10,000 doctors completed their studies in this country.
The fact that Switzerland trains so few doctors is not due to a lack of interest in this profession. But because there are simply not enough study places. There are around three times as many applicants for the 2,000 places available today. The number of study places has been gradually increased in recent years. Nevertheless, calls are now being made in Federal Bern to lift the numerus clausus, the admission restriction for medical studies.
In addition to the lack of study places, there is a second problem. Too many young doctors leave their jobs before they have even started. The Association of Assistant and Senior Physicians (VSAO) speaks of a third of female doctors who quit after completing their studies or during their time as an assistant doctor. This not only exacerbates the shortage of skilled workers, but also causes high costs. According to federal calculations, studying medicine costs around 642,000 francs per person.
Josef Widler has an idea on how the exit rate could be reduced. The Zurich doctor and cantonal councilor of the center describes the problem as follows: “Medical students sit in an ivory tower; they often have false ideas about what everyday life in the hospital is like.” They often only come into contact with sick and dying people in their fifth year of study – and then realize that this stressful job is not for them.
Widler’s solution: Anyone who wants to study medicine must first complete a six-month internship in nursing. A kind of reality check for the young aspirants. He wants to prevent premature departures. “Anyone who realizes during their internship that medicine isn’t the right thing for them will leave one of the rare study places to someone who is better suited for the job.” The current selection method, which consists exclusively of an exam, is apparently not good enough to select people with the necessary resilience for studying.
Widler has submitted a motion to the cantonal council that would oblige the government council to create a legal basis for such nursing internships. And the motion has the best chance of being referred by Parliament. In addition to the center, the GLP, FDP and SP also support the project – the four parties have a majority in parliament.
“Nursing and the medical profession must see themselves as a team”
SP cantonal councilor Renata Grünenfelder co-signed the motion. The nursing specialist also hopes that the internships will improve collaboration between nursing and the medical profession and strengthen understanding of the concerns of nurses.
Grünenfelder completed her training in the 1990s. Back then it was still completely normal for prospective doctors to do an internship before studying. “Many people still speak positively about this experience today.” The internship gave them an insight into this profession, which is also demanding on a human level, and showed them what the tasks of nursing are. It is important to recognize each other and see each other as a treatment team. “Only then can patients be treated optimally.”
Companies could also benefit from the innovation, says Grünenfelder. However, it is important that the internship lasts at least six months. Only after a certain training period are the interns able to take on work independently. The experiences with those doing community service are always positive. From their point of view, prospective medical students should also be able to complete their internships as part of their community service.
Aren’t the students moving to other cantons?
However, some questions about the nursing internships have not yet been clarified: How should the project be financed? Do hospitals, which are already complaining about tight finances, have to bear the costs? And how much should the interns earn? The government council must define this, says Widler. From his point of view, the remuneration shouldn’t be too high, after all, the prospective students also benefit from the experience they have.
But what if potential medical students move to other cantons where an internship is not required? “Where should they go?” asks Widler rhetorically. There are not enough training places in the other cantons.
If the idea is implemented, a considerable number of internships will be needed in the canton. In Zurich, over 1,500 people regularly apply to study human medicine. If everyone previously worked in nursing for six months, there would be a need for 700 to 800 positions for assistant nurses every year. Widler is confident that this is possible, especially if you include not only the hospitals but also the homes.
However, the government council will first have to work out a concrete proposal for the new law – provided the motion is passed.
Other measures would be more important to young doctors
The idea enjoys broad political support. But what do the young doctors think about it? The Zurich Association of Assistant and Senior Physicians is reserved. When asked, “we are not sure” whether such an internship is the right thing to do to reduce the departure of young doctors.
From the association’s point of view, other measures should have priority. Particular attention must be paid to improving working conditions. For example, by reducing weekly working hours to 42 hours plus 4 hours of further training for assistant doctors. Today the average working time is over 56 hours per week.
In order to select the right people for medical training, the association believes that new assessment procedures should also be examined. In the Netherlands, for example, interviews are carried out with the candidates. This could potentially also be a model for Switzerland.
The hospitals generally view the idea of nursing internships as positive. When asked, the Zurich Hospital Association wrote that they would welcome doctors being prepared for the challenges of the job at an early stage. However, hospitals are also concerned about a few points: especially the costs, the amount of care required for the interns and the long duration of the internship.
The association therefore writes that the hospitals must be reimbursed for the effort to cover costs. In addition, the canton should ensure that the matter is handled as unbureaucratically as possible. And the duration of the internship would have to be limited to one month. On the one hand, in order not to put excessive strain on the hospitals, and on the other hand, in order not to extend the training of doctors. It already takes at least 11 years from the start of your studies to obtain the specialist title of internal medicine.
