Recruitment to psychiatry in Sweden
- Jillian Howlin
- Jun 4
- 5 min read
Interview with Jonas Eberhard and Dr Karl-Axel Lundblad
As a recent appointee to the editorial board of the Newsletter of the EPA Council of National Psychiatric Associations, InterACT(1), Jillian Howlin, a psychiatry resident from Malmö, spoke with Jonas Eberhard, President of the Swedish Psychiatric Association, and Dr Karl-Axel Lundblad, board member, about recruitment to psychiatry in Sweden. The discussion forms part of an upcoming InterACT issue exploring similarities and shared challenges across the EU. Sweden presents a mixed picture: recruitment into psychiatric specialist training has improved markedly in several major urban regions, while public psychiatric services continue to struggle with retention and with the recruitment of specialists and consultants. The following summary highlights the key themes that emerged from the conversation.
Jonas Eberhard
President of the Swedish Psychiatric Association.
Karl-Axel Lundblad
MD, Board member of the Swedish Psychiatric association.
Jillian Howlin: Is recruitment to psychiatry generally considered a challenge in Sweden?
Jonas and Karl-Axel: At present, the main recruitment challenge in Sweden does not seem to concern psychiatry training as such, at least not in the larger urban regions where recruitment to specialist training posts in adult psychiatry has in recent years been strong. The more persistent challenge has rather been recruitment and retention at specialist and consultant level, particularly in services with heavy clinical workloads or long-standing staffing instability. The situation may be even more pronounced outside the university cities and in more rural areas.
How competitive is psychiatry as a specialty?
In the larger Swedish regions, psychiatry currently appears substantially more competitive than it was a decade ago. In some regions, specialist training posts attract many applicants, in certain cases far more applicants than available positions. Recent recruitment data from two comparably large adult psychiatric services, Northern Stockholm and Malmö–Trelleborg in Skåne, offer concrete examples. In the Northern Stockholm area, the most recent recruitment round, approximately 18 months ago, attracted 91 applicants; 11 applicants were ultimately appointed to specialist training posts, corresponding to an applicant-to-post ratio of approximately 8:1. Figures from Malmö–Trelleborg are comparable, with a total of 52 applicants for 6 posts during 2025; an approximate 9:1 applicant-to-post ratio. Application figures were provided by the doctors responsible for specialist trainee appointments and junior doctor staffing in North Stockholm and Malmö–Trelleborg, Skåne, respectively. Although direct comparison with other specialties is limited by the lack of systematically published national applicant-to-post data, these figures suggest that psychiatry training posts can be relatively competitive and that psychiatry has become a more attractive specialty choice among junior doctors. Unfortunately, this positive trend is not always mirrored by equally strong retention later in the career path.
Have there been noticeable changes in recruitment to psychiatry in recent years?
Yes. Apart from improved recruitment to psychiatry training posts in major urban areas, there also seems to have been a shift in the gender balance, with increasing interest among male applicants. Psychiatry, in contrast to most other female-dominated specialties, has seen a clear trend reversal in recent years. In 2019, 56% of practising psychiatrists were women; by 2023, that proportion had fallen to 53%, and among those completing specialist training in 2022–2025, 55% were men (2). One possible explanation, albeit speculative, is the concurrent expansion of a private market particularly for ADHD and autism spectrum disorder (ASD) assessments, as well as opioid substitution clinics. These developments may have created new and more financially attractive career paths for specialists outside the public sector. In southern Sweden, the public services in Malmö and Lund must also compete with the Danish labour market due to proximity to Copenhagen and the more lucrative specialist and consultant posts available there.
Are there particular areas of psychiatry where recruitment remains especially difficult?
It is evident that the current difficulty lies at specialist and consultant level rather than at trainee level, and that recruitment and retention problems are seen primarily, but not exclusively, in general adult psychiatry outpatient clinics. In fact, the inability to fill specialist and consultant posts, despite funding being considered adequate, has become serious enough that the doctors’ union in Skåne recently submitted a formal request for action under the Swedish Work Environment Act. This procedure is intended to compel the public employer to take immediate action on staffing and related work-environment issues.
What are perceived as the main barriers to recruitment in Sweden?
The main barriers are probably less about stigma than in some other settings, and more about working conditions: high clinical pressure, administrative burden, difficulties with continuity of care, and relatively limited time for reflection, supervision, teaching, and professional development. Violence and safety concerns are relevant, though probably not the primary explanation overall. The recent expansion of private clinics has also drawn specialists away from the public sector. More broadly, it may have contributed to fragmentation of psychiatric services, with different subspecialties increasingly divided between separate providers. This can create challenges for specialist training, particularly when private providers do not participate in the external placements on which training programmes rely.
What actions, if any, have been taken by the Swedish Psychiatric Association to improve recruitment?
The Swedish Psychiatric Association has worked actively with specialist training, continuing professional development, national congresses, educational initiatives, and efforts to strengthen psychiatry’s professional identity and visibility. The association has also collaborated closely with resident psychiatrists and engaged in broader policy discussions on training quality, recruitment, and the long-term development of the specialty.
What actions have been taken at regional or national level by healthcare authorities that have affected recruitment?
This varies by region. Important factors include local salary structures, working conditions, staffing models, opportunities for professional development, and how psychiatric services are organised. National and regional policies related to private providers have also influenced recruitment patterns, especially where private neuropsychiatric or addiction services have expanded. More generally, the way healthcare systems balance continuity, workload, and long-term competence development seems highly relevant to recruitment and retention.
What data are available on psychiatry in Sweden?
There are national and regional reports on psychiatric care, workforce needs, and staffing, but they do not always capture recruitment dynamics in a very precise or up-to-date way. Some of the most useful information may currently come from regional experiences and local recruitment figures for specialist training posts, consultant vacancies, and staffing stability over time.
Are there examples of good practice from Sweden that could be shared with other European countries?
One positive development is that psychiatry in many Swedish regions appears to have become more attractive among junior doctors. Where recruitment has improved, this may reflect better educational environments, stronger professional identity, more structured supervision, and a clearer emphasis on training quality. Specialist training in Sweden is supported by METIS, a highly regarded and rigorous course system covering the entire field of adult and child and adolescent psychiatry, including forensic and addiction psychiatry (3). METIS was developed in consultation with clinicians, researchers, patient organisations, and the national associations, including the Swedish Psychiatric Association following dissatisfaction with the limited availability of the courses previously provided by the Swedish health authorities. It has been continuously developed over the last decade or so and aims to ensure that specialist doctors fulfil the theoretical component of their required core competencies in a comprehensive manner. Sweden may also have something to contribute in terms of linking specialist training, continuing professional development, and national professional collaboration in a system where participation in continuing education after specialisation is both a right and a growing professional expectation.
Final comments and thoughts?
The Swedish picture is not simply one of “shortage” or “success.” Recruitment into psychiatry seems better than before in several major regions, but retention and long-term specialist staffing remain significant concerns. This creates an important opportunity: if psychiatry is becoming more attractive, we must use that momentum not only to fill training posts, but also to improve quality, continuity, competence development, and long-term working conditions across the specialty. □
References
AUTHOR:
Jillian Howlin
Psychiatry resident and InterACT editorial board member.
