Clinical clerkship in Oulu

15 min readAug 26, 2022

Week 3/4

I cannot believe how fast is the time flying by. I have had so much fun here and it really shows. I am already over the half of my medical exchange and I am starting to feel bad that the end is approaching.

The healthcare

I have not yet wrote about the health system here and I think it deserves a close look at. It is working much better than in Slovenia and they still manage to have complaints over it and want to make it better. It is a dynamic process of improving and making every iteration better.

Becoming a doctor

I had written about this a little in my first post. I have already covered the period until the graduation. Now I will write about the path after leaving the medical school.

I am more interested in surgery, some parts might be different for other medical professionals.

The residency is part of University education. The resident is a “student” at the faculty of medicine that falls under the university hospital where he is doing the residency. In Slovenia the residency falls under the Chamber of physicians.

In the old system you only had to let them know that you want to choose a certain specialisation, but now you have to go through an interview (I am told that you can still choose anything you want, they need all kinds of doctors). It is not as structured as in Slovenia, with getting different scores and competing with each other (recommendation 20 % + interview 40 % + grade average 20 % + research/exchanges/COVID-19 work 20 %). For example, if you wanted to do plastic surgery you send a letter of intent to them and that is how you get it.

As a freshly graduated person you have to first conduct work in primary care. You do primary care between for 9 months, afterwards you can choose to specialise it or move on with your residency or just do it some more. Personally this feels like a good way to keep the primary care strong.

Choosing a surgical residency you have to do 3 years in a local/general hospital (they have 4 levels of care: primary, local hospitals, general hospitals, university hospitals). This ensures that you see a lot of case throughput and strengthens the rural communities healthcare. Afterwards you have to finish the residency training for 3 years in a university hospital. It is also not mandatory to do it all at once, you can do a little of rural hospital and a little of university and switch back and forth.

The residency ends with an exam after around 6 years of education. The jobs in the university hospital are not guaranteed, you might not get it. If you do not get it, you can work for a higher wage somewhere more rural.

Wages

It depends on where you conduct your medical practice.

A doctor can choose how will he go about his carrer. Residency is not mandatory and you can stay in primary care as long as you wish. This is making it a tough choice for young doctors, as they can get a better wage not doing residency and working somewhere rural.

The highest wage a doctor can get is in primary care (the pillar of public health system), then you can get even higher if you do primary care rurally. The best decision financial wise is going up to the North and opening up a GP practice.

Now for some numbers*…

In Slovenia after one finishes medical school he/she becomes a rookie doctor, you do not have a license and you have to do at least half a year rotation on different departments. During which your base salary is 1,428.34 EUR/month**.

Starting salary of a resident is around 3300 EUR /month. In Slovenia that would be 1572.49 EUR/month or 9.03 EUR/hour.

3 years after graduation you get 3500 EUR/month.

This is quite lower compared to what a student gets (3,5k-10k).

Overtime is very valued. The night shift on Monday-Thursday afternoon multiplies your hourly wage 1.75x, working from 22.00–8.00 is 2-5x (depending on your location, specialty, contract), weekends 8.00–22.00 get you 2.25x and night shifts on weekends get you 3x.

After becoming a specialist you make in university hospital 4900 EUR/month. In Slovenia what would be 1,737.79 EUR/month. In Finland you also get university hospital bonus. After working for longer time (for many years) you get more bonuses.

Another cool thing is, you get paid by the procedure. It is not a lot of money, but if you for example remove a lot of moles, you get paid for each one individually.

GP makes around in 9k-12k EUR/month in Lapland and 5k EUR/month in Helsinki. There is no distinction like that in Slovenia. An example of extremely high wage is 10k EUR/day for a cardiologist that goes to do ultrasound examinations to the places in the middle of nowhere.

Many doctors work part time in public and part in private. In private sector you basically name the price and if there is demand you will get it.

Another thing I find very important is that doctors I talked to are content with their wages.

Above are the wages on paper in real life they differ. Slovenian wages can be seen here.

*All of the wages are in gross, before taxes and other fees. The source of wages in Slovenia is Young Doctors’ website.
** This wage was derived from 31st wage class for public workers.

Recruiting companies

There is a special market for recruiting companies in Finland. It is often that the hospitals cannot staff their shifts. Some services are mandatory by law, like A&E. This is where recruiting companies come into play.

Their sole purpose is to call as many doctors as possible (they get about 300 EUR if the doctor then only calls the hospital they were hired for, not even sign a contract and start working there). Once the doctor agrees to work for the recruiting company he joins the pool of other doctors that are already working for it.

The pool the company has, makes it possible to assign doctors to different hospitals. The working force is not static. If there is no one in hospital A, they send a doctor there. But the next day, there might be a spot in hospital B, so he goes there. This makes it easier to cover shifts that got missing last minute, for example because of sick leave.

Companies have also a big responsibility to staff those shifts, if they do not, there might not be a doctor present at all. That is why huge fines are imposed if they do not perform. Missing only one shift can get you a fine between 5,000 and 10,000 EUR.

Primary care

A patient does not have his personal GP, but rather just goes to the community health center and whoever is free to examine him, will examine him. In Slovenia you get your personal GP, you send an email/call, schedule a visit and wait for others that did that before you.

If you want to see the specialist right away, you can. But you have to pay for it, same as at home.

How is it all paid for

Taxation is gradual, like in Slovenia.

Resident salary is taxed 32–40 %. If you have high salary you get 45–50 % taxes.

To pay for healthcare they take from every salary about 5–7 %, this is then used for pension and healthcare.

Participation fee. It is an important contingency that makes it hard for people to take advantage of the system. For a single visit you would pay around 50 EUR, but if it is a surgery it will cost you around 150 EUR. If you are a chronic patient and need a lot of checkups, it will be cheaper around 12 EUR.

Another important thing is co-pay in pharmacies. If you get prescribed a drug you also have to pay a small fee. The government covers the bulk of it, but you still have to chip in. If you need a drug every day in a year, like insulin, you have to pay around 600 EUR. But that does not increase for more expensive drugs, it’s the same for all of them.

Just when I thought our schedules could possibly not get more packed, here came the 3rd week.

Day 16 (Monday/maanantai)

Starting new 2-week rotation. I have been assigned to hand surgery. It is quite a different between the plastic surgery and hand surgery.

During the summer, the department was actually closed so it is slowly coming back up to speed. They have a lot of residents, I think that around 3 or 5. So the only day I managed to scrub in this week was on Monday, when there was just me and the hand surgery specialist.

The hand surgery is an interesting, but very complicated field. To even see what is going on you need special glasses, called the loops. Everything is quite small and most of the surgeries are classified as microsurgeries. Using sutures above 5–0 and special instruments that are very precise and take time to master.

To just give you an idea of how complicated everything is, here is a screenshot from anotated MRI of the hand. Can you name it all? I can’t.

Coming home was quite fast paced, as we were going to a back to school medical party in the evening.

It was a very interesting concept, all of us meet in a park. There were some games that the freshmen had to go through.

It was fun to watch, there was a valley full of newcomers and a hill filled with older students who had already done it and of course us, the exchange students.

We then after rooting for the newcomers moved towards a local club. It was a very nice place, with drinks sold by a reasonable price — considering where we were. A beer cost us around 5,5 EUR.

We left the club around 2 and decided to get some pizza. That turned out to be a "bad” idea, as we stayed and talked about our cultures and lives at home until 5 AM. I really liked it.

Day 17 (Tuesday/tiistai)

The day started early on close to no sleep. The rest of the hand surgery dept. team was back. I was able to watch some surgeries, but it is quite hard to see anything when doing microsurgery and not using a microscope. Everyone is very accommodating, speaking good English, answering my questions and commenting what they do.

I also met my friend from plastic surgery and found about the classic Finnish sweets called Salmiakki.

After the clerkship we tried to meet for some volleyball; but as said before, August is really rainy here, so we cancelled the match and stayed indoors.

This picture is from the day after, it was really really a lot of water.

This gave me a good opportunity to catch on with Better call Saul last few episodes and season finale. What a masterpiece!

Day 18 (Wednesday/keskiviikko)

The surgeries were interesting to watch.

After the clerkship we went climbing to the gym. It was this one Oulun Kiipeilykeskus.

And afterwards we got caught in the rain.

Day 19 — trip to Sweden (Thursday/torstai)

We rode a Tesla! Oh wow how cool of a gadget. It has so many cool features, that you just do not see in a "normal” car. From Karaoke, to self driving. Not only it keeps the speed, it also holds the direction on the road.

You can actually sing karaoke whilst driving.

We first went on a little walk to the Aavasaksa. It is a nice flat path, that is not too long and offers quite nice views.

Then we crossed the border to Sweden and went to a little town called Övertorneå.

What was funny to me was this old lady coming up to my friend telling her that the pants she is wearing are to short. Never seen that happen in my life.

We then went to eat a burger and do some shopping. Alcohol is cheaper in Sweden than in Finland.

Another thing that is quite different from home is the tobacco culture. You can seldomly see people smoking. What is very popular, are the tobacco patches (here they call them Snus, in Slovenia they are called Fuge) that you put on your gum. They are not sold in Finland neither in Slovenia, so people have to drive to Sweden to get them.

We then headed home.

These signs are everywhere, deer and moose are a real danger here.

Driving home we stopped in a swamp Martimoaapa. It was one of the most beautiful places I have seen here. You have to walk on a wooden path as the ground is soft and watery — it’s a swamp after all.

We came home quite late and decided to also do some beach volley. We played until very late, we actually were on the court until we couldn’t see the ball anymore.

To conclude, two guys working on a boat sauna invited us to join them. Such a cool experience, after getting out you can jump directly into the river and the furnace is run on wood, so it has a very different feeling than the electric ones.

Day 20 (Friday/perjantai)

I talked a little about the system with the residents. Which can be seen in the chapter above and some information I have divided into the next blog post.

What I liked was the special hat and sword you get after finishing your PhD.

Something to think about when choosing where to do a PhD (www.oulu.fi)

As we were travelling for the whole weekend, we took an easy day, met at friends place and chilled a little bit.

Trip to Rovaniemi

Some of the most important info to plan a trip like this.

For the forward journey we took a Onni bus from Oulu to Rovaniemi.
We stayed in a hostel Cafe Koti for 1 night (Saturday and Sunday).
We returned with a Matkahuolto bus.

With this out of the way, here are all of the fun details about the trip.

The bus is really tightly packed, if you do not like driving I would recommend to take a train.

Day 21 (Saturday/lauantai)

We started our journey quite early and the bus took a few hours to get there. Elina, our trip leader, decided to use the time on the bus to teach us a very fun game, they always play in situations like that. It was the "bus” bingo! You get a paper with a matrix of numbers, then you use a random number generator and try to get 5 in a row, until you get all of the numbers on the paper. For every round you have to get one more number. It was a fun way of making the drive feel shorter.

We arrived to a bus station and we still had to come to a hotel somehow. We choose the city bus. You can download the bus app (Waltti Mobili)from the app store. I recommend taking a 24 hour ticket, it costs 8 EUR and will get you anywhere. The app is not very good, but if you really attentively follow the instructions you can make it work.

We went to the hostel, it was such a nice place. Everything clean and you can get a private double room with breakfast for 35 EUR/night.

We were so lucky with the hostel, it was the nicest one during my stay in Finland.

We had check-in quite late at 15:00 so we went to do fun activities for that time.

Firstly, of course, was the Santa’s village.

First stop were the reindeers. They are so soft and mushy, even the antlers.

Then we went to see the Santa. We took a picture, but it was so expensive (45 EUR), we decided not to buy it.

So here is a heavily watermarked image of us.

A cool service they offer is delayed mail. You can choose if you want your postcards to come for Christmas.

Another nice thing they have in their "post office” is the mail they get from all around the world, and it is a lot of mail.

We finished off with a photo on the Arctic circle line.

We returned to our hostel and checked in. The rooms were really nice too.

After a quick pause we went out for a little hike around the area.

As you can see there are not many hills, usually it is flat. To build stamina you have to take a long trip.

First stop was a nice rock.

And another group photo…

We walked up to a viewing tower and were greeted by some very nice views.

We then went to a free public wooden sauna. Our friend had a bad experience as he got his wallet emptied. So beware of your personal belongings. Other than that it was very nice and I loved it.

We returned to the city centre and went for some Mexican food in Yuca. You should order the big burrito, as tortillias are very little.

We then went to the only club in the city. It is a nice place and the drinks are quite cheap, 4 EUR a shot. What was very interesting to me was the ear plugs, you can get them for free and a lot of people use them. Tinnitus is a real disease and hearing health is a very important thing for QOL.

Day 22 (Sunday/sunnuntai)

For the 2nd day we split. The majority of group went to see the museums. Here are some links:

Elina, Ariane and myself chose to do sports. We went to the adventure park. It costed us 22 EUR per person and it was so fun.

We got so hungry after hours and hours of moving, we decided to go and get a burger. We went to the restaurant called Pure burger. Price of a deer burger with fries and ginger beer was 27 EUR.