Chiropractic in Sweden
By Dr Peter McIntyre

I am an Australian chiropractor that has been working in Sweden for four years now. I live here with my wife, Marie, who is Swedish and our three-year-old daughter, Matilda. We decided to live in Sweden after we had spent two years living together in Australia, where I had my own practice in Mount Isa.

There are notable differences practising in Sweden, with the most obvious difference being that manual therapy in Sweden is dominated by a profession called naprapathy. Naprapathy was started in the United States by a chiropractor called William Oakley Smith. He decided that chiropractic treatments were neglecting the muscular component of the problem. He founded a school in Chicago that remains active to this day, where students learn soft tissue techniques as well as manipulation. It was one of his students who brought naprapathy to Sweden and founded a school in Stockholm in 1970. There is one other school of naprapathy in Scandinavia located in Finland.

Naprapaths in Sweden undergo a four-year full-time education after which they must complete a further six months training under the guidance of a registered naprapath, three months in the Swedish public health system and three months work experience. It is only then that they may apply to the Swedish Health Department for registration. Registration was granted to the naprapathic profession in 1994.

The Naprapathic Association in Sweden claims to have 600 active members. An average treatment lasts 30 to 45 minutes and costs $70 to $85. There are 22 naprapaths in Sweden that have a contract with their local health department so that the patient receives a substantial discount and pays around $15.

Chiropractors in Sweden have divided themselves into two organisations - one for those educated overseas at schools with international accreditation, and another for those educated in Sweden at a school that hopes to receive international accreditation next year. The Swedish school has accordingly boosted its course to a five-year full-time degree. The overseas educated chiropractic group have around 130 active members, of whom it is claimed 70% have the same contract with the health department allowing patient rebates. The other group has around 250 active members. The overseas-trained chiropractors received registration in Sweden in 1989, while the Swedish-trained chiropractors had to wait until 1999. All chiropractors have the same requirements as naprapaths to gain registration in Sweden, however, it is my understanding that a chiropractor who has gained registration in another country, that is part of the European Union, is able to work as a registered chiropractor in Sweden.

Osteopathy in Sweden is practised according to the English model. There is one school in Sweden that has started a four-year course. The Osteopathic Association in Sweden claims to have around 80 members, but they have no registration entitlements in Sweden as yet.

In Sweden it is quite okay to both practise and advertise as an unregistered chiropractor or naprapath. The real benefit that comes with registration is that one ceases to pay the 25% goods and services tax on patient treatments.

As one might imagine, with all this division among the manual therapists, they are not particularly powerful as a group in the Swedish health system. Doctors rarely refer patients to anyone apart from physiotherapists, of whom nearly all have a contract with the health department allowing rebates on treatments. Another result of this division is that in Sweden it is against the law for a registered chiropractor or naprapath to treat children under the age of sixteen. It is stated, however, that children between the ages of eight and sixteen may be treated provided that they are referred by a medical doctor.

As an Australian coming to Sweden, I had a number of barriers to cross before obtaining my registration. The first was a language test which is compulsory for all non-European Union health professionals. The main point of this is that one must be able to both read and understand the legal jargon in the laws pertaining to practise as a health professional in Sweden. Then I had to complete three months work experience within the Swedish public health system, which I spent at the local hospital in the orthopaedics department. It has taken me nearly four years since my arrival to achieve this, but I have been fortunate in being able to practise during this time.

I must admit that I enjoy working here. Now that the Svenska flows a bit easier, I find that there is a sense of being a chiropractic pioneer in Sweden. The majority of my patients have never received treatment from a chiropractor before, and most are pleasantly surprised with the results that the treatment can achieve.