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Sports and exercise medicine in Finland
  1. Pekka Kannus1,
  2. Jari Parkkari2
  1. 1Chief Physician and Head, Accident and Trauma Research Center, UKK Institute, PO Box 30, FIN-33501 Tampere, Finland
  2. 2Chief Physician and Head, Research Center of Sports Medicine, UKK Institute, PO Box 30, FIN-33501 Tampere, Finland

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    Sports and exercise medicine has a long tradition in Finland. Organised medical care of athletes has been available since the 1930s. The Finnish Society of Sports Medicine was founded in 1939 and is probably the oldest nationwide sports medicine society in the world. Today, the society has about 500 physician members (5.2 million population) and publishes, along with the Finnish Society of Sports Physical Therapists, its own journal (three or four issues a year) and, together with the other Scandinavian societies, the international peer reviewed journal Scandinavian Journal of Medicine and Science in Sports (six issues a year). Organisation of instructional courses, seminars, and symposia on sports and exercise medicine is also an important part of the work of the Finnish Society. Every other year, one of the Scandinavian societies organises the international Scandinavian Congress on Medicine and Science in Sports (300–600 participants). In 1998, this congress was held in Finland.

    In 1946, the first sports medical centre was opened at the Olympic Stadium of Helsinki. In 1956, a similar unit was founded in Turku. Today, Finland has six sports and exercise medicine research centres funded by the Ministy of Education (Helsinki, Turku, Tampere, Jyväskylä, Oulu, and Kuopio). Each has a staff of between five and eight full time workers and a varying number of part time workers such as consulting doctors. The tasks of the full time staff are to carry out research work in sports and exercise medicine (research should cover about 50% of the work), offer sports medical services, exercise tests, laboratory services, doping control, and physical therapy services to competitive and recreational athletes (25%), look after resident education, and organise symposia and lectures for doctors, medical and physical therapy students, coaches, athletes, and the general public (25%). In addition to these centres, the University of Jyväskylä, Research Institute of Olympic Sports, and about 10 other sports institutes provide facilities for research, education, fitness testing, and/or sports medical services. One or two private (orthopaedic) sports medicine clinics also operate in the largest cities of Finland.

    In 1985, sports and exercise medicine was accepted as a full university based medical specialty in Finland—that is, in line with the other large specialties such as surgery, internal medicine, and paediatrics. From the very beginning, it was recognised that the specialty should be more than just taking care of sporting elite: the basis of the new specialty was accepted to be public health work and medical care of all people who exercise and improving the general wellbeing and health of the population through promotion of an active lifestyle. Until 1998, the education programme in sports and exercise medicine lasted six years, but after the major reorganisation of medical specialties in Finland in 1998, sports and exercise medicine was reduced to a five year curriculum. This would appear to be a backward step, but considering that during the 1998 reorganisation about 50% of the medical specialties were abolished, the five year curriculum was actually a major victory for sports and exercise medicine in Finland.

    Thus, after the six years in medical school, residents of sports and exercise medicine serve an additional five years in a specialisation programme. Eight resident positions are available, and the programme includes one year of general training (as a general practitioner in the community based primary care centres) and four years of specialist training. The entire education programme is based on general practice—that is, the specialty of sports and exercise medicine in Finland is not a subspecialty or fellowship of orthopaedic surgery (or any other full specialty)—although 1–1.5 years of the specialist training has to be served in at least two of the following areas: surgery, orthopaedics and traumatology, physical medicine and rehabilitation, internal medicine (including rheumatology), clinical physiology, clinical chemistry, paediatrics, neurology, or radiology.

    The remaining 2.5–3 years of specialist training is carried out as a resident of the specialty. These resident posts are located in the six sports and exercise medicine research centres mentioned above. During this period of training, the residents take part in practical work as well as a wide selection of instructional courses and symposia on sports and exercise medicine—as a participant as well as a speaker. It is also stated in the curriculum that they must participate in research work during the residency. As a result, many of the resident doctors publish their academic thesis during or after their residency. The specialist training culminates in the national specialist examination, which includes seven books and three recent volumes of the selected peer reviewed journals of general and sports medicine.

    Today, Finland has over 40 doctors who specialise in sports and exercise medicine, working in universities, research centres, sports institutes, health centres, private clinics, and the Finnish army. In 1988, a society for specialists in sports and exercise medicine was founded. In 1989, the first full time chair in sports medicine was established, in 1998 one part time professor was nominated, and during the year 2000 one or two additional chairs will probably be established.

    Sports and exercise medicine in Finland also faces difficulties. Economics is always a problem. The basic financial support (50–60% of the budget) for the six sports medicine research centres comes from the Ministry of Education (not the Ministry of Health), emphasising the research work and resident education. However, much of the work is carried out at the expense of the centres' medical services and other money generating activities and therefore their own economic wealth. Secondly, the specialists being trained now may have difficulty in finding suitable jobs. The first 40 specialists are well employed, but the situation will probably not be so easy for the new generation. Perhaps the growth in professional sport will create new opportunities in the near future. Finally, in Finland, we should consider creating a two year postgraduate degree in sports and exercise medicine (subspecialty, fellowship) for those who are already specialists in another branch of medicine. Orthopaedic surgery, physical medicine and rehabilitation, internal medicine (cardiology), clinical physiology, radiology, and general practice at least should have such a programme. This would definitely calm the lively debate on the issue of who is the “true” specialist in the field of sports and exercise medicine.

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