The Finnish Medical Association (FMA) is a professional organization of which almost all doctors practising in Finland are members. Values promoted by the Association include advancement of medical expertise, humanity, ethics, and collegiality. The Association binds its members together to support these values, and represents their common professional, social and economic interests.

A central task of the Association is to ensure fair remuneration and other terms of employment for its members. The Association also works in numerous ways to develop health care and advance medical expertise, on the basis of the professional knowledge of its entire membership.

Promotion of medical ethics has been a basic activity of the Association since its establishment. The Association is active in relation to ethical issues and safeguarding of the interests of doctors and patients, in Finland and internationally.

FMA membership is voluntary but nearly all doctors who practise in Finland belong. Entire classes of medical students join the Association after their fourth year of study, i.e. when they can practise medically for the first time. Doctors from abroad can join the Association if they have a licence to practise medicine in Finland and the senior doctor in their place of employment recommends membership.

More than 90 % of Finnish physicians belong to the Association. In the beginnig of 2003 the Association had 18 894 members, 17 834 of whom were physicians and 1 060 medical students

FMA members automatically belong to one or other of its 56 local chapters. They may also join one or other of the 27 national subdivisions.

HEALTH CARE AND PATIENT BENEFITS

The FMA collaborates with various authorities and decision-making bodies in relation to the development of health care in Finland. The Association is ideally placed to contribute expertise in this connection as it represents the medical profession throughout Finland. Ensuring high-quality health services for everyone serves the interests of both doctors and patients.

The FMA pursues several initiatives and issues a number of statements each year with the aim of improving health care and related legislation. The Association has put forward plans intended to ensure a sound financial basis for provision of health services.

The FMA has played a significant role in establishing a general patient insurance scheme and developing a family-doctor system for Finnish health centres. The aim of the Association is to promote the right of patients to have access to the treatment they need promptly. Possibilities for choosing a doctor and place of treatment need to be improved.

The highest FMA decision-making body is the Delegate Committee. This is elected by members every three years. More than 60 % of members usually vote. The Delegate Committee decides the main policies of the Association and its budget. It elects the Chairman and other Board members. The Delegate Committee has 60 members.

The practical work of the Association is directed by the Board, which has 10 members. The Chairman of the Board is the FMA President. The Board is assisted by some 15 permanent committees, which it appoints, and various temporary working groups. These committees and groups deal with issues relating to members' interests, health policy, medical education, ethics, finances and member services.

DEVELOPMENT OF MEDICAL EDUCATION

In collaboration with the universities and specialist associations, the FMA is involved with development of basic, postgraduate and continuing education of doctors. Finnish medical education is well regarded internationally.

Finnish specialist training underwent reform in 1999. To conform to new legislation, the number of specialties in Finland, which had been exceptionally high, was reduced to 49, 16 of which have a 5-year training and the other 33 a 6-year training. Approximately 60 % of Finnish doctors are specialists.

The FMA has recently introduced a new system of special competences, supplementary to the official system of specialization. Special competences can relate to specific areas of specialties in which particular skills of demanding natures are required. Suggestions for the establishment of new areas of special competence usually stem from the specialist association in question.

Each year the FMA organizes the largest medical congress in Finland, Lääkäripäivät, the Finnish Medical Convention. It also organizes various other continuing education events for its members.

The FMA has undertaken pioneering work in connection with the development of medical education and improvement of the quality of health services. The Ethical Guidelines for the Quality Assessment of Health Care which have been approved by the Board of the Association state that each doctor must continually evaluate the quality of her or his work and the level of her or his skills by means of self-assessment procedures. The Association has prepared a recommendation Quality of Medical Consultation to help compilation of guidelines specific to particular places of work.

Each year, the Association confers a quality award on a project that has been shown to benefit the provision of health care and the treatment of patients.

ETHICS IN FINLAND AND INTERNATIONALLY

A basic activity of the FMA throughout its existence has been to promote ethical principals. When the Association was established in 1910, the first President expressed the hope that it would become the heart and conscience of the medical profession.

The rapid development of medicine constantly confronts doctors with new ethical issues. Ethical issues are reviewed by the FMA Ethics Committee. Every few years, the FMA publishes a compilation of the opinions of its Ethics Committee and ethical guidelines issued by the Association. This publication is distributed to all Association members.

In 1993, Finland became the first country in Europe to enact legislation relating to the status and rights of patients. The legislation provides that each permanent resident of Finland is entitled to the health and medical care that her or his state of health requires, within the limits of resources available for health care. Patient care must be arranged in such a way that the dignity of the patient is not impaired. Each patient's privacy must be respected. The mother tongue of the patient, and the patient's individual needs and culture must be taken into account in providing treatment.

In response to an initiative taken by the FMA, the World Medical Association (WMA) has adopted the Declaration on the Rights of the Patient which is binding on the medical profession in every country.

Finland has also been active in establishing other ethical provisions internationally, via both the WMA and the umbrella organization Standing Committee of European Doctors (CP). In recent years, the WMA has, in response to initiatives taken by the FMA, adopted the Declaration with Guidelines for Continuous Quality Improvement in Health Care and the Statement on Accountability, Responsibilities and the Ethical Guidelines in the Practice of Telemedicine. The FMA also made significant contributions to amendment of the Ethical Principles for Medical Research Involving Human Subjects (the Declaration of Helsinki).

SERVICES TO MEMBERS

The FMA looks after the interests of its members and offers them high-quality services. The Trade Union Department of the Association offers help in relation to professional legal matters, and remuneration, contractual and social-security issues.

All FMA members receive Suomen Lääkärilehti (The Finnish Medical Journal) weekly. This is the medical publication most widely read by Finnish doctors. Suomen Lääkärilehti articles are also available to members in electronic form.

The Association offers members internet services doctors need in their work. All members and all medical students receive, free, an internet user code and password. These allow access to medical databases and other useful services of the Finnish Medical Network (FiMnet).

Benefits available to FMA members include comprehensive insurance coverage. The Association pays for patient insurance for doctors in private practice. The Association has also negotiated insurance policies under favourable terms in which members can participate if they wish.

FMA members can participate free of charge in the Doctors' Unemployment Fund. This pays an earnings-related daily allowance during periods of unemployment. The Association operates its own employment agency. Doctors who plan to work abroad can obtain information from the Association about applying rights to practise medicine and finding employment in a range of countries.

PROMOTION OF MEMBERS' INTERESTS THROUGH STRIKE ACTION

The FMA is recognized as one of the strongest and most influential professional organizations in Finland. Medical practitioners are highly educated experts, whose remuneration should reflect their professional status and demands. The development of salaries paid to doctors working in the public sector has been unsatisfactory for a long period. This led to a strike by doctors in the municipal sector in 2001.

As a result of the strike, which lasted for over five months, salaries were increased. The improvements in professional remuneration also involve negotiation at local level. Individual practitioners also have to negotiate their remuneration individually with their employers. Adaptation to this new culture involving negotiation is difficult for many Finnish doctors, since the public-sector remuneration system has been agreed centrally for decades. In accordance with the aims of the Association, there is now more latitude in relation to salary scales to reflect the competences of particular practitioners, and local circumstances. This increases possibilities for improvement of professional remuneration.

Apart from remuneration problems, pressures associated with having to be on-call and cope with high workloads are stressful to the members of the medical profession. The problems are greatest in small remote communities served by only a few doctors. In recent years, many Finnish medical practitioners have sought to leave the public sector and establish private practices, undertake medical research, work abroad or retire early. This has led to a shortage of doctors in many places.