They have been promising to fix primary care since 1994. They have not.

I started practising in 1985. Back then, we were told primary care was the future. That resources would shift. That licensed clinicians would be integrated, supported, used properly.

Most of us believed it.

Thirty-five billion kronor later. That is the audited figure. No measurable structural improvement came out. This is not surprising. It is a pattern.

Now Socialstyrelsen projects a shortage of 5,500 licensed clinicians in primary care by 2040. District nurses. Physiotherapists. Occupational therapists. Quietly disappearing from the system. Not because of a sudden crisis. Because of decades of quiet neglect compounding into something measurable.

The average GP now carries 1,750 patients. The recommended level is 1,100. That is not pressure. That is failure already in motion.

If you think this stays inside healthcare, it does not. It shows up elsewhere first. In slower decisions. Lower tolerance. Reduced clarity under pressure. Long before anyone calls it a health problem.

I am not interested in telling you things will improve on their own. They will not. But I can tell you this the clinicians who understand what is happening and position themselves accordingly will still be practising, and in demand, a decade from now. The ones waiting for the system to correct itself will be waiting a very long time.

"Thirty-five billion kronor. Not one lasting improvement. I stopped being surprised years ago. Now I just plan around it."

THE NUMBER THAT MATTERS

790 physiotherapists short by 2040

This is where the shift starts.

When a region is short 790 physiotherapists, they stop asking who the ideal provider is.

They ask who is available. Who is competent. Who can take responsibility immediately.

That is a different conversation. Be in it before they come looking.

Source: Socialstyrelsen / SCB, Tabell 1, p.20 https://www.socialstyrelsen.se/contentassets/39dee30874d1408cb8bd5794dcac9e27/2026-3-10115.pdf

Mental Health in Primary Care What the Report Says vs What It Means

Nearly half a billion kronor was allocated to mental health in primary care in 2025. It sounds substantial. Here is the reality one in five healthcare centres has no psychologist. And projections show a shortage approaching 1,000 by 2040.

In forty-two years, I have never seen a purely physical patient.

The back pain that does not resolve. The neck that tightens during a divorce. The shoulder that flares after job loss. These are not separate problems. They are the same system, expressing overload.

When the psychologist's chair is empty, and often it is, those patients come to us. They always have. What has changed is this the system is now acknowledging it in writing. A new national framework requires primary care to address both physical and psychological conditions. This is not philosophy. It is a commissioning signal. It will shape contracts, expectations, and scope.

The clinicians who can manage the whole patient are not ahead of the curve. They are simply ready for what is already here.

THE EVIDENCE: Gedin et al., BMC Musculoskeletal Disorders, February 2025. Karolinska Institutet. Ten Swedish primary care units. Chiropractic vs physiotherapy vs combination. Equivalent outcomes on every measure. Direct costs in the chiropractic group: SEK 3,081 over six months. The evidence is not missing. Most clinicians simply have not read it. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-08392-7

"The evidence is not missing. Most clinicians simply have not read it."

WHAT THE NUMBERS ACTUALLY LOOK LIKE · November 2024

0.75% That is the share of all primary care workers who are psychologists.

450,000 people work in Swedish primary care. Of those, 3,381 are psychologists. Psychologist numbers grew 25% between 2019 and 2024. And still one in five centres has none. The growth is real. The baseline it started from was almost zero.

THE REGIONAL GAP

Västra Götaland: 45 psychologists per 100,000 residents Norrbotten: 12 psychologists per 100,000 residents

A patient in Norrbotten has one quarter the access to psychological primary care as a patient in Gothenburg. This is not a gap. It is a different healthcare system inside the same country. The regions with the fewest psychologists are also the ones carrying the heaviest GP load. The pressure compounds. In the same postcodes.

POLICY SIGNAL

The government already has a plan for the gap. You are not in it yet.

SOU 2025:63 proposes a new profession: the avancerad specialistsjuksköterska, advanced specialist nurse. It will work inside primary care. It does not exist yet in Sweden but exists in other countries and is being formally evaluated as a solution to the staffing shortage.

This is the first government document to name a specific profession as the intended structural answer. It is not chiropractors. It is an advanced nurse role built to absorb the gap between GP and specialist.

This does not close the door. It tells you where the conversation is happening and who is currently being written into it. The commissioning language of July 2026 will follow the political preparation of 2025. If you are not in that preparation, you will not be in the outcome.

ALREADY HAPPENING

Care assistant numbers are already down 4% since 2022. The projected collapse of 46,000 by 2040 has already started.

Part 2 projects the shortage. Part 1 shows it in motion. The 2040 number is not a warning about the future. It is the direction of a trend that began years ago and has not reversed.

Socialstyrelsen does not have complete data on chiropractors. Ours is one of the professions the system cannot see clearly.

The statistics in both Part 1 and Part 2 are built on SNI codes, the standard Swedish industrial classification system. Socialstyrelsen acknowledges directly that these codes require adjustments and carry limitations. Some professions are not cleanly separated from other care sectors in the data.

Chiropractors are among those professions. We are not tracked as a distinct category in the LOVA registry in the same way as physiotherapists or district nurses. Private chiropractic clinics may be classified under different SNI codes depending on how they are registered. Many licensed chiropractors working in primary care-adjacent roles are invisible in this dataset.

This cuts both ways. It means the shortage figures almost certainly undercount the real gap in musculoskeletal capacity. And it means that when commissioning bodies read these reports and plan their workforce response, chiropractors do not appear in the data they are reading.

You cannot be part of the solution to a problem you are not counted in. That is not a clinical argument. It is a data argument. And it is one worth making to anyone who will listen before July 2026.

BALANCE SHEET · 2040 FORECAST

District nurses: −1,400 Physiotherapists: −790 Occupational therapists: −1,900 Psychologists: Continued shortage GPs: Trending toward balance Care assistants: −46,000

Source: Socialstyrelsen / SCB, Tabell 1 https://www.socialstyrelsen.se/contentassets/39dee30874d1408cb8bd5794dcac9e27/2026-3-10115.pdf

WHAT THIS MEANS IN PRACTICE

Stop positioning around pain. Start positioning around capacity, function, and decision quality.

Document outcomes beyond symptoms. Track tolerance, recovery speed, and performance stability. These are the metrics the commissioning system will eventually ask for.

Build relationships with high-burden regions now. Not when they are already forced to adapt. The conversation is easier before the crisis than during it.

Pay attention to July 2026. The definition of who treats what is being rewritten. Most clinicians will read about it after the fact. You are reading about it now.

TAKES

01 — The GP numbers look stable. They are not. A third of new GP specialists are trained abroad. Remove migration and projected growth drops sharply. The headline numbers look reassuring. The foundation under them does not.

02 — 35 billion kronor. Absorbed. Independent regional analysis confirms it: no measurable capacity improvement. Regions report feeling underfinanced. This pattern does not reverse on its own.

03 — July 2026 changes everything. Primary care will be required to manage both physical and psychological conditions. The definition of qualified provider is still open. That is where attention should be.

04 — Örebro: 2,337 patients per GP. This is a preview. The most strained regions will adapt first. The national average of 1,750 hides the real picture. In Örebro it is 2,337. With or without you.

BEFORE NEXT THURSDAY

Find out what your region has published about alternative licensed providers in primary care.

Search your region name plus "kompetensförsörjning primärvård" and read the most recent document. You are looking for one thing: whether the language around licensed providers is narrowing or opening.

If it is opening, you have a conversation to request. If it is narrowing, you have a case to make. Either way, you need to know which one you are in before July 2026.

Next issue: Thursday 24 April The commissioning framework changing in July 2026 and the exact conversation you should already be having with your region.

SOURCES

Part 1: Socialstyrelsen 2026-3-10114 https://www.socialstyrelsen.se/contentassets/9600952e1af549f78a33c87bba8abc9d/2026-3-10114.pdf

Part 2: Socialstyrelsen 2026-3-10115 https://www.socialstyrelsen.se/contentassets/39dee30874d1408cb8bd5794dcac9e27/2026-3-10115.pdf

Karolinska RCT: Gedin et al., BMC Musculoskeletal Disorders, February 2025 https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-08392-7

Pull your organisation’s sick leave data by diagnosis category.

Filter for ICD-10 codes M00–M99 (musculoskeletal conditions).

Then calculate

That number is your direct cost exposure.

(Source: Afa Försäkring · Försäkringskassan · Skandia)

You are not measuring:

That cost is not in your reports.

For every 100 kr lost in production,
less than 4 kr is invested in rehabilitation.

This is not a medical issue.

It is a capital allocation problem.

Most organisations only measure absence.
Almost none measure decline.

The number you calculate is not the full cost.

It is the visible part.

Until the next signal,

Dr Erik Rudberg
Chiropractor

Most people wait for pain. The attentive ones notice the signal.