DMA History
The first association of Danish doctors was established in 1772 in Copenhagen. This was a scientific society, originally called the Royal Society of Medicine, which is still active under the name of the Copenhagen Medical Society. Outside of Copenhagen, the district medical associations first began to be established in the 1840s.
The Danish Medical Association was established on 1 September 1857. The first Danish hospital law dates back to 1806, but the doctors were not satisfied with the official effort in the field of a health system. The establishment of a Danish medical association was based on the existing lack of hospitals, poor quality of the hospitals which did exist, the need for health care to come within the scope of the local authorities in order to support the efforts of the medical profession, the reformation of medical legislation, and the involvement of the medical profession in the development of these matters.
In the years following the establishment of The Danish Medical Association, from 1857 up to 1900, local medical associations were set up throughout the nation as subgroups within The DMA. Until 1904, the DMA had an undifferentiated membership including mostly general practitioners and a few chief physicians from amongst the nation's hospitals.

Craft Associations
At the end of the 19th and the beginning of the 20th centuries to a greater and greater extent, what we call "junior doctors" were being appointed to the hospitals i.e. persons who were trained as doctors in the universities and who worked in the hospitals as house officers (in-terns), registrars (residents), and senior registrars, not independently, but under the supervision and responsibility of a consultant (head of department).In 1904, the junior doctors acted to form their own medical association which was at first independent of the DMA, but which became a DMA subdivision three years later.
Still later, in 1934, the medical specialists and, in 1967, the general practitioners, set up their own associations, thus constituting the three different subdivisions or "pillars" or craft organizations which make up the current structure of the Danish Medical Association.

HISTORICAL LANDMARKS IN DANISH HEALTH & MEDICINE
1772 First Danish doctors society established.
1806 First Danish public hospital law enacted.
1857 National Danish Medical Association established.
1892 First official legislation enacted regarding voluntary sickness insurance arrangement.
1971 Comprehensive public financed health service enacted.

Membership and Organizational Structure

About 94% of the doctors authorized to practice in Denmark are members of the DMA as well as one of the three craft organization subdivisions. The task of the subdivisions - each within its own area of concern - is to look after the members' professional and financial interests.
The membership of the Association of Junior Hospital Doctors (which, it should be noted, does not refer to age, but rather to hospital training positions beneath the senior, "end position" level) includes hospital house officers (interns) and registrars (residents), senior regis-trars and staff specialists (afdelingslæger) as well as doctors appointed as university lecturers or to other nonpermanent subordinate positions such as an amanuensis/trainee in general practice.
Membership in the Organization of General Practitioners in Denmark includes those doctors engaged in general practice for the social security or who in some other way have general practice as their principal occupation such as occupational health doctors outside the public health system and nursing home doctors.
The Association of Medical Specialists includes senior hospital doctors (consultants or heads of department), specialists with their own private practice in or outside of the hospital and other doctors who are neither junior doctors nor GPs - such as public health doctors. Under the aegis of the Specialist Association, there are 26 "monospecialist" organizations, one for each of the specialities recognized in Denmark. In addition, senior hospital doctors or doctors employed in the civil service also become members of the Danish Association of Senior Hos-pital Physicians (Overlægeforeningen) which was established in 1992 as an amalgamation of previously existing organizations.

Local Branch Associations
With certain exceptions, a DMA member must also enroll in the local DMA branch association in the geographical area within which they carry out their principal occupation. In all, there are 17 such local associations - one for each of the 14 Danish counties, one for Copenhagen, one for the Faroe Islands and one for Greenland.
The task of these local branches is to look after the medical profession's interests vis-à-vis the local authorities, the city and County Councils and, on the whole, to coordinate the professions' interests within the local sphere. The local branches, however, are not involved in con-tract negotiations, which are handled only by the three craft associations.

Contract negotiations
Every second year, the respective craft organizations renegotiate the terms and conditions of their contracts with the public authorities.
Any agreement or contract of a comprehensive nature may be considered in a special committee composed of representatives of all three craft organizations and the Danish Medical Association itself and before it can come into force must be approved by the Executive Coun-cil of the Danish Medical Association (the umbrella body).

DMA Involvement in Medical Ethics
Through most of the history of the DMA, written regulations have existed concerning the du-ties of the doctors towards their patients, towards society, and towards each other as col-leagues. In 1989, the representative body of the DMA adopted a new set of ethical rules to regulate the doctors' relationship to their patients and to society. At the same time, the DMA representative body adopted a revised set of collegial regulations to ensure good collegial co-operation between Danish doctors. These rules were revised in 2001.
In the new ethical regulations, emphasis is placed on underlining the rights of the patients. The DMA ethical rules contain regulations concerning the patients' rights to information on diagnosis, prognosis, and treatment possibilities as a basis upon which they can decide whether to accept or decline treatment. The rules also clearly emphasize the patient's right for the doctor to observe professional confidentiality.

DMA Collegial Regulations
The collegial rules of the DMA contain a regulation concerning the way in which intercollegial criticism should be presented as well as rules concerning the cooperation between doctors treating the same patient. For example, the collegial rules prohibit a doctor from taking advantage of the population's fear of disease and false advertisements.

Enforcement of ethical rules
The ethical and collegial rules are enforced by the DMA Ethical Council, which is empow-ered to reprimand a doctor who does not respect the regulations.
Matters which require further consideration are handled by the DMA Arbitration Committee which can fine a doctor up to 50,000 Danish kroner (approximately ECU 6,500 or USD 6000) for violation of the rules, or they can exclude a doctor from the DMA.

International Cooperation
For many years, the DMA has taken a keen interest in the international field of the medical profession.
The cooperation with the other Nordic associations (Norway, Sweden, Iceland and Finland) has been particularly close since the beginning of the century, and since 1950 regular formal meetings of the Executive Councils of the five Nordic medical associations have been held to discuss the many problems and interests shared among them.
In 1992, this cooperation was formalized with the creation of the Nordic Medical Council (Nordisk Lægeråd).
DMA was a founding member of The World Medical Association in 1947, and DMA's international activities continued to increase to the point where, in 1970, the Council set up an International Committee to coordinate DMA's participation in international cooperation.
The International Committee's membership is representative of all medical subgroups via the following composition:
3 members appointed by DMA Executive Council
(one specialist, one GP, one junior doctor)
2 members by the GP organization
2 by the Junior Doctors association
2 by the Specialists association
The Committee is chaired by the President of the DMA who is also the Chairman of the Executive Council.
The International Committee's task is to follow developments on the international level relevant to health and medicine and to submit recommendations and advice to the Executive Council in this respect.
DMA is a member of the
Standing Committee of European Doctors (CP).
European Union of Medical Specialists (UEMS)
European Union of General Practitioners (UEMO)
Permanent Working Group of European Junior Doctors (PWG)
European Association of Senior Hospital Physicians (AEMH)
International Conference of Orders (CIO)
and participates in the European Forum of Medical Associations and WHO (EFMA/WHO)

The European Union's medical directives give Danish doctors the right to migrate amongst the 15 member states of the EU as well as the EEA countries.

New international activities
The Danish Medical Association has been very active in leading the effort to extend coverage to European junior doctors of the protection offered to other groups for a 48-hour work week under the EU Directive on working time. DMA has also initiated an action to set up an international network with the aim of assisting doctors to resist any direct or indirect pressure to transgress their ethical obligation not to countenance, condone or participate in torture or other inhumane acts. In this connection, the DMA President and Managing Director attended as an observer for DMA and WMA the recent trials in Turkey of physicians and others from The Human Rights Foundation og Turkey who han been arrested and charged, amongst other things with disobeying an official demand to disclose information about individuals treated for the effects of torture. The development of this network is still underway.

Publications

Ugeskrift for Læger
Weekly Journal of The Danish Medical Association, in Danish with English-language summaries and table of contents. Carries articles on scientific, health and social problems as well as serving as an information organ for members of the DMA and its subdivisions.

Danish Medical Bulletin
An international English-language scientific journal issued six times per year published in cooperation with The Danish National Board of Health, the three Danish medical faculties and The Danish Medical Association.

DMA Directory (Vejviser)
Directory of members of the DMA and of hospital and other health care institutions in Denmark. An English-language guide to the contents is available.

Bibliotek for Læger A quarterly journal on the history of Danish medicine - the oldest medical periodical in Denmark - issued four times a year.

Lægeforeningens Medicinfortegnelse (Physicians Desk Reference)
Issued biannually - physician's pharmaceutical reference book including all medical specialties recognized in Denmark with a description of their use, doses, price, etc.

September 2004