Capabilities and motivation
The district medical officer's knowledge, expertise and experience during pandemics and in normal circumstances were considered to promote the execution of the role.
'The district medical officer possesses additional expertise that can be valuable. It became clear how important it is to have an expert in such a key role (during the pandemic).' (Participant 2)
During the pandemic, the role of the district medical officer became more apparent and its importance easier to substantiate.
'It's now very clear what a district medical officer is and how useful it is to have professional medical assessments.' (Participant 12)
However, one of the participants did not share this view and said:
'I don't think my role became clearer during the pandemic. On the contrary, you become a sort of jack-of-all-trades that people call to solve problems, so in many ways, it has perhaps made the role even more undefined.' (Participant 6)
The community medicine expertise that district medical officers had used during the pandemic was in less demand by the municipal management after the pandemic was over. The participants expressed low expectations of becoming more involved over time. All participants expressed that they perceived the role as barely visible since the end of lockdown and protection control measures in spring 2022.
'When things settle down, you go back to everyday life as it was.' (Participant 2)
Access to decision-making arenas was also considered better during the pandemic than afterwards:
'The pandemic was a special time when all of our input was listened to, both by politicians and the administration. This is not the case in normal circumstances.' (Participant 11)
The lack of demand for the district medical officers' expertise was considered a barrier to involvement in decision-making processes and a source of concern.
'What worries me the most is the cases where I should perhaps have been in the loop, but that I'm not familiar with and am not even aware of.' (Participant 3)
When the participants themselves were called on to define the role of the district medical officer, it proved to be difficult. The role was described as vague, expansive and diffuse, and challenging to fulfil and execute in an efficient and satisfactory manner. The role's lack of clarity and visibility externally hindered its execution. In contrast, the role was also described as autonomous, with a high degree of freedom to shape it. This freedom was considered to be an important motivating factor. However, participants also highlighted the responsibility for further developing the role.
'I think (...) we need to carve out a place for ourselves and make ourselves relevant. It's important for the municipalities to have district medical officers with expertise in community medicine.' (Participant 9)
Nevertheless, striking a balance between autonomy and involvement in the decision-making was considered a challenge.
'I mostly manage my daily work myself, so in that sense, I have autonomy, but I don't have the influence I desire.' (Participant 5)
On the one hand, the participants wanted clearer frameworks for the position in order to promote opportunities for influence. On the other hand, they wanted to maintain the flexible nature of the position. This ambivalence contributed to a sense of uncertainty.
'The good thing about being a district medical officer is the freedom (...) I'm not sure how to more closely define the role without compromising the freedom we have.' (Participant 7)