in addition the free choice reform with a free establishment right for providers has tended to concentrate physicians in urban areas the number of patients in sweden reporting they have had to seek hospital emergency care because a primary care physician was not available is considerably higher than in most other eu countries van den berg et al also afterhour accessibility to primary care is often limited and unnecessary hospital emergency department visits for minor problems is a common complaint among both patients and health care professionals commonwealth fund however the number of specialist nurses and other advance practice nurses remains low and the number of new nurses graduating with specialty training and an advanced degree has fallen since