Journal-Healthmanagement

The need carries woman

German doctors are mobilizing, but the German medical profession in general is neither starving nor threatened with extinction

The organizers spoke in advance of the largest demonstration of doctors after the Second World War, and in the end it seems to have been true. In Berlin alone, more than 40 associations participated and about 20.000 participants in the "Day of the Doctors" rallies, and nationwide, half of all practices remained closed. In this way, Germany’s physicians in private practice also protested against undesirable developments in the health care system, which, according to Jorg-Dietrich Hoppe, have led to "inhumane working conditions and unpaid overtime" for some time.

The president of the German Medical Association estimates that additional expenditures of seven billion euros per year would have been necessary if all services provided by physicians in private practice had been paid in full. By compensating all overtime in hospitals, this amount could increase by another five billion euros.

All in all, the health insurance companies would have to pay an additional twelve billion euros a year. This is roughly the amount that doctors are currently giving to the health care system.

Jorg-Dietrich Hoppe

In view of these alarming figures, a wave of solidarity is sweeping through the country, where medical personnel are not only highly valued in TV series. According to an Infratest survey conducted by the Verband der niedergelassenen arzte Deutschlands e.V. (NAV-Virchow-Bund:http:.Nav-virchowbund.De), 81 percent of respondents were sympathetic to demands for better working conditions, less bureaucracy and more pay. The medicament savings law, fought by the interest representatives for a long time, is rejected logically – by breath-robbing 84%. And the headline hunters of a well-known daily newspaper had the right nose already at the end of November last year. "Why does a surgeon make less than an electrician?"Bild" asked at the time, describing the sad fate of Berlin resident Dr. Frank Unterhauser. Frank Unterhauser, who earns only 1,800 euros for 70 hours a week, while Michael Wenk, a master electrician, earns a good 2,800 euros.800 euros, while master electrician Michael Wenk earns a good 2.500 euros.

No wonder, then, that Germany is now facing a shortage of doctors and that more and more physicians are seeking their salvation abroad, where, according to "Die Zeit," "paradisiacal working conditions" await them. Thus, Great Britain has already lost 2.600 German doctors with less on-call time and overtime coded and lured away. The USA, Switzerland and many other countries are also seizing the opportunity and currently offering a good 12.000 doctors a new home. The president of the German Medical Association, Joppe, was visibly excited when he pointed out in Berlin that "medical students in their third semester are already starting to learn Norwegian. Semester start learning Norwegian (…)."

Figures from the Ministry of Health

The Federal Ministry of Health (BMG) did not want to accept these figures and interpretations without comment and therefore presented its own assessment, dubbed a "farce paper" by Jorg-Dietrich Hoppe, with facts and figures on the situation of the medical profession one day before Doctors’ Day. Sie halt den 12.000 emigrants not only 18.000 foreign physicians in Germany, but comes up with a number of other interesting statistics.

According to this, the turnover per medical practice in 2003 amounted to 202.588 euros (West: 205.257/Osten: 187.693 Euro). After deducting the practical costs, this resulted in a surplus of 84.976 euros (West) and 78 respectively.268 euros (east), which was supplemented by income from the treatment of private patients.

If one believes the micro census data of the year 2003, also physicians in the public service came in this year still on a monthly net income of 3.093 euros. The gross annual income of 32,834 euros that the average employee took home in 2004 is not particularly impressive.834, although in the case of physicians there are considerable differences between chief physicians, specialists and assistants. While doctoral assistants under 35 years of age in the public sector "have to get by" with a net salary of 2,176 euros.176, the chief physician can easily plan on three times that amount under certain circumstances, whereby the Federal Ministry still assumes a "private liquidation from approx. 50.000. Where there is room for the salary increase of up to 30 percent demanded by Frank Ulrich Montgomery and his Marburger Bund remains a mystery.

Furthermore, according to the OECD, Germany is apparently not the poorhouse of Europe when it comes to the remuneration of its doctors. Although the earnings potential of family doctors in Germany is significantly lower than that of their colleagues in the Netherlands, Switzerland, Denmark or Great Britain, they are also clearly higher than doctors’ salaries in France, Finland or Sweden.

According to the Ministry of Health, a similarly differentiated picture emerges from the analysis of working hours. High weekly working hours are more common among physicians than among other academics in the public sector, and 7.6 percent of young physicians regularly work more than 60 hours a week. However, according to the BMG, the average weekly working time is 46.1 hours, which is not yet beyond all reasonableness.

The ministry also emphasizes that the number of physicians in private practice has increased by almost 22 percent since 1992. Because population growth has not kept pace, in 2004 a doctor had to care for an average of only 269 inhabitants, compared with 322 in 1992. However, there are also major regional differences, for example between Hamburg (184) and Brandenburg (332) and generally between eastern and western Germany. Nevertheless …

… For comparison: in the Netherlands there are 317 inhabitants per professional physician, in Norway 345 inhabitants and in Great Britain 557 inhabitants. A higher physician density than in Germany can only be found in a few countries.

Federal Ministry of Health

The Federal Medical Association holds with the age development of our society and the medical progress against it. In 1993 only 404.963.284 outpatient curative medical services were provided, but this number had already risen to 491 in 2000.746.184 increased.

Possible, but again hardly decisive, because according to opinion of the BMG cannot be spoken for example also from the fact that the number of the medicine students and – graduates would have decreased appreciably. As is so often the case, the opposite is true.

Since 1999, the number of students has fluctuated between 80.000 and 81.000 with a slight upward trend in the past three years. The number of graduates in the past years has also regularly hovered around 9,000.000, thus remained relatively constant.

Federal Ministry of Health

The above figures leave little doubt that the German medical profession is neither starving nor threatened with extinction. Nevertheless, their protests are not entirely unjustified. Particularly in the lower income brackets, a salary increase – now also announced by the Federal Minister of Health, Ulla Schmidt, after the protests – would be just as necessary as a significant reduction in working hours, and the entire health care system must be interested in removing the many bureaucratic obstacles anyway. Moreover, it might be interesting to bring into the discussion the salaries of the board members of the health insurance funds or to take into account the not inconsiderable allowances paid to the members of the board of directors of the National Association of Statutory Health Insurance Physicians, which for the top officials of the National Association of Statutory Health Insurance Physicians amount to as much as 260 euros.000 euros a year.

But it’s not just about the money. Patients want to talk about the quality of the medical care they receive. The fact that this does not necessarily have to go hand in hand with an increase in the cost of the healthcare system is also currently being discussed in Great Britain. In Germany, this more important debate has already begun. Assessments of the German citizens can be read in the quoted Infratest survey of the NAV-Virchow-Bund, even if they were not taken into account in the press release for the "Day of the Doctors".

Why not? For the evaluation of the conflicting opinions, it is somewhat revealing that the simple task "I will now name a number of institutions and organizations from the German health care sector and you will please tell me how much trust you have in each of them, using school grades, where 1 means ‘very great trust’ and 6 means ‘no trust at all’" was responded to as follows: Only 26 percent gave the German healthcare system a grade of 1 or 2, but 43 percent gave doctors a 3, 4, 5 or 6, 78 percent gave doctors’ associations a 3, 4, 5 or 6, and 92 percent gave the federal government a 3, 4, 5 or 6.

That something is wrong or no longer right here is quite obvious, but the German health care system can hardly be helped with cosmetic corrections. Rougher operations are needed to bring about lasting changes and improvements. For the next construction site is already waiting: Barmer boss Eckart Fiedler fears a financing gap of seven billion euros in the statutory health insurance system in 2007 and has already announced that premiums "will have to rise across the board" in this case. Before the federal government lets this declaration of bankruptcy pass, the coalition should put the topic of "health", which has been avoided so far because of too many differences, at the top of the agenda as soon as possible.

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