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„If Nothing Changes We Are at the Beginning of a Supply Problem“
MEDICA.de spoke to Norbert Schmacke, head of the working and coordination unit on health care supply research at the University of Bremen, about the German shortage of physicians, the recruiting of young physicians and alternative medical care models.
MEDICA.de: Mister Schmacke, in city centres, physicians are ten a penny whereas on the countryside successors for practices are barely to find. What is the reason?
Schmacke: For a long time, physicians in Germany have been unequally distributed. This unevenness between rural and urban areas has increased and will further increase if nothing is done.
MEDICA.de: Does Germany suffer from a shortage of physicians then?
Schmacke: No, I would not say so. Moreover, I do not think there is a mathematical formula with which the demand of physicians could be calculated objectively. The number of physicians in Germany compared to other countries with a similar good working health care system does not yet suggest a shortage of physicians in total, though.
MEDICA.de: A law came into effect this year in Germany that abrogates the retirement age for physicians supposed to ease the shortage of countryside physicians by letting retired doctors practice longer.
Schmacke: This is a reasonable step as physicians definitely can practise even in older age and also because it does ease the situation on the countryside. However, it is only a small building block and it does not solve the underlying problems. It only delays them. Junior physicians that could replace the older colleagues are still lacking if we do not change the reroute soon.
MEDICA.de: Can 70, 80 year old physicians in still cope with the responsibilities of their profession?
Schmacke: A retirement age as late as 67 is unrealistic in physically exhausting jobs. Physicians though have high life expectancies. In this field I find working with the age of 68 absolutely realistic. However, it is difficult where to draw the line. Certainly, the retirement age should be regulated and not be left to individual decisions.
MEDICA.de: What needs to be done to attract young physicians to the countryside?
Schmacke: For example, the admission to medical studies could be tied to conditions: applications of persons from certain rural areas could be preferred. These students would then be used to the countryside life and would more likely feel at ease in those surroundings. At the same time, these students would have to obligate themselves to work in rural areas for a number of years after their studies. Such methods are used in other countries such as the USA successfully – in Germany, however, there is no legal basis for such requests.
MEDICA.de: What will happen if young physicians do not start to settle down in the countryside soon?
Schmacke: If nothing changes we are at the beginning of a supply problem. We have to think about how to make life on the countryside more attractive for both male and female physicians and about alternative medical care models already in existence.
MEDICA.de: What do you mean by that?
Schmacke: It has to be checked and evaluated how well models from other countries apply also to Germany. Countries such as Ireland often have far less physicians in sparsely populated areas than Germany. They solved the problem by, for example, outreach consultations hours: A practice on the countryside is maybe not opened five but two days a week attended by a physician coming over from the nearest town. That way people know for sure: on Monday and Thursday the physician is available and they can plan accordingly. Of course, in addition to this, a well organised emergency system has to be developed. This might not be a perfect solution but if there is no alternative because the physicians are not moving to the countryside, then this is a common instrument worldwide.
We also need to consider carefully which functions could be taken over by other employees in the health care sector to unburden the general practitioner. In a whole lot of countries such as Great Britain, nursing staff with additional academic education can work in ambulatory care, partly limited, partly autonomous. A variety of models exist: the nursing staff can for example take over consultation hours while being bound by instructions at the same time. Or the physician and the qualified nursing staff both work self-determined in one practice and the patient can chose its contact person. This is predominantly regarded as utopian in Germany at present.
MEDICA.de: Does that not compromise quality of care?
Schmacke: No, there is no indication that such health care models are worse than others. And there are certainly good reasons that imply giving alternative models a try; even though there is no definite formula for success. The organisation of different health care systems in the world depends very much on geographic and cultural habits. In Germany, we probably have to say good bye to some much appreciated customs such as the “physician just around the corner”.
The interview was conducted by Anke Barth.