German doctors shun eastern states

Germany has for decades shunned its junior doctors working conditions,
educational needs and income levels - it is only starting to pay the bill
now. This will not sink in until wide parts of the German states are
affected by staff-shortages. Not amazing considering that the financial
motor of the German healthcare is the bank like organized compulsory
healthinsurance company, which so far over the last decade have tried to
save their customer fees by steadily reducing the value of points. Points
is the currency doctors getting paid in for their services by the
insurances in primary care in Germany.

Furthermore the lower point-value
of the east will predictably yet for another 8 years at least stay below
the higher West German point. Where at the same time Insurance companies
and Health Insurance Unions (KV’en) pay standard West German levels of
income to their employees and directors.

Pay of practitioners in the east is further reduced by the fact that due
to lower income levels of population and higher percentage of pensioners
the part of privately insured patients in the average general practice
only reaches 1% compared to 10-20 % in West Germany.

Relief or true reform is not in sight - not from introduced DMP’s (Disease
Management Programme) aiming to shift money into improved quality of care
and areas of need with high mortality and morbidity as they predominantly
exist in East German rural and deprived areas and not from most recently
introduced reform laws of the German Government – all only aiming at
further reduction of cost or shifting it to the insurance or pension
customer.

True reforms would need to reduce bureaucracy, reduce cost dried up within
the system, probably need to introduce a citizen’s insurance, abolish
opting out of public insurance for healthy better earning clients, cut
down the number of hundreds of healthinsurance companies. These might be
circulating ideas, but you will fail to find them in recent law
applications at the Bundestag, as this would touch the very base of the
German insurance system. Matters are not helped by the disagreements
between GP’s and specialists and lobbying against each other - who should
provide primary care and get the bigger piece from the ever shrinking
cake.

Saying that – GPs are between the best earning practitioners in primary
care. Net-income in the east for GPs averages 2200 €, orthopaedic
surgeons and ophthalmologists for instance earn even less. Rural GPs in
areas of greatest need work up to 70 hours not counting on calls for that
money a week.

I doubt immediate help could come from the Eastern European countries -
apart from the doubtful morality of drawing resources from there – without
reduction in quality of care and think: this only serves as a desperate
attempt to draw attention to the pending crisis.
Hurdles to work as a GP ironically also built up, to prevent returning
Germans to work in their country by a trap called reciprocal
discrimination, where EU trained doctors are allowed free move and
practice in Germany but only if they not German passport-holders. Germans
have to go through the German GP training to qualify as GPs under
regulations. I for my part after 7 years practice, JCTGP and MRCGP had to
work ½ year as a GP registrar for the generous net income of 1200€ again ,
pass numerous courses of doubtful significance and sit a joke of exam
called Facharztpruefung asked only 3 short questions by 3 wise men. For
details of my questions check the German website
http://www.klinikleitfaden.de/. And this is only part of the difficulties
German returnees face, just try to get healthinsurance if you pregnant
and out of the country for longer than 3 years – Gordon’s knot is an easy
riddle compared to that.

Yes there are staff shortages and it is much easier than even 7 years ago
to get training posts but the market based German Health Care has not
changed to improve conditions of work, training , learning and pay of
their doctors overall. True you get headhunted if anyone picks up that you
could consider practicing as a GP – but there is not much to headhunt and
recruit with.

I am grateful to the people who supported and lobbied my return to Saxony
Anhalt - foremost to my great trainer and BDA (Union of German GP's)-
politician Frau Dr. Gitta Kudela in Magdeburg and my father Herwart, who
stood by us in times of financial and emotional hardship.
And I beg their forgiveness, that we turn our back again on East Germany
and it’s patients for “greener” pastures - but maybe we were spoiled by 7
years of training and work in Scotland, England and Australia - before we
even got there.

We are “shunning” Germany.

Helko , Berit and Martha Schenk

Competing interests:
I am shunning Germany.