Risks and side effects of a shortage of doctors?
‘He was an impressive man in every respect: tall and powerfully built, with a wild brown mane and a striking face. At over fifty years of age, he was still a figure that patients around the world flocked to see.’ This is how or very similarly doctors’ novels from the penny dreadful genre portray leading male doctors in hospitals. Patience and care beyond any normal measure and never tired, not even after three appendectomies. No wonder that reality can hardly keep up. Not only is a great deal expected of doctors around the clock, but the white coat in the hospital has also been clearly torn. There is already a shortage of around 15,000 doctors in Germany’s hospitals.
A career beyond the clinic
Cost-cutting pressures on hospitals, inflexible working hours, increasing bureaucracy and time pressure in patient care are just some of the reasons why doctors are increasingly leaving hospitals or not even applying for jobs there. There is a marked migration to the non-inpatient sector or to countries where higher salaries are more attractive, such as Switzerland. A brilliant career in hospital at any price – that was once the case. The work-life balance, i.e. the compatibility of private life, family and career, has also become more important to doctors. Digital healthcare providers (online counselling) as well as pharmaceutical and industrial companies are increasingly valued as a more flexible and independent alternative to working in a hospital. Others prefer the regular service in a private clinic or an MVZ. After completing their training, some switch directly to a management consultancy and support private and statutory health insurance companies, associations and medical practices from there.
Numerus Clausus is not the only obstacle
And the shortage starts at the universities. Between 3,000 and 6,000 additional medical study places per year would have to be created in Germany in order to maintain the current level of care alone (source: Central Institute for Statutory Health Insurance Physicians, 2019). The numerus clausus continues to be a hurdle that leaves many young people who would be perfectly suited to the responsible medical profession feeling like they are being left behind. A reform of university admissions, as called for by the German Medical Association, is long overdue.
All of this is already having far-reaching consequences for hospitals. Just one example: if a specialist department can no longer provide a fixed staffing ratio to maintain a department, it is threatened with closure and the hospital loses an important specialist area for patient care in the region. It should be noted that the exodus does not only affect the medical profession. It is also significantly noticeable in commercial positions. Here, too, the reasons lie in the high workload in the ‘agile hospital’ and the increasing number of legal regulations and requirements that must be complied with.
The HAGER Business Unit Life Sciences & Healthcare has identified another phenomenon. In clinics, fewer male and female senior physicians are aspiring to the position of chief physician or head of clinic. The personal liability of a head physician under civil law has emerged as a key motivation here. A responsibility from which subordinate doctors are exempt in the event of damage.
‘Many doctors are being lost to hospitals because the structures are too rigid. And they can earn twice as much in the pharmaceutical industry or in consulting.’
Hurdles for foreign doctors
The shortage of doctors continues to worsen. Even outside of hospitals: according to a study, if nothing changes in the near future, around 11,000 GP positions will be vacant in Germany by 2035 and almost 40 per cent of rural districts will be undersupplied or at risk of undersupply (source: Robert Bosch Stiftung, 2021). There are several possible solutions. However, the root of these must be to promote the next generation of doctors and make the profession more attractive again.
This includes new rota regulations and fairer pay that does not favour individual specialist areas. Another key point would be to reduce the bureaucratic hurdles that foreign doctors (especially if they come from a non-EU country) face when they want to work in German clinics – and practices. Foreign doctors have to prove their German language skills with the specialist language test and have their qualifications recognised for their specialist licence. This can be a lengthy and time-consuming process that could be streamlined. Experience has shown that both general German and medical terminology are learnt quickly and the level of commitment is above average.
Without immigrant doctors – and medical professionals in general – and the coronavirus pandemic has shown this as if under a magnifying glass, the healthcare system may face collapse in the near future, and not just in hospitals. As things stand today: 56,000 doctors in Germany do not have German citizenship, which is 13.7 per cent of the total number (source: Expert Council for Integration and Migration, Berlin, 2022). Looking at the demographic development, the German healthcare system would hardly be able to function without these specialists (including in the nursing professions).
Offer more options
It is therefore not only more efficient structures in hospitals that can be used to counteract the shortage of doctors and thus a gap in care. Many hospital doctors no longer want to work full-time, and they should also be offered more options. And finally, doctors’ novels need to be reformulated: Patients don’t want to ‘lie at the feet’ of the modern hospital doctor, but want to find a competent and motivated contact person in him or her. The white coat is protective clothing and no longer a status symbol.
Do you need help with the recruitment of doctors? Then contact the authors of the article Dr med. Markus Neumann, Head of Business Unit Life Sciences & Healthcare and Michaela Bender, Manager Healthcare.
