Will there soon be no more doctors in rural areas?
After studying together, a friend became a country doctor in the far north. We met at long intervals over the years, and then we put our professions side by side, he a generalist alone in the country, I a surgeon in a maximum-care hospital in the big city. Professional worlds could hardly be more different. I am part of a large team in daily exchange, he is always on his own with everything. Me with a fixed salary, he with changing point values. I have regular working hours, he is always on duty.
Even when the practice was closed, his patients sometimes came into the garden behind his house and knocked on the window, even on Sundays, even at Christmas. But still he radiated an enviable satisfaction with his work, he knew his patients: inside, and he knew their families, sometimes for generations. His work as a country doctor gave him great satisfaction.
In Germany there were around 537,000 doctors at the end of 2020, of whom a little over 410,000 were employed, so statistically there is one doctor for every 200 inhabitants. 212,000 work in the hospital, 161,000 in the outpatient sector, 115,000 of them in private practice. That would be almost 700 inhabitants per practice. One often hears about a shortage of doctors, but these numbers don’t actually look like a shortage.
But the problem lies in the detail. If one only looks at the 44,000 or so general practitioners, it is noticeable that more than 17,000 of them are over 60 years old, that is almost forty percent! This gives rise to a gigantic succession problem. However, the interest of young doctors in general practice is decreasing from year to year, and there are now more and more medical practices for which no successor can be found and which simply close. In a survey of medical students, family doctor work came in second, behind internal medicine, but around half of those questioned could not imagine working in rural areas. The compatibility of family and work, regular working hours in the team and a range of leisure and cultural activities are at least as important to young doctors today as satisfactory work.
However, this cannot be achieved with a country doctor’s practice with 60 to 80 hours of weekly working hours. Incidentally, this also applies to paediatrics, where miserable remuneration is added as a further deterrent. The specialist medical care in the cities will boom, the family and pediatric care in the country will collapse more and more. There – and only there is the shortage of doctors localized.
The health minister of North Rhine-Westphalia, Karl-Josef Laumann (CDU), has just proudly praised the “country doctor quota” that he introduced into medical studies three years ago by law: Anyone who undertakes to sign up after a total of twelve years of study and specialist training as The Numerus Clausus does not apply to the general practitioner in an underserved region in the country. On the other hand, activities in the care sector and in the rescue service are counted positively when allocating study places. Combined with financial incentives to set up a business, every 13th place in medicine in North Rhine-Westphalia is reserved for the rural doctor quota. This is a good idea that has sparked off: the rush is great, and there are seven applications for one place. There are now similar programs in eight other federal states.
A major criticism of all of these programs is that the first graduates will not be available until 2030 at the earliest. By then, however, the number of general practitioners and paediatricians will have dropped dramatically to less than half of what is needed! Doctors’ organizations also point out that there are increasing supply problems in cities too, especially in socially disadvantaged neighborhoods. They are calling for a significant increase in the number of study places and significantly better working conditions in outpatient basic care. The country doctor quota will remain symbolic politics if the problems here and now are not solved at the same time. Telemedicine, branch practices and omnibuses as mobile medical practices are not sufficient for this.
As the latest act of desperation, doctors from other parts of the world are to be recruited in the future. But this is another story.
