With the pandemic coming, people in rural areas are once again being reminded of the important work done by resident doctors. But the supply of people is unstable – the offspring is missing. Approach.

Rotenberg – The young woman does what is described in the vernacular as “seemingly restrained”. She has recently moved from the Bremen district of Findorf to Bremen-Nord. Well, she must have thought, a doctor’s practice in the neighborhood, where she could register as a patient. Away from this, please write an email.

However, you have to expect a waiting period of three months. What the young woman experiences is typical: on the one hand, family doctor practices are literally dismantled by interested patients, on the other hand, more and more doctors are leaving their jobs, mostly for reasons of age. There are no successors in sight – statutory health insurance practitioners, unions of health insurers and scientists have been recording a steadily decreasing desire for potential physicians to practice as general practitioners or specialists over the years. This problem currently affects fewer urban centers than rural areas and city outskirts.

“When filling doctors’ seats, the magic word is work-life-balance,” says Detlef Hafke, spokesman for the Lower Saxony Association of Statutory Health Insurance Physicians (KVN). For example, those faced with the question of taking over an existing practice or opening a new one today may want to see if a partner can find a “good enough job” nearby. And if children are there or are employed, schools and childcare facilities play a decisive role. According to Haffke, further questions are the frequency of on-call duty in the evening or weekend, possibilities of collaboration with other doctors in the area, leisure opportunities and the expansion of local public transport.

District still in good supply

According to KVN, the district of Rotenberg still has a good supply of general practitioners and specialists, even though there is still room for improvement. The legal basis for this is what is known as need planning. For these there are field observation areas, planning areas. A specialty’s “population to doctors” ratio is also important. In addition, there is the question of how high the standard of medical care is in a specialty. If it is 110 percent in relation to the population, then this area is blocked. This calculation is again based on a ratio. For example, according to Haffke, a family doctor should care for 1,609 residents. One ophthalmologist is responsible for approximately 12,460 residents. AND: Ratios may vary slightly in different regions. The lower the level of care, the more doctors in the specialty can settle there. Or to put it another way: “A supply level below 100 percent indicates a need.”

According to KVN, general practitioner care for the entire district of Rotenberg is still good, but no longer optimal. The requirement is for eleven general practitioners. It looks different with the experts. The district is blocked here as the coverage level is more than 110 percent. According to KVN statistics, only one psychiatrist and 2.5 psychotherapists are needed.

But what can be done so that the supply of population in rural areas does not turn into a disaster in the medium and long term? This is primarily the case for the Association of Statutory Health Insurance Practitioners. Above all, our own infrastructure funds must bring at least relief, if not a cure. So far, according to its spokesperson, KVN has spent 20 million euros on “acquisition of branches, employment and practices in areas with short supply.” However: “The district of Rotenberg has not yet been included.”

There is a shortage of doctors.

But securing the future has to start much earlier – even with students. For a long time, doctors’ representatives have been demanding an expansion of the number of locations offered and targeted support to future general practitioners. However, not only money is necessary. It also includes addressing students by attending trade fairs, university consultations, student meetings and excursions. In the district of Rotenberg, following a 2018 district council resolution, six medical students are now supported with scholarships – on condition that they also work here later.

To ensure that the people of the city and country are supplied with adequate general practitioners and specialists in the future, medical care centers (MVZs) have been established in recent years – others after the closure of the Ostmed clinic in Zeven. Apart from things. Here doctors from different departments work under one roof. However: an MVZ is only successful thanks to specialist medical care. At least that’s what Lars Wiesmann, theological director and press spokesman for the Egglesen Diaconiclinicum Rotenberg, suggests. “The medical care provided by the MVZ has proven itself. Thus we are making a major contribution in ensuring supply to the region, and we do not see any point in retrofitting the existing structures.” The clinic attempted to set up a family doctor’s practice with a permanent doctor, but this did not work because the desire to be self-employed was high in this case.

MVZ. good experience with

The hospital in the neighboring district of Osterholz has also had positive experiences with the MVZ – and has been doing so since 2006. According to hospital manager Klaus Vogt, doctors only work in the MVZ. MVZ “sometimes fills a large medical gap”, Vagt said, adding that it “can create a connection between outpatient and inpatient care”.

But what comes after MVZ or specialist medical treatment? Here, Wiseman outlines the particular (Rotenberger) problem: post-patient care in the Diaconiclinicum. It then becomes particularly noticeable that the shortage of general practitioners continues to grow. “Problems also arise in our emergency department when patients present with complaints that absorb procedures and resources that should be reserved for critically ill patients,” an Eggplacen spokesperson said. Wißmann draws up a grim balance sheet: “The shortage of doctors is obvious.” Politicians urgently need to do more “to improve the framework conditions for family doctor activities in rural areas, among other things”. “You have to go looking for new concepts.” This may include “opening clinics for certain outpatient services” through a licensing law. Until now, this has been the sole responsibility of the statutory health insurance associations of the federal states.