A doctor or a health care professional is a medically trained and to exercise the medicine approved person. The medical profession is considered the prevention ( prevention ), detection ( diagnosis ), treatment ( therapy ) and aftercare of diseases , ailments or health problems and also includes forming activities.
Doctors put themselves at the service of health and are committed to moral and ethical principles in their actions (see, for example, the Geneva Declaration of the World Medical Association ). The variety of diseases and treatment options has led to a large number of specialties and further differentiations in human and veterinary medicine (see the list of medical specialties ).
The term doctor ( Middle High German arzāt, arzet, artzt , Dutch arts ; related to " Arznei ") moved from the Latin scholarly language to German during the Middle Ages , via the Latinized variant archiater (late Latin also arciater ) of the Greek ἀρχίατρος archiatros , classical pronunciation [ arkʰíatros ], consultant ',' personal physician '(since the 2nd century the official title of personal physicians at court and for public bestallten community physicians), a composition of ἀρχή ark [ arkʰɛː ], German , domination' , command 'and ἰατρός iatros [ iatrós ], German 'doctor' . The original Greek word ἰατρός or the Latinized form -iater appears as a word component in many technical language compound words: iatrogenic "caused by medical action"; Psychiatrist "soul doctor"; Pediatrician “pediatrician” etc. The word found its way into other languages through Middle High German, such as Latvian ārsts , Estonian arst .
The Germanic term for the medical profession ( Old High German lâchi ) is for example in Danish læge , in Swedish läkare , in English leech ' leech ' (see Bald's Leechbook ), or in the German family name Lachmann and has spread into other languages, e.g. B. Finnish lääkäri , Irish Dochtúir leighis . In Polish lekarz and Czech lékař , the Germanic root is connected with a Slavic suffix ( -arz , -ař ).
The Latin name medicus 'doctor' (originally as a general professional designation independent of the level of training; since the 10th century then differentiated from chirurgicus or chirurgus , the surgeon ), or a form derived from it, is mainly found in the Romance languages , for example Italian medico , Spanish médico , Portuguese médico , Romanian medic , French médecin , but under Romance influence also in other languages: Basque mediku , English medic . To distinguish from the (not yet in the 18th century "full doctorate") chirurgicus was also the term medicus purus ( "pure Doctor") used (efforts to unite the surgery with the "medicine", translated roughly in the middle of the 18th century a). The term physicus usually meant an academically trained doctor (see English physician ).
In many languages, the doctor is colloquially after his mostly guided academic degree Doctor called. From the 13th century onwards, lay doctors working in folk medicine were also occasionally referred to as doctors .
To the medical profession
The role of doctor is one of the oldest known to man . Medical History seen the medical profession arose (deprecated also Arzttum ) from the prior healers who have been among the priests of antiquity were found. The first written evidence of the medical profession comes from Mesopotamia and was published in the 3rd millennium BC. Written in BC.
The training of doctors of antiquity found in so-called medical schools (z. B. School of Kos , School of Knidos , Alexandrian school ) instead of the (z. B. in terms of their knowledge to different medical theories methodologists , pneumatics , Hippocratics ) and philosophical Aligned currents (e.g. Epicureans , Stoics ).
The modern training of doctors began in the 18th century with the expansion of scientific knowledge and the introduction of systematic practical teaching at the bedside.
Uniform examination regulations (see also licensing regulations ) for doctors first existed in Germany in 1883.
In 2014, the proportion of women doctors in the total number of working doctors had already risen to 45.5 percent, although the proportion of women at the start of their studies in 2015 was almost two thirds.
Salus aegroti suprema lex (“The well-being of the sick is the top priority”) was the norm for doctors into the 21st century . The patient's right to self-determination has also been added in the case law .
Health and disease behavior
While the physical health of male doctors appears to be comparable to that of the general male population, the physical health of female doctors appears to be better than that of the general female population.
With regard to mental health, it is noticeable that depression and addictions are more common among doctors than in the rest of the population. Another clinical picture that frequently occurs in doctors is burnout syndrome , which can already be detected in medical students at an increased rate.
Several studies have shown an increased rate of suicide among doctors compared to the general population . The increased relative risk of committing suicide compared to the normal population was 1.1–3.4 for doctors and 2.5–3.7 for women doctors. Since in most of the studies only a small number of suicides were examined, the confidence intervals for the true value of the risk increase were wide. It is believed that a significant number of suicides are not recorded because they are mistakenly labeled as poisonings or accidents . Of the various professional specializations, psychiatrists , anesthetists and general practitioners in particular are affected by an increased suicide rate. Various factors are discussed as causes of the increased risk of suicide. A personality profile with obsessive-compulsive features can lead to a depressive disorder as a result of job demands. The difficulties of reconciling family and career aspirations can lead to exhaustion and depression, especially for doctors . Addictions (such as alcohol , drug and medication addiction ), which are more common among doctors, are usually associated with depression and an increased suicide rate. This risk profile established for doctors is independent of their occupation and applies to most suicides.
Psychological problems often correlate with time pressure and a lack of autonomy in the workplace as well as stressful patient-doctor relationships . Doctors are less likely to be on sick leave and show under-utilization of medical care services. Doctors often treat themselves. However, treating one's own mental disorders independently is often ineffective.
Because of their medical profession, the holy twin brothers Cosmas and Damian are among other things the patron saints of doctors. Another patron saint is St. Pantaleon , one of the fourteen helpers in need .
Legal classification of the occupation
Doctors are subject to state monitoring of approval ( license to practice medicine in Germany, see below in other EU countries) and, among other things, the law on doctor's advertising , which means extensive restrictions in publication and publications. As a rule, doctors are not liable to their patients for the success of their actions, but can be obliged to pay compensation to them from the point of view of medical liability .
The free exercise of medicine is in Germany only allows licensed doctors. Non-medical practitioners are also allowed to treat the sick with defined restrictions , whereby the clearly defined limits must be observed. As an exception, special areas of diagnostics and therapy are also carried out (mostly at the request of doctors) by members of the health professions .
From the time of the medical license to practice medicine, the doctor is allowed to use the legally protected designation "doctor" and receives with it the state permission for self-dependent and independent medical activity. The nationwide uniform license to practice medicine regulates the previously successfully completed at least six years of medical studies with regard to the duration and content of the training in the individual subjects, as well as the exams. The study of medicine includes a. three exams and one year of practical experience (so-called “practical year”). From October 1988 to October 2004, in order to obtain a full license, an additional 18-month, low-paid work as a doctor in an internship under the supervision of a licensed doctor was required by law. Usually, a licensed doctor works for several years as an assistant doctor at further training facilities recognized by the State Medical Association (such as hospitals in 1956 , 35.6% were privately owned in 2015; less often individual large practices) in order to receive credit for further training in one or more specialist areas of medicine and possibly follow up In addition, to take a specialist examination with at least four years of further training. The requirements for this are regulated in the advanced training regulations of the state medical associations. Resident doctors work in private practices , if necessary with several doctors in a professional group (formerly: group practice) or practice group (see also Contract Doctor Law Amendment Act ). Fee -based doctors work on a fee basis for various clinics or resident doctors.
Every doctor is a notifiable compulsory member of the medical association (of the federal state) in whose area he lives or carries out his medical activity. In 2012, 459,021 doctors were registered with the state medical associations in Germany. To treat those insured by statutory health insurance , the doctor needs a license ( specialist in his own practice) or authorization (as a doctor in a hospital or similar institution ) and is then also a compulsory member of the Association of Statutory Health Insurance Physicians in the district where he is based . The Ambulatory Health approval have 135,388 doctors (end of 2008): independent 58,095 family doctors and 77,293 specialists. 146,300 doctors are employed in the clinics. At the end of 2013, 35,893 foreign doctors were working in Germany, more often in the east. In 2013, the number of employed doctors in Germany was 357,252.
Under criminal law, medical interventions are equated with bodily harm . This is not an offense when the consent of the person being treated for a reconnaissance present and the action is taken on the status of the current medical knowledge (§§ 223 ff. StGB ). Exceptions exist if the patient is unable to communicate his decision due to his or her condition (e.g. unconsciousness ) and if the intervention is not carried out there is a risk of negative health consequences or even death of the patient. In addition, people who are restricted or unable to consent, such as B. children or, in certain cases, mentally ill people are treated against their will. There are strict legal regulations and procedures for this, in which, in addition to the doctor, other institutions, e.g. B. Local court or legal guardian , participate in the decision.
Before the Act to Combat Corruption in the Health Care System came into force , resident doctors who were licensed to provide statutory medical care did not meet the criteria of Criminal Code, as, according to the decision of the Federal Court of Justice (BGH) of March 29, 2012, they were neither public officials i. S. d. § 11 I No. 2c StGB still as an agent of the statutory health insurance i. S. d. § 299 StGB acted. The loophole in the law was closed from June 4, 2016 by adding StGB (bribery in the health care system) and StGB (bribery in the health care system), as well as changing § 300 and § 302 StGB.
Since April 1, 2012, the granting of the license to practice medicine no longer depends on nationality (amendment of § 3 BAÖ by § 29 of the law to improve the determination and recognition of professional qualifications acquired abroad ).
Competencies and duties
The prescription of prescription drugs and most invasive measures are exclusively reserved for licensed doctors in Germany. In doing so, he is personally obliged to adhere to the recognized scientific standards and medical ethical guidelines. The Geneva Declaration was based on the Hippocratic oath in 1948 . Doctors are also subject to special regulations, such as professional and ethical law , which is also linked to the Geneva Convention . In particular, compliance with medical confidentiality in accordance with Section 203 of the Criminal Code is also laid down in criminal law .
For historical reasons, there are different medical degrees in Germany. In contrast to the specialist title, these do not indicate a special professional competence, but serve as evidence of a scientific achievement in a medical field:
- Dr. med. - Here, following the state examination or the medical diploma ( GDR ), a medical doctorate was carried out. In contrast to other fields of study, it is common in medicine to start the dissertation while studying . The doctorate only takes place after graduation. Details are regulated in the doctoral regulations of the universities.
- Dr. med. dent. - doctor medicinae dentariae (Doctor of Dentistry)
- Dr. rer. medic. / Dr. rer. med. - "Doctor of theoretical medicine", "Doctor of medical sciences", "Doctor of medical sciences" or a comparable designation.
- Dipl.-Med. - The degree of medical doctor from GDR times (acquired 1971 to 1990) is still often to be found in the new federal states. According to various experts, this degree is related to the workload of the acquisition with the Dr. med. to compare the Federal Republic at that time.
- Dr. med. habil. - For a habilitation in medicine, medical work and independent research work as well as completion of the habilitation process are necessary. Then the academic titles Privatdozent and, if necessary, after several years, adjunct professor are awarded, provided that courses are regularly offered at a university. Graduates who do not belong to a university can be appointed as honorary professors for corresponding services .
- Dr. sc. med. - This evenly matched habilitation degrees - awarded in the GDR from 1971 to 1990 - was during the so-called B Promotion acquired.
According to a study by the Institute for Quality and Efficiency in Health Care , German doctors have the shortest consultation times in Europe for each patient, despite longer working hours. It is 30% lower than the European average.
Clinicians spend around 44% of their time writing and taking minutes (as of 2014/2015). According to a project report by the Federal Statistical Office from August 2015, medical, psychotherapist and dental practices spend an average of 96 days a year on fulfilling information obligations, whereby this value represents the total time required by all practice employees and includes all information obligations, including those of joint self-administration.
According to the Germany-wide MB online survey of the Marburger Bund “MB Monitor” from 2017, 66% of hospital doctors are of the opinion that they do not have enough time to treat their patients.
The incomes of doctors in Germany vary because the range of medical activities is broad. There are also differences in working hours among doctors, especially between those who work clinically (for example, 24-hour shifts and a high number of overtime hours) and those who work in private practice (high proportion of “non-medical” work due to being self-employed).
According to the Zi-Praxis-Panel of the Central Institute for Statutory Health Insurance in Germany (2017 annual report) on the economic situation and the framework conditions in statutory medical care from 2013 to 2016, the mean value of the annual surplus per practice owner in 2016 was around 170,000 euros .
Mean values of the annual surpluses per practice owner (according to medical specialty) in Germany in 2016:
|Area of Expertise||
Average values of the annual surpluses per practice owner in 2016 ( rounded to EUR thousand )
|General medicine and internal medicine (family doctor)||174,000 EUR|
|Ear, nose and throat medicine||188,000 EUR|
|Internal medicine - gastroenterology||EUR 260,000|
|Internal medicine - cardiology||EUR 255,000|
|Internal medicine - pulmonology||280,000 EUR|
|Internal medicine - without or with several focuses||EUR 222,000|
|Internal medicine - other specialties||EUR 300,000|
|Child and Adolescent Psychiatry||165,000 EUR|
|Neurology, Neurology and Psychiatry||194,000 EUR|
|Nuclear medicine||EUR 343,000|
|Physical and rehabilitative medicine||130,000 EUR|
|Psychosomatic medicine and psychotherapy||EUR 86,000|
|Comprehensive practices||EUR 284,000|
In order to counteract a shortage of country doctors , the federal government wanted to increase the income of country doctors in a new "Supply Act" in 2011 . Among a large number of laws, the Statutory Health Insurance Supply Structure Act 2012 and June 2015 was the law to strengthen supply in statutory health insurance .
Clinically active doctors
The average salaries of clinically active doctors differ greatly depending on the respective positions:
|position||( rounded to the nearest thousand EUR )|
|chief doctor||290,000 EUR|
|Senior physician||130,000 EUR|
|Assistant doctor||68,000 EUR|
External presentation and advertising
In addition to the strict legal requirements for the practice of his profession, the doctor is also subject to extensive regulations and laws when it comes to the external presentation or advertising of his services and his practice. In contrast to other branches, doctors are absolutely prohibited from promoting or comparing advertising. Since the 105th German Medical Association in 2002, factual, job-related information about your work has been permitted. The main criterion is the protective interest of the responsible patient. The individual health service introduced in 1998 was controversial .
At the end of 2006 there were around 407,000 doctors registered in Germany, 95,700 of whom were not doctors (see figure). 59,000 general practitioners and 60,600 specialists were approved by the health insurance fund. 148,300 doctors were employed in the hospitals.
In 2011 there were around 342,100 working doctors and around 107,300 doctors without medical activity in Germany. There was one working doctor for every 239 inhabitants.
The chronological development can be read from the following table and the illustration.
|As of December 31 of
The total number of licensed physicians also includes physicians who are no longer employed and physicians who are not physicians. The German Medical Association and the National Association of Statutory Health Insurance Physicians have counted 385,149 doctors in Germany who were medically active in 2017, and 6,542 doctors more than last year. The proportion of women continued to rise and reached 46.8% in 2017, after 46.5% in the previous year. The proportion of older doctors also continued to rise. In 2017, 18.4% of doctors were 60 years of age or older (2016: 17.9%). In 2017, a total of 172,647 doctors were contracted doctors, i.e. working as residents, self-employed or employed by a contract doctor.
Visits to the doctor : German adults (between 18 and 79 years of age) visit the doctor 9.2 times a year on average.
In Austria , when you graduate, you are initially a doctor of all medicine (Doctor medicinae universae / Dr. med. Univ. ). In the meantime, contrary to the name, it is not a doctoral degree, but a diploma degree similar to the Magister or the graduate engineer. Before the 2002/03 winter semester, medical studies in Austria were doctoral studies, which also had transitional regulations. The actual doctoral degree in medicine ( Doctor scientae medicinae or Dr. scient. Med. ) Can since then be acquired in a three-year doctoral program following the diploma course.
You are only allowed to work independently as a doctor if various (defined) disciplines have been completed for three years as part of the “rotation” and the work has been positively assessed by the respective department head. Then another final exam has to be taken. With this you have acquired the “jus practicandi”, i.e. the authorization to practice independently as a general practitioner. Alternatively, the (usually six-year) training to become a specialist can take place immediately after graduation, after which an examination must again be taken. Many specialists complete or partially complete the cycle before the start of their training. It has become common practice in Austria to complete the general practitioner training beforehand. Many hospitals only employ resident doctors who have completed regular training, as they are allowed to do night or weekend shifts alone. Doctors from other EU countries can apply for recognition as licensed doctors .
On December 14, 2010, the EU Commission published a notice of amendment to , Appendix 5.1.1 in its Official Journal C377 / 10 . published, according to which from this point on all graduates of the Austrian medical studies have already completed their basic diploma with their doctorate and thus start an independent activity or training as a specialist within the entire EU and EEA area as well as Switzerland and Liechtenstein under the same conditions as local medical professionals allowed to. Until then, medical professionals from Austria only had the right to automatic crediting of their diploma in the other member states after completing their training to become a general practitioner or specialist.
|in %||per 100,000 PE / PE per doctor|
|authorized to exercise their profession independently.||34,363||83%||406/246|
|Doctors with employer (DG, with TA: hospital staff)||28,650||70%||339/295|
|Doctors with ordination (ORD: resident Ä.)||16,673||40%||197/508|
|Regular doctors (TA: in training)||6,820||17% (24% of DG)|
|exclusively employed Ä.||15,886||39% (55% of DG)|
|Doctors with ORD and DG||5,962||14% (36% of ORD / 21% of DG)|
|exclusively resident Ä.||10,711||26% (64% of ord)|
|Statutory health insurance physicians (KA, ORD with KK contract)||8,406||20% (49% of ord)||99/1007|
|Statutory health insurance physicians with GKK contracts (large employee funds)||7,028||17% (41% of ORD / 84% of KA)|
|Doctors without a health insurance contract ( elective doctors , private doctors )||8,667||21% (51% of ORD)||102/976|
- The quota of just under 5 doctors per 1000 inhabitants is one of the highest density of doctors in Europe and one of the highest in the world.
- Quota of residents with statutory health insurance physicians: Since there is compulsory insurance in Austria, 99% of the population pay health insurance. The quota is therefore representative.
|2011||Change from 2010|
|Cases of statutory medical assistance per insured person||6.85||−1.7%|
|Costs per contract doctor help||€ 50.56||0.7%|
Doctors in Austria have to complete 50 hours of advanced training per year, which is checked every 5 years by the Medical Association.
In 2017, around 36,700 (36,900, depending on the source) doctors worked in Switzerland, of which around 15,200 (42%) women and 21,400 (58%) men, 51% in the outpatient and 47% in the inpatient sector , around 12,600 (34%) were foreigners (ie without Swiss citizenship ).
In Switzerland , after completing the six-year degree with the state examination, one is initially a federally certified doctor and as such is authorized to work as an assistant doctor in hospitals and medical practices .
The further training to become a specialist ( specialist ) authorized to practice independently takes between 3 (“ general practitioner ”) and 8 years after graduation, depending on the subject . In order to obtain a specialist title, a specialist examination must also be taken. Thereafter, the doctor may call himself a “specialist for ⟨specialist area FMH ”.
The respective professional association checks whether every specialist is fulfilling his / her obligation to further training (60–100 hours per year depending on the specialist area). [ref. complete]
Admission, medical practices
The authorization to practice the profession at the expense of the health insurance companies is granted by the Central Health Insurance Association Santésuisse , but is only a formality with the appropriate qualifications.
The permission to open a practice is regulated by the cantons. However, there is currently a practice opening stop, [ref. add] which restricts the professional practice at the expense of the health insurance companies. Only with proof of need, e.g. B. when taking over a practice, admission is possible. [ref. complete]
Working time law for assistant and senior physicians
Since January 1, 2005, after long struggles , the nationwide Working Hours Act and thus the maximum weekly working hours of 50 hours stipulated therein (Art. 9 ArG, maximum weekly working hours) have been in force for assistant doctors and senior physicians at Swiss hospitals . Although it is significantly higher than the usual working hours in Switzerland (38.5–42.5 hours), it was a certain step forward - up until then there were employment contracts with the phrase “Working hours are based on the needs of the hospital”. common, which meant that working hours of more than 60 or 70 hours per week had to be worked without financial compensation. The remuneration of the assistant doctors was therefore at the level of the nursing staff in the upper management (nursing services).
Hierarchy of hospitals, professional chambers
This hierarchical separation, which is primarily due to historical reasons, is also shown by the separate professional chambers of the hospital doctors VLSS and VSAO . On the other hand, the older FMH Medical Association is open to all qualified doctors, as is the specialist medical associations. Membership is voluntary, in contrast to other countries such as Germany or Austria.
In Switzerland (still in 2017/18) there is hardly any transparency with regard to the income situation - in general and also in the medical field. Whereby applies - the higher the position, the less transparency. However, reliable information "seeps through". The hospital management has recently been trying to increase transparency. Like the Zurich University Hospital which is currently “checking” whether and in what form it should disclose the doctor's wages in the future.
Half of the doctors in Switzerland work in the hospitals. Radiologists, cardiologists, gastroenterologists, intensive care physicians and urologists are particularly well paid there. At the lower end of the pay scale are psychiatrists, paediatricians and doctors from the field of physical medicine and rehabilitation. The normal wages are ( p. A. ):
- Senior physician - between 120,000 and 360,000 CHF
- Head doctor - between CHF 200,000 and CHF 600,000
- Head physician - between CHF 250,000 and 750,000.
This information from a consulting company corresponds to that of the Association of Leading Hospital Doctors in Switzerland ( VLSS ) - in one of its surveys, the senior doctors declared the following average wages:
- Head physicians - around CHF 370,000
- Head doctors - around CHF 290,000.
In addition to the basic wages and bonuses, especially for management doctors, there are additional fees for treatment of patients with additional insurance in the inpatient area and for those with basic and additional insurance in the outpatient area. For head physicians, this can be up to 9 times the basic wage. "Individual chief physicians come to annual wages of 2 million francs or more," says a consultant, who also criticizes that the chief physicians can often determine how the fees are distributed.
- Medical officer
- Medical Association
- Company doctor
- District doctor
- Personal physician
- Emergency doctor
- Medical officer
- Ship's doctor
- Contract doctor (health insurance doctor)
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