A doctor's practice , or ordination in Austrian , comprises the various rooms of a resident (practicing) doctor , where he receives, advises, examines and treats patients . From a functional perspective, a medical practice is a freelance business enterprise .
Medical practices are equipped differently depending on the specialty. Today practices mostly consist of several rooms such as B. the reception , the waiting room and the consultation room . Modern practices usually have several treatment rooms, even if only one doctor is practicing. This has organizational reasons and also serves to save the doctor's time when changing patients (calling, undressing and dressing, examinations and test procedures by assistant staff, effective and rest times for therapies such as acupuncture, instruction and training, etc.). This is why there are almost always functional rooms in which no detailed consultation is to be held, but mainly injections are administered, bandages are changed or smaller applications and device diagnostics are carried out.
A so-called single laboratory has become rare . Usually the analyzes carried out in practice are limited to the evaluation of dry chemistry , blood coagulation tests and a few other components of the so-called "small laboratory".
In addition to medical facilities, doctors' surgeries now also have complete office facilities such as computers, telephone systems, etc. In the practices, in addition to the doctor, so-called non-medical specialists work, also known as medical assistants in conventional parlance . In addition to providing assistance in the medical field, these specialists also deal with everyday office business (making appointments, calling patients, correspondence, invoices, etc.). The colloquial term "nurse" is antiquated, the original semi-skilled and since 1965 repeatedly revised teaching medical assistants is in Germany since 2006. " Medical employee ," the comparable profession in Switzerland " of Medical Practice Assistants ".
The first "doctor software" with industry-specific applications was already being used in isolated cases in Germany in the first half of the 1980s, although health insurance associations advised their members against it at the time. At this point in time, they wanted to coordinate the program development with the manufacturers in order to come up with uniform, mature and secure solutions, and the time for the general introduction of a system was not yet considered to have come. There were also considerable objections under data protection law to the submission of quarterly accounts on data carriers. Today it is impossible to imagine the electronic processing of administrative and medical support tasks without it. Also telematics and telemedicine is no way prejudice a topic that practices for years.
Forms of cooperation
For reasons of cost (equipment, rent, staff), many doctors have decided to operate professional associations , group practices or joint practices . In Germany, the medical care center has been introduced as a new form of organization through the latest health reform . For the differences cf. there. For details see a. Contract Doctor Law Amendment Act . The legal form of partnership is also possible for medical practices in Germany.
In the welfare organization , so-called homeless mobiles serve as mobile medical practices. These are ambulance vehicles that drive to the homeless in order to offer free medical help from a doctor to destitute patients. Caritas in Hamburg, for example, operates vehicles with the label "Mobile Help - Medical Care for the Homeless" with the small addition "HospiMobil". In addition, according to media reports, there have been permanent treatment centers in Germany for those who are not health insured and " sans papiers ", where treatment may be anonymous and no review, recording, reporting or display of legal or illegal residence status takes place. After an increase in the number of people with no health insurance in Germany for years, the recently introduced expansion of compulsory insurance can be expected to ease the situation. On the other hand, there are still gaps in the so-called social network, and practitioners expect an increase in destitute patients in Germany in the next few years. The health center for the homeless on Pflugstrasse in Berlin, for example, is a well-known facility . In such treatment centers, medical staff work partly on a voluntary basis, partly the material resources are provided by institutions and individuals, and personnel costs and other needs are also covered by donations.
As the only such institution in Germany, there has been a “Zahnmobil”, a mobile dental practice in Hamburg since March 3rd, 2008, which offers treatment to the homeless and the poor. The operator is Caritas. However, there are also reports about dental mobiles or clinic mobiles from other German regions and so-called developing countries, so that the model of mobile, mobile or rolling dental practice is no longer an absolute novelty.
Regular outpatient clinics (not to be confused with the emergency department of a hospital) at inpatient facilities (even in West Germany, the term polyclinic was sometimes used for this before the fall of the Wall, especially at university hospitals with highly specialized outpatient departments) only partially offer consultation hours for so-called statutory health insurance patients (i.e. at a charge statutory or social health insurance), in which the services can be billed on the basis of referral slips issued by registered contract doctors. Special contracts, approvals or authorizations are required for this. With a hospital admission, issued by the contract doctor, the outpatient department can bill examinations and treatments as pre- or post-inpatient services even without special approval. In addition, senior doctors in clinics can hold private consultations for self-pay or private patients. The doctors authorized to liquidate agree with the hospital operator (the operating company) on the financial compensation for the shared use of the clinic staff and material resources.
In addition to the medical emergency service of the Association of Statutory Health Insurance Physicians in Hamburg (a mobile on-call service for those with statutory health insurance, who makes house calls and gives advice by phone, not to be confused with the emergency service emergency number 112 via the fire brigade), there have been two emergency practices with specialist emergency care that are available at seven Are open days a week in addition to the usually usual contract doctor's office hours until midnight. The child emergency service for those with social health insurance is also provided in several hospitals.
So-called drug clinics are special contact points for addicts or drug addicts . Whether more counseling work is done here or whether medical treatment is provided depends on the design and equipment of the individual facility.
Other services where the demarcation is difficult and smooth transitions can be assumed are, for example, the port and airport medical service, with which the central advice center for monitoring male and female prostitution in Hamburg was previously connected. The first Hamburg port doctor was Bernhard Nocht . From 1961 to 1990 the shipping physician, Russian Orthodox archpriest and company doctor Arnold Backhaus worked in this service, including many years in a leading position.
As a contact point for male prostitutes in Hamburg, the basic project (founded in 1986, since 2005 operating part of the basis & woge eV, created by the merger) also provides basic medical care (this low-threshold help offer is called Doctor Georg, medical help for prostitutes, with a weekly medical consultation, without making an appointment, without an insurance card). There is also a virtual consultation hour for “pocket money boys” who are mainly or exclusively on the Internet as “ escorts ”, organized through a network of similar contact points.
On January 20, 2010, “Germany's first doctor for the poor” Uwe Denker opened his “practice without borders” in Bad Segeberg. Here, those in need are treated free of charge. The project, realized in cooperation with the Segeberger Tafel, was separated from the Tafel at the end of 2010 and has since been financed by a non-profit association through donations.
There are purely private and statutory medical practices. The latter usually also treat private patients or self-payers. Licensed contract physicians (formerly statutory health insurance physicians of the primary health insurances and contract physicians of the substitute health insurances) predominantly still have collective contracts with the insurance carriers of the statutory health insurance (GKV) and various other sponsors, whereby GKV insured persons make up the majority of the treatment cases and thus the application cases of the entire remuneration system. Special regulations for treatments at the expense of the statutory accident insurance institutions, the police, the armed forces, the civil service administrations and the professional fire brigades and other groups of civil servants only affect a relatively small part of the total volume of billable services. But they should be mentioned, especially since the abolition of the statutory health insurance associations is a political demand or an organizational idea. Before 1934 there was a much larger number of group and individual contracts between the health insurance companies and their medical and other contractual partners. Lately there have been special contracts for family doctor models, integrated care, disease management programs (DMP), so-called optional tariffs, etc., so that the contract landscape is becoming more and more colorful. With optional tariffs in the dental sector, statutory health insurance carriers try to save costs with dentures manufactured abroad (China, Singapore). You will make special agreements on this with the participating dentists. A different fee is presumably also agreed here (as of March 2009).
Recently, the treatment of private patients has become less important for general practitioners. In a comparison between 2011 and 2015, the income of a practice from private billing fell by almost three percent to an average of 133,000 euros. There is a contrary trend in the treatment of those with statutory health insurance: In the same period, practice income rose by 7.5 percent to an average of 357,000 euros per practice.
Private doctors, on the other hand, are in principle not bound by contracts with insurance companies or other payers that are not identical to the patient. (It looks a little different when participating in the family doctor model of private health insurers. And of course the examination, advice and treatment are always based on a treatment contract that is always concluded, regardless of whether the patient has social, private or no health insurance. From this, the rights and obligations of both sides are derived.) For billing, the statutory fee schedule for doctors (GOÄ) or dentists (GOZ), including the possibility of analogous evaluations of new services not listed, then applies almost exclusively. For the doctor-patient relationship, general statutory provisions on the contract (treatment contract) apply, which also apply to the treatment of people with social health insurance. There are also general and professional regulations on liability and professional secrecy. (The list is not exhaustive. The medical and medical liability law, which is relevant here, is now a very extensive subject.)
The remuneration of medical experts or experts by various public or private cost carriers such as insurance companies, authorities, courts is regulated very differently. Although the statutory fee schedule for doctors contains positions for expert opinions, many clients make their own agreements with the experts who work for them. The financing of the former medical examiner service (today: medical service of the health insurance ), for which numerous external experts also work, is even different . There has also been repeated recruitment of consulting doctors by health insurance companies. Billing numbers for scientific reports are also included in the contracts between the statutory health insurance carriers and the statutory health insurance associations and other cost carriers. This information applies to conditions in the old Federal Republic up to 1990. They have largely been transferred unchanged or only slightly modified to the new federal states. For example, medical health insurance services were established across the board (but in the legal form of a registered association, not as a public corporation as in the old federal states, where these services, which had been a structural part of the state insurance institutions since around 1934, were outsourced around 1988).
There have always been some private medical practices in the GDR. The model preferred by the state, however, was the polyclinic . After 1989/1990 the founding of new medical practices became possible again and the conditions were largely similar to those in the old federal states. However, different prices applied to the remuneration for medical services. In the early 2000s, a dentist in Herrnburg , on the Lübeck city limits in Mecklenburg-Western Pomerania, received less money for his work than a dentist a few hundred meters away in the Lübeck city area.
The statutory health insurance physicians have threatened politicians several times that they would return their health insurance licenses if certain requirements were not met. At least in individual cases, doctors have decided to give up the medical practice and only work as private doctors. Or they went into the industry as a medical adviser or were employed as appraisers when long-term care insurance was introduced (1995/1996) and instead gave up their no longer profitable practice. For years it has also been reported that medical students leave Germany after completing their training because they find better earning opportunities and more favorable, more attractive working conditions in various European (sometimes also non-European) countries.
In Austria, doctors with contractual relationships with at least one statutory health insurance provider (e.g. regional health insurance fund ) are referred to as contract doctors .
Abandonment and closure of a doctor's office
Doctors can transfer their medical practice to their spouses or children. Since 2012, this has also applied to same-sex partners . Insofar as doctors sell their medical practice to strangers, associations of statutory health insurance physicians have had a right of first refusal since 2012 . You must provide the retiring doctor with a reasonable offer. For doctors, the sale of the licensed medical practice is part of the retirement provision . The patient file is usually taken over by the accepting doctor.
Other health professions
More generally, the treatment rooms of freelancers in other health professions are also referred to as “practices”. This is how the dental , veterinary and psychotherapeutic practice can be found. With regard to professions that (in Germany) are not subject to the license to practice medicine , there is also occupational therapy , physiotherapy , speech therapy and, finally, the alternative practitioner practice.
- Regional health insurances with the Austrian social insurance carriers
↑ Ordination on duden.de;
Ordination - doctor's office on ostarrichi.org
- ↑ On June 2nd, 2020 I photographed a vehicle of the Caritasverband für Hamburg eV with the current label: "KRANKENMOBIL Outpatient Medical Care for the Homeless". Franconian students.
- ↑ tooth mobile Hamburg, accessed January 13, 2010
- ↑ Klinomobil of the Unna district, vehicle in use since 1962, Westfälische Rundschau, July 29, 2009
- ↑ Segeberg: A practice for needy people, Lübecker Nachrichten, October 12, 2009 ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ "Praxis ohne Grenzen" First free practice for needy people in the north, sh: z Schleswig-Holsteinischer Zeitungsverlag, December 30th, 2009 ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Only home visits are not possible, Kieler Nachrichten, January 11, 2010
- ↑ Dr. His practice opens free of charge, Lübecker Nachrichten, January 12, 2010 ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Private income for medical practices is falling . In: DER SPIEGEL . Page 59 Edition. Economy, no. 36/2017 . SPIEGEL-Verlag, September 2, 2017.
- ^ A b Coalition for Gay Doctors . In: Süddeutsche Zeitung . June 7, 2011.