Transit doctor
A transit doctor - in short: D doctor - is a specialist in surgery with a focus on trauma surgery or a specialist in orthopedics and trauma surgery with the additional designation "special trauma surgery", who has received special approval from the regional associations of the German Social Accident Insurance (DGUV). He is responsible for carrying out treatment after accidents at work and commuting accidents . Accidents at work, for example, also include school accidents and accidents involving road workers. In addition, private caregivers are legally insured against accidents in the context of care under the Care Insurance Act, regardless of age. In principle, every employee is legally insured against accidents. The self-employed can become voluntary members of a professional association; Even then, the D doctors are responsible.
The transit doctor procedure
Basics
The transit doctor procedure (D-doctor procedure) regulates the treatment and billing of an occupational accident (this also includes accidents on the way to or from work) in Germany. It is therefore only used in cases in which a statutory accident insurance ( commercial trade association , agricultural BG , statutory accident insurance fund ) pays the costs for the treatment. The term "transit doctor" was used for the first time in the contractual regulation of the relationships between professional associations and health insurance companies according to §§ 1513, 1501, 1503 Reich Insurance Code (RVO) of November 29, 1921 in § 3. Thereafter, at the request of the employers' liability insurance association, the health insurance company had to urge those injured in an accident to consult a specialist (transit doctor) designated by the employers liability insurance association immediately after reporting sickness and before using the health insurance physician for the first time.
Participation in the D-doctor is granted by the responsible regional associations of the German Social Accident Insurance (DGUV). The participation involves extensive powers of attorney , but also obligations. As a quasi-representative of the statutory accident insurance, the D-doctor is supposed to control the entire healing process, so he is coordinating from the initial care to the rehabilitation up to the recommendation of compensation payments. Among other things, he is in contact with the treating family doctor , the accident clinic, the rehabilitation facilities, the specialists consulted and the responsible accident insurance institution.
In Germany there are around 3,500 licensed transit doctors, and around three million insured persons are treated in the transit doctor procedure every year.
Procedure
In the event of an accident at work or recurrence due to an accident at work, the freedom to choose a doctor is restricted: The injured person usually has to be presented to a doctor . The employer should inform his employees about this. If an injured person first visits his / her family doctor , then the latter has to refer the patient to a D-doctor. Since in the event of an accident at work, it is not the health insurance company but the statutory accident insurance that is the cost bearer, no health insurance certificate or chip card is required to visit the D-doctor . Prescribed drugs as well as remedies and aids are free of charge. This regulation also applies to private patients . Exceptions to the D-doctor treatment include:
- In the case of small accidents: If the incapacity for work does not last longer than the day of the accident and the treatment does not last longer than a week, a general practitioner can carry out the treatment (at the expense of the BG) without referral to a D-doctor.
- Injured people with isolated eye or ear, nose and throat injuries should be presented to an ophthalmologist or ENT specialist immediately . These are automatically considered to be in-service doctors. The same applies to dentists .
- In the case of very serious injuries (e.g. open skull , joint fracture), a D-doctor does not have to be consulted first. Rather, the injured person should be admitted directly to a professional association accident clinic or a corresponding hospital. In most cases, there are also doctors working there. As a rule, every accident ambulance is regarded as a transit doctor if the lead doctor is approved as a D-doctor.
- Any doctor can be consulted if an occupational disease is suspected or present . Any suspicion of an occupational disease must be reported to the responsible trade association.
D-doctor's duties
The D doctor has the following tasks, among others:
- Establishing the medical diagnosis and ascertaining the facts of the matter (e.g. whether it is even a work accident)
- Specialist first aid
- Creation of the transit doctor report for the accident insurance company
- if necessary, call in other specialists
The D-doctor also determines which doctor should carry out the further treatment. He himself should only take over the treatment in around 20% of the cases. Most patients remain under treatment by a general practitioner. However, the D-doctor has the option of carrying out so-called checks. For example, at the end of the treatment, the patient has to go to the transit doctor again, as he controls the entire healing process. In addition, only the emergency doctor may prescribe remedies (e.g. massages) and aids (e.g. prostheses). This procedure is called the trade association procedure (BG procedure for short). The transit doctor is only responsible for accidents at work, not for occupational diseases. Health insurance and private accident insurance are responsible for private accidents .
Requirements for D doctors
Strict requirements apply to participation in the transit doctor procedure. Until December 31, 2010, all D doctors had to be specialists in surgery with a focus on trauma surgery . Due to the new specialist in orthopedics and trauma surgery, the admission criteria were extended on January 1, 2011. Prerequisites are a specialist in orthopedics and trauma surgery and, after the specialist examination, another year of medical activity in a trauma surgery department of a hospital approved for serious types of injury (VAV house). This means that a branch as a transit doctor is possible, but without a permit for outpatient surgery. The latter requires the completion of the specialization special trauma surgery . The practice of a D-doctor must be specially equipped. B. Rooms for invasive procedures and an X-ray room are available. The practice must also be accessible to those who are lying down.
There are also special personnel requirements. So z. For example, two medical assistants must always be present, and the D-doctor must ensure continuous availability from 8:00 a.m. to 6:00 p.m. (Monday to Friday).
A D-doctor has to undergo further training at least once a year and keep himself or his practice up to date with the latest technology and medicine. Furthermore, there are extensive documentation, reporting and assessment obligations.
Special case: H doctor
The 9th additional agreement of October 7, 1963 to the agreement between doctors and employers' liability insurance associations included the provisions regulating the details of the procedure for doctors (H doctors) to be involved in professional association medical treatment. In a sense, the H-doctor was a “slimmed-down version” of the D-doctor. "H" stands for "in the special H eilbehandlung involved". Due to the restructuring of the transit doctor procedure, the emergency doctor has been omitted since January 1, 2016. Until December 31, 2015, previous H-doctors had the opportunity to switch to the transit doctor procedure under certain conditions.
The H doctor was also allowed to treat cases in which a non-licensed doctor had to refer to the D doctor (inability to work for more than a day, treatment for more than a week). However, the H doctor was not in charge of managing the healing process, but only participated passively. He was only allowed to handle those cases (at the expense of the statutory accident insurance) that came to his practice by themselves. Another doctor was not allowed to refer to an H-doctor for treatment.
The conditions for admission to the H-doctor were less strict, so the H-doctor did not have to be a surgeon, but only had to demonstrate "accident medicine knowledge". The personal and material requirements for the practice were also lower. Admission to the H-doctor was intended for doctors who did not (wanted to meet) the strict requirements of the D-doctor, but who were nevertheless visited by many patients with occupational accidents and who did not always want to refer all the accident victims to the D-doctor (e.g. B. because of the great distance to the nearest D-doctor). Furthermore, the practices of the H doctors had to meet fewer requirements. D-doctor practices had to be handicapped accessible , H-doctor practices in turn not.
See also
literature
- E. Froese: How is the transit doctor procedure developing? Necessary further development from the perspective of the accident insurance carrier . Trauma and occupational disease, Suppl. 3 (2017), pp. S240 – S245.
Web links
- Seventh Book of the Social Security Code (on statutory accident insurance)