Country Doctor

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A Country Doctor at Work (1972)

A country doctor is colloquially referred to as a family doctor - usually a specialist in general medicine or a general practitioner internist - who works in a rural region.

In rural areas , the distances between doctor and patient and between family doctor and specialist or clinic are greater, and the average age of the patients is higher. The country doctor often takes on activities that are carried out by specialists in urban regions. In addition, he is the first point of contact in emergencies. Regular home visits are more important than in city general practitioners' practices.

In Bavaria, the term “country doctor” first appeared at the beginning of the 19th century, after the University of Bamberg was abolished in 1805 and its medical faculty had ceased teaching in October 1809. The Munich government then set up a "rural medical school" (after it had already envisaged the training of second-class doctors for the rural population in 1808).

Situation in Germany

In Germany there has been an increasing shortage of country doctors for a number of years , initially in Eastern Germany , but now also in other German regions. The reasons given for this are often unattractive working and living conditions for young doctors in rural areas compared to metropolitan areas with the simultaneous aging of the current rural medical profession. The entrepreneurial risk of economic independence deter many young doctors from setting up a branch, as well as a poor compatibility of self-employment and family planning and the threat of recourse payments in the event of above-average prescription of medicinal products. This uncertainty is intensified by health policy reforms and the resulting lack of calculability for self-employment. By 2021, 42 percent of general practitioners will be retiring. The Osterheide district on the southern edge of the Lüneburg Heath recorded the largest population decline in Germany (minus 12.8%). Only a few vacation spots, especially on the coast, have been able to decouple from this development. Neustrelitz (Mecklenburg-Western Pomerania) and Görlitz (Saxony) also held their own in a rural setting. According to the figures of the study, the population group of 18 to under 30 year olds in particular is very mobile. For their training and career, they mainly move from small towns and rural communities to large centers and university towns. In contrast to earlier times, they return to their hometowns much less often after completing their training.

Attempts are made to counteract the shortage of country doctors with measures such as grants or financial incentives. 2014, the proposed experts for the investigation of the development in the health plan to increase the remuneration for rural doctors by 50 percent and twice as many doctors to specialist general practitioners and specialists in internal medicine develop . Other approaches are the Rothenburg model or the networking of practices. A delegation of activities to medical assistants is also discussed. There are various approaches to this, such as the MoNI model in Lower Saxony or Verah (care assistant in the family doctor's practice). In Lower Saxony there was also the pilot project “rolling medical practice” at times to ensure a minimum of medical care. In Hesse, too, there is a pilot project known as the Medibus , which acts as a "rolling doctor's practice" to provide medical care to villagers.

At the end of 2012, the Federal Joint Committee increased the requirement planning by 3000 new positions for general practitioners in rural regions. In return, 1,800 jobs in over-supplied cities are being cut. In addition, simplifications should make settlement in rural regions more attractive, for example the elimination of the residence obligation or the abolition of claims for recourse in the event of excessive medication prescriptions. The target is one resident doctor per 1671 resident population.

In some regions, especially in the GDR , rural medical care within the framework of so-called rural outpatient clinics was common. These were polyclinics with employed doctors, similar to medical care centers , which have become more important in recent years.

Situation in other countries

In Australia , the Royal Flying Doctor Service of Australia was set up for sparsely populated regions . In Sweden , the provincial councils in the north of the country have practices with small hospital wards ( Sjukstuga ). In some countries there are also additional training courses in “Medicine in sparsely populated regions” ( Rural Medicine ) or there are plans for this.

Filling a practice

There are strict rules for filling a contract doctor's seat, which are intended to prevent the approvals from being traded. After the death, waiver or withdrawal of a contract doctor, the admissions committee has been deciding since 2013 whether a replacement procedure should be carried out at all. Otherwise, the KV must pay the contract doctor or his heirs compensation. It is currently unclear whether the statutory health insurance associations will make use of such a "purchase right". In the event of a replacement, the National Association of Statutory Health Insurance Physicians (KBV) must advertise the contract doctor's seat and draw up a list of incoming applications. Applicants must work at the previous practice location. The continuation of the practice thus includes a spatial and also a personnel component.
A branch practice operated at the previous location is not a continuation in this sense (BSG, judgment of March 20, 2013, Az .: B 6 KA 19/12). In order to make it easier to fill the position, the budgets can also be transferred to employed specialists, and such appointments can now be converted back into regular licensing.

The planned purchase regulation of statistically surplus doctor's seats by KV threatens almost 9% of all practices, says the Central Institute for Health Insurance (Zi). Even if the limit of the degree of coverage were raised from the current 110% to 140%, as planned in the GKV-VSG, around 12,000 doctor and psychotherapist seats would still be about to end. Of the doctor's and psychotherapist's seats that are available nationwide, about 37% of the internists would be affected, and about 19% of the psychotherapists would not find any practice successors. Broken down regionally, KV Bavaria would be at the top with 2,291 seats to be delisted, followed by KVen Baden-Württemberg (1,254) and North Rhine (1,440).

Master plan medical studies 2020

In order to counteract the shortage of general practitioners, the federal government is currently working on the “Master Plan Medical Studies 2020”. Medicine is still one of the most popular fields of study, measured by the number of applicants per study place. 43,000 school leavers have applied for the current semester, but together the 35 universities at which one can study human medicine in Germany were only able to allocate just under 9,100 places. Of the students who make it to their license to practice medicine, on average only about ten percent decide to work as a family doctor.

Individual evidence

  1. ↑ Article of the WAZ with a description of the work profile
  2. ^ Max Döllner : History of the development of the city of Neustadt an der Aisch up to 1933. Ph. C. W. Schmidt, Neustadt a. d. Aisch 1950, OCLC 42823280 ; New edition to mark the 150th anniversary of the Ph. C. W. Schmidt publishing house, Neustadt an der Aisch 1828–1978. Ibid 1978, ISBN 3-87707-013-2 , p. 526.
  3. ↑ See also Otto-Friedrich-Universität Bamberg # 1803: Continuation of studies despite closure of the university .
  4. ↑ Christopher Piltz: The doctor is coming soon. zeit.de, July 2, 2014, accessed on July 2, 2014
  5. ↑ Norbert Schwaldt: Pulsating metropolises and deserted villages. welt.de, August 14, 2015, accessed April 25, 2016 .
  6. ^ Report of the NDR ( Memento from January 1, 2013 in the Internet Archive )
  7. ^ Nicola Kuhrt: Reviewers name errors in the German health care system. spiegel.de, June 23, 2014, accessed June 23, 2014
  8. ^ Editorial of the Tagesschau on the topic
  9. ^ Article on the lack of country doctors, Handelsblatt
  10. ^ Report of the medical newspaper
  11. ↑ Hessen wants to pay a premium for country doctors . FAZ.NET.
  12. ^ Rural medical care in the rural outpatient clinic
  13. ↑ about the rural medical care model MoNI ( Memento of October 10, 2013 in the Internet Archive ) (PDF; 1.6 MB)
  14. ↑ https://www.verah.de/
  15. ↑ Christopher Piltz: The doctor is coming soon. zeit.de, July 2, 2014, accessed on July 2, 2014
  16. ↑ David Gutensohn: When the practice comes to the patient. Retrieved April 4, 2020 .
  17. ↑ https://www.g-ba.de/informationen/bedingungen/4/
  18. ^ Michael Inacker: Lure offers for country doctors . In: Handelsblatt . No. 248, December 21-26 , 2012, ISSN  0017-7296 , p. 11.
  19. ↑ Nina Weber: Medical practices in Germany remain unfairly distributed. spiegel.de, July 10, 2014, accessed on July 10, 2014
  20. ^ GKV supply structure law, in § 103 paragraph 3 a SGB V [1]
  21. ↑ http://www.kbv.de/html/
  22. ↑ http://datenbank.nwb.de/Dokument/Anhaben/473766/
  23. ↑ Rainer Kuhlen: Practice succession: In good hands . In: Deutsches Ärzteblatt . tape 109 , no. 45 . Deutscher Ärzte-Verlag , 2012, p. [24] .
  24. ↑ https://www.landarztboerse.de/mag/Neun-Prozent-aller-Arztsitze-gefaehrdet/134
  25. ↑ Operation Future. In: sueddeutsche.de. November 18, 2015, accessed June 13, 2018 .

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