Regular doctor

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In Austria, a regular doctor is referred to in the broadest sense as the doctor in training to become a general practitioner ( general practitioner ) or the doctor in training as a specialist . However, the term is applied almost exclusively to doctors in training to become general practitioners.

The regular doctor is comparable to the internship doctor that existed in the Federal Republic of Germany until September 30, 2004, but whose internship only lasted 18 months. Since then, doctors in Germany have received their license to practice medicine immediately after they have completed their studies and thus (after successful application) the status of an assistant doctor in a clinic.

Legal basis

Doctors Act

§ 3 (1) The independent practice of the medical profession is reserved exclusively for general practitioners and licensed doctors as well as specialists. (2) The independent exercise of the medical profession consists in the independent performance of the activities described in Section 2 Paragraphs 2 and 3, regardless of whether such activities are carried out on a freelance basis or as part of an employment relationship. (3) Doctors who are in training to become general practitioners or specialists (regular doctors) are only permitted to perform the activities described in Section 2, Paragraphs 2 and 3 in the institutions recognized as training centers in accordance with Sections 9 to 11, within the framework of Teaching practices or teaching outpatient clinics under the guidance and supervision of the training doctors. If the organizational regulations of the hospital do not require the permanent presence of a specialist, regular doctors who already have the relevant knowledge and skills can work temporarily without the supervision of a specialist responsible for the training .
Section 4 (4) Training requirements for general practitioners within the meaning of paragraph 3 subparagraph 3 are at least three years of successfully completed practical training in the type described in this Federal Act as well as the successfully passed examination to become a general practitioner.
§ 7 (1) People who ... intend to work independently as a general practitioner doctor have to undergo practical training for the duration (cycle) to become a general practitioner as specified in Article 4 (4) within the framework of To submit to employment relationships and the examination to become a general practitioner and to prove the success of this training. (2) The cycle must in any case include training in the fields of general medicine, surgery, gynecology and obstetrics, ear, nose and throat diseases, skin and venereal diseases, internal medicine, paediatrics and adolescent medicine as well as neurology or psychiatry.

The rotation

The cycle is the training to become a general practitioner and lasts at least 36 months in Austria . It consists of a rotation through the subjects of general medicine ( 6 months, outpatient months), surgery (4 months), gynecology and obstetrics (4 months), ENT (2 months), dermatology (2 months), internal medicine (12 months), paediatrics (4 months), and Neurology / Psychiatry (2 months). After passing the examination to become a general practitioner, it ends with the award of the Ius Practicandi , which is the authorization to practice independently.

With the change in medical training in 2015, the duration of the training was extended and the subject areas to be covered changed; the conditions listed above only apply to old training that can be completed but no longer started again.

Criticism of the rotation system

In many cases, the regular training is considered to be inadequate. The main daily tasks of the regular doctor are to draw blood, attach infusions, inject heparin and set intravenous access - he is often referred to as the system maintainer. Periodic doctors are usually called in for non-medical activities, the actual goal of the period - training - is often neglected. The young doctors often have to educate patients about interventions where they cannot even be present themselves. In addition, they are encouraged to make decisions on night duty that senior physicians decide on during the day, but they are usually not trained for this. Work (administrative, organizational) that neither assistant nor senior physicians want to do is left to the regular doctor. In the operating theater, its function is often limited to holding the hook, often without any view of the operating area. Trainees have to use handwritten, hard-to-read medical histories to write medical reports about patients they often don't even know. The conditions in some hospitals are now so bad that more than half of the regular doctors in Bludenz had jointly submitted the notice of termination.

Reform plans

Reform plans were discussed in many cases, such as the abolition of the cycle, the introduction of a separate, longer specialist training for general practitioners (similar to Germany) and the granting of the license to practice medicine directly after graduation or after a year of "common trunk". However, no major reform was implemented until 2014. In mid-2014, another reform proposal was aired and even introduced as a draft law in parliament. In the opinion of political observers, however, this reform is more likely to serve to prolong the current situation, since regular doctors will continue to be employed as system maintainers and without a license to practice medicine, and the training period will be considerably longer. The migration of young physicians will not be countered.

Shortage of regular doctors

Due to the migration of young doctors to the surrounding countries, there has been a severe shortage of regular doctors in recent years, especially in rural areas. As a result, many hospitals are forced to change the profile of their regular doctors and, in particular, outsource non-medical and administrative activities to other professional groups such as nursing staff . At some hospitals such as the LKH Steyr , the so-called iv activities ( blood collection , intravenous administration of infusions & medication) have already been handed over to the nursing staff. Other measures that have been taken by some hospital providers are more attractive salary schemes, increased advertising or help with finding accommodation. Furthermore, a new medical university was created in Linz. How far this can remedy the shortage of doctors, however, remains controversial even in specialist circles.

European and USA comparison

In continental Europe, postgraduate training in Austria to become a doctor with the right to practice an independent profession takes the longest. Only in Great Britain is it longer. Since 2005 they have been talking about the "Foundation House Officer", FHO, duration 2 years (in hospitals, "Foundation Doctor" is common), followed by training as a "Specialty Registrar", the 3 years for the general practitioner (GP) or 6 years for the specialist (specialist / consultant). (Note: "Consultant" is a hierarchical level, comparable to the senior physician in charge.) Before the reform in 2005, the terms "Pre-Registration House Officer" (PRHO, 1 year), "Senior House Officer" (2 years) and " Registrar ”(1 for the GP, or 4-6 years for the Specialist) usual.

The “rotation” is roughly comparable to the generally only one-year “internship” in the USA, which is followed by the “residency”.

In Scandinavia, too, there is the term of the regular doctor (norw. "Rotating doctor" ). In Norway, the training period after graduation is one year in a hospital and ½ year in a general practitioner's practice before the full license (Norwegian "autorisasjon" ) is granted.

In Sweden, the corresponding part of medical training is called Allmäntjänstgöring , and the doctors performing the training are called AT-läkare .

13 other EU countries do not have a cycle and grant the license to practice medicine (= jus practicandi) immediately after graduation.

In Switzerland you can apply for the FMH title "General Practitioner" after 3 years. The prerequisite is 3 years of clinical activity (any clinical specialty), whereby half a year must be completed on an outpatient basis. This entitles you to practice your profession independently, but you cannot conclude health insurance contracts. This would require 6 years of specialist training, whereby the subject "General Medicine" was abolished and merged with the subject "Internal Medicine". All general practitioners are therefore internists according to the new training regulations. The "general practitioner" was introduced for legal reasons (EU conformity). The "Practical Doctor (FMH)" can, however, be credited as a "General Practitioner (ÖAK)" in Austria and thus entitles the holder to run a general medical practice.

Individual evidence

  1. ↑ Physicians Act 1998 Federal Law Gazette I No. 169/1998 of 10. November 1998
  2. ↑ Basic information on the cycle ( memento of July 8, 2012 in the Internet Archive ) www.turnusarzt.com.
  3. ↑ Viamedici-online / Thieme-Verlag, 2004
  4. ↑ Regular doctors set the signal by giving notice. In: vorarlberg.orf.at. June 1, 2012, accessed November 24, 2017 .
  5. ↑ Viamedici-online / Thieme-Verlag, 2009
  6. ↑ Federal law amending the Physicians Act 1998, received on July 25, 2014
  7. ↑ Recipe blog / analysis of the new medical training - a huge bluff
  8. ↑ Rotus at the LKH Steyr, 2013 ( Memento from March 5, 2016 in the Internet Archive )
  9. ↑ Österreichische Ärztezeitung, 2013
  10. ↑ http://www.meduni-linzooe.at/home/
  11. ↑ ORF Upper Austria Online, 2013
  12. ↑ Kastner S .: Approval - The Austrian way in comparison; Notices from the Medical Association of Tyrol, 2008: 1, page 27