Contract doctor

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A contract doctor , traditionally and in Austria a statutory health insurance doctor , is a licensed, resident doctor with a contract doctor's seat. The approval as a contract physician sets the entry in a register of medical practitioners requires that the physicians' associations will be conducted. It takes place by resolution of an admissions committee and only applies to the district of the contract doctor's seat.

In the past, a distinction was made in Germany between contract doctors and statutory health insurance physicians: contract doctors were approved for the substitute health insurance area , and statutory health insurance doctors for the primary health insurance area . This distinction was abandoned by the legislature in the course of a reform of the health system .

Regardless of the contractual relationship, the contract or statutory health insurance physicians in Germany and Austria practice a free profession.

Germany

Organization and legal

The contract doctor can work alone, in a joint practice , in a joint practice (formerly: joint practice ), in a partial joint practice or as a freelance doctor in a medical care center. Doctors employed in medical care centers do not have contract doctor status, but since they have to be entered in the doctor's register, they are members of the respective statutory health insurance associations. Authorized hospital doctors are also not contract doctors, but members of the regional association of statutory health insurance physicians. The Admission Ordinance for Contract Doctors (Ärzte-ZV) provides the following framework for this:

"The joint exercise of contract medical work is permitted among all service providers authorized to provide contract medical care at a joint contract doctor's seat (local professional association). It is also permissible in the case of different contract doctor offices of the members of the professional community (supra-local professional community), if the fulfillment of the duty of care of the respective member at his contract doctor seat is guaranteed to the required extent, taking into account the participation of employed doctors and psychotherapists as well as the member and the doctors employed by him and psychotherapists only work for a limited time at the contract doctor's offices of the other members. [...] "

- Section 33 (2) Doctors ZV

Supply problems of the statutory health insurance patients

Overall, a shortage of contract doctors is expected in the future , as 78,000 resident doctors will be looking for a successor for reasons of age within 15 years. Because the profession has lost a lot of its attractiveness in the last 15 years due to the various restrictions such as budgeting, regulation, bureaucratisation and worsened remuneration, many medical graduates turn to other tasks than treating sick people or go abroad.

Termination of the registration

Statutory health insurance physicians lost their license as a contract doctor until 2008 when they reached the age of 68. This was repealed by the Bundestag on October 17, 2008 with effect from January 1, 2009.

Since then, drawing a pension from the occupational pension scheme has been dependent on the respective medical care.

  • The Berliner Ärzteversorgung offers retirement at 67 with the option of bringing it forward by up to five years.
  • It is similar in North Rhine-Westphalia.
  • At Bayerische Ärzteversorgung, a member who has reached the regular retirement age is entitled to retirement benefits. As with the statutory pension insurance, this will be gradually increased for those born between 1947 and 1963. For those born before 1947, the standard retirement age is reached at the age of 65, for those born after 1963 at the age of 67. Employment does not have to be stopped or restricted. Members who have reached the age of 60 (or 62 if they first started membership after December 31, 2011) can apply for an early retirement pension.

Tables

Sales and income of contract doctors and psychological contract psychotherapists from the statutory health insurance in 2006 in euros:

Specialist title Statutory health insurance sales in 2006 in euros Surplus from SHI sales, before taxes
Radiologists 414,827 116,566
Specialist internists 403,777 112,636
Ophthalmologists 224,532 100,815
Paediatricians 187.096 87,000
Urologist 201,452 86,221
Orthopedists 219.819 86,169
Gynecologists 191,822 85.169
General practitioners 177.980 83.117
General practitioner internists 186,966 82,452
ENT doctors 177,569 79,373
Surgeons 199.086 71,671
Dermatologists 165.406 65,666
psychiatrist 134,100 65,575
Non-medical (psychological) psychotherapists 62,882 38,673
Family doctors 181.859 84,240
Specialists without psychol. Psychotherapists 226.239 95,466
All doctors without psychol. Psychotherapists 204,643 91.178

With regard to the income listed in the second column, it must be taken into account that they do not reflect the disposable income of contract doctors and psychotherapists. So the comparison of income z. B. with gross salaries of employees not easily possible, since the employer pays half of the social security contributions, i.e. half of the contributions to health, care, unemployment and pension insurance for employees . The self-employed person has to provide this coverage in full from his income, as well as contributions for a daily allowance insurance, because he does not receive continued wages from the employer in the event of illness or pregnancy. Incidentally, the figures given are average values ​​that naturally vary widely. The figures include the income from privately insured persons and self-pay benefits ( individual health care ). These values ​​are collected every four years by the Federal Statistical Office.

Individual / group practice, specialization Recorded practices Income itself. Medical activity per practice owner. in 1000 € Expenses in% of income Net income per practice owner in 1000 €
Individual practices of general / general practitioners 20,160 234 52.9 110
Individual practices of internists 7,817 319 52.8 151
Individual practices for gynecology 5,571 278 52.3 133
Individual practices for paediatrics 2,946 266 53.1 125
Individual practices for ophthalmology 2,839 290 51.8 140
Individual practices for ear, nose and throat medicine 2,180 275 50.7 135
Individual practices for orthopedics 2,306 380 56.6 165
Individual practices for surgery 1.936 373 62.4 140
Individual practices for skin and venereal diseases 2,004 336 52.6 159
Individual practices for radiology and nuclear medicine 291 685 66.5 229
Individual practices for neurology, psychiatry, child psychiatry, psychotherapy 2387 235 48.9 120
Individual practices for urology 1,236 341 52.9 161
Group practices of general / general practitioners 6.371 222 43.6 125
Group practices of internists 3.117 369 54.6 168
Group practices for gynecology 1,164 316 45.8 171
Group practices for paediatrics 1.011 228 44.1 127
Group practices for ear, nose and throat medicine 637 272 41.3 160
Group practices for orthopedics 1.011 400 47 212
Group practices for surgery 691 343 52 165
Group practices for radiology and nuclear medicine 647 758 64.7 267
Group practices for neurology, psychiatry, child psychiatry, psychotherapy 698 274 46.5 147
Group practices for urology 452 309 44.7 171

Recently, there has been an increasing effort by contract doctors to leave the system in which they no longer see a future. In some cases, the doctors plan to collectively waive their contract doctor license. There are more than a thousand resident doctors in Germany who are not licensed as contract doctors and who only treat those with private insurance, self-payers or those with statutory health insurance after approval by the health insurance fund. In underserved areas in particular, the health insurance fund may feel compelled to grant this permit.

2011 net income

According to the KBV fee report of the National Association of Statutory Health Insurance Physicians for the first half of 2011, the national average net income is :

  • General practitioners € 5,017.50 / month
  • Orthopedist € 6,343.50 / month
  • Psychotherapist € 2,657.80 / month

The net income corresponds to about a quarter (23.5%) of the practice turnover.

Austria

organization

Statutory health insurance physicians are freelance doctors who have a contractual relationship with a social health insurance company through the conclusion of an individual contract. The contract medical services are remunerated via the fee schedule, which is an integral part of the overall contract. The general contracts are in turn concluded in accordance with the General Social Insurance Act (§§ 338 ff. ASVG) for the health insurance providers by the main association of Austrian social insurance institutions with the locally responsible medical associations .

In contrast, elective doctors are freelance doctors who have no contractual relationship with social health insurance providers and who charge the patient for their medical services via private fees.

Doctors can join forces in the same or interdisciplinary way in the legal form of an OG ( open company ) or a GmbH ( company with limited liability ) to form a group practice.

Upon presentation of the e-card , the medical service provided to the insured person ( benefit in kind ) will be charged directly to the responsible insurance company.

Individual contracts

In order to conclude an individual contract, interested parties must apply for an advertised position. There are certain criteria for ranking applicants. The ranking criteria are laid down in an ordinance issued by the Federal Ministry of Health (Section 343 (1a) ASVG). These criteria are in particular the professional suitability, additional professional qualifications through further training, the time of the first entry in an applicant list, in the case of gynecology and obstetrics also the special trustworthiness that can be additionally conveyed by the female gender (§ 2 Paragraph 1 Z 1 to 4 Ranking Criteria Ordinance ). The individual criteria are included in the selection decision with certain point values. Successful applicants are also referred to as § 2 doctors .

The contractual relationship expires by law, for example in the event of the death of the contract doctor or the dissolution of the contract group practice as well as in the event of a final conviction of the contract doctor to a prison term of more than one year. The health insurance provider has to terminate it if the doctor loses his citizenship of a member state of the European Economic Area or the right to practice the medical profession. The contract can also be properly terminated by both parties with a three-month notice period at the end of a calendar quarter.

statistics

At the end of 2014 there were 7 208 § 2 doctors in human medicine in Austria, the majority of whom were male and between 50 and 64 years old, this for the total number of doctors as well as for the specialty “general medicine” and for general medicine Specialists applies.

See also

Web links

Individual evidence

  1. Regulation until the end of 2008
  2. ^ Article by the Bureau against Age Discrimination from Jan. 1, 2009
  3. ^ Report of the Berlin Medical Association of September 22, 2010
  4. Article of the Ärzteversorgung NRW ( Memento from December 9, 2012 in the Internet Archive ) (as of 2012)
  5. Bavarian medical care, old-age pension
  6. Evaluation Committee, KBV, Federal Ministry of Health , quoted from Ärzte Zeitung , 11./12. July 2008, p. 6
  7. Federal Statistical Office Special Series 2, Series 1.6.1 (as of October 2009) for 2007
  8. Cost structure statistics for medical and dental practices, Federal Statistical Office, Bonn branch
  9. ^ Kassenarzt ( Memento from December 25, 2014 in the Internet Archive ) Website of the Austrian Medical Association , accessed on October 17, 2018
  10. Wahlarzt ( Memento from October 17, 2018 in the Internet Archive ) Website of the Austrian Medical Association , accessed on October 17, 2018
  11. Group practice ( Memento from October 17, 2018 in the Internet Archive ) Website of the Austrian Medical Association , accessed on October 17, 2018
  12. Ordinance of the Federal Minister for Health and Women on the criteria for the ranking of medical applicants for individual contracts with the health insurance carriers (doctor ranking criteria regulation) Federal Law Gazette II No. 379/2017
  13. Contract doctors in Austria: Inventory and analysis of the website of the Main Association of Austrian Social Insurance Institutions, accessed on October 17, 2018