Germany struggles to recruit rural doctors

For my father it was not just a job, but a calling, said Stefan Lichtinghagen. For 32 years, his father led a successful family doctor's practice in Marienheide, a municipality with a population of 14,000 about 50 kilometers (30 miles) northeast of Cologne.

About 20 years ago, he was looking for someone to take it over, and it ended up being his son, who, as a specialist in internal medicine and gastroenterology, initially had a different plan for his life. 

"My father was really on the go from morning until evening," the doctor said with a smile. "I saw him very little and always thought to myself: 'you don't want to have a job like that.' Now it turns out that I work almost as much."

50-hour weeks, but as his own boss  

On the day DW met him, Lichtinghagen had diagnosed a 20-year-old with appendicitis, treated a neighborhood friend with respiratory problems and tended to a 91-year-old's head wound.  

With 3,300 patients and house calls to deal with, it easily adds up to a 50-hour working week — but he has never regretted his decision.  

"My colleagues are put off this type of work because of the bureaucratic hurdles," he said, referring to the documentation and administrative work required, "but with your own practice you're your own boss, free to arrange things as you like."   

Increasingly few young doctors in Germany want to become general practitioners in rural communities. According to a study by the Robert Bosch Foundation, 11,000 family doctor positions are expected to be unfilled by the year 2035.  

That has severe consequences for Germany and especially its rural areas: 40% of which are threatened by the lack of doctor. The trend is rising because every third family doctor in Germany is currently older than 60 and therefore soon to retire. 

Politicians in Germany, a country that prides itself on its healthcare service, are desperately trying to counteract this and entice doctors into the countryside with money. German Health Minister Karl Lauterbach is calling for 5,000 additional places in medical schools to allow for adequate care of the aging population. The German health ministry has earmarked €23 billion ($25 billion) across various projects for tackling the shortage of rural doctors.  

Pilot project for rural doctor training quota  

A so-called "rural doctor quota" has been introduced in nine of Germany's 16 states. It means that up to 10% of places in medical schools would come under the condition that graduates work for 10 years in a region that is facing shortages. Candidates do not even need to have received good marks in their final high school examinations.

Even Lichtinghagen, who was initially skeptical about the quota, now considers it a first step in the right direction. "We need to do something: Specialists can be organized in a different way, but the system can't work without family doctors. I'm surprised that there isn't a bigger public outcry over this," he said.  

To understand more about how important family doctors are, one must travel 100 kilometers south from Lichtinghagen's practice — to Klaus Korte in the municipality of Ahrbrück. The general practitioner was perhaps the most important doctor in Germany two years ago, when 134 people were killed and hundreds injured during catastrophic flooding in the Ahr Valley. Korte's practice was also destroyed in the flooding, and the doctor provided emergency care for six weeks at a makeshift center set up at a school.  

"To be a family doctor is the most wonderful thing that I can imagine," Korte told DW. "The people of this region have grown close to my heart over the past 20 years, even more so in the two years since the flood. These thousands of fates on the river have woven us together in a completely new way." 

That goes as far as patients remaining loyal to him as their doctor, even though they now live in emergency accommodation more than 100 kilometers away.  

When Korte began his practice 20 years ago, five family doctors served the area. Now there are two, he said. 

The significance of 'goalkeepers' 

Klaus Korte is familiar with the prejudices that continue to circulate about general practitioners. There are colleagues who disparagingly speak of them as second-class doctors. Korte laughs it off: for him, family doctors are the "goalkeepers," who, like the gloved football players, must always be vigilant and careful. 

"There is no senior physician or specialist here that you can ask. We need to make the correct decisions to avert severe consequences, such as with cardiovascular diseases or the detection of tumors. Of course, we do not do invasive medicine or intensive care, but you can save lives in the family doctor's office, and many do." 

There is also the element of familiarity: Klaus Korte said that he can treat his patients in a unique way because, for instance, he knows someone's father died of cancer three years ago, or because he knows that someone's sister ended up in a psychiatric ward with anorexia. And because he, too, witnessed the energy-sapping neighborhood dispute. His plea: Germany urgently needs to do more to combat the rural doctor shortage. 

"There is no other branch of medicine where you are as close to the people as the family doctor. It is the foundation, and if the foundation is missing, the building above will collapse." 

This article was originally published in German.

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