The fact that his father-in-law works 70 hours a week as a general practitioner, that patients ring the doorbell even on sundays, that budgeting and bureaucracy dominate everyday life: all of this does not deter daniel grimm. The medical student from erlangen will take over the practice in the district of hof together with his brother-in-law. Not only is grimm's father-in-law happy, but the bavarian government is happy, too: it honors grimm's plans with a scholarship.
The 29-year-old from erlangen and 24 other medical students from bavaria (six of them from france) receive 300 euros a month from the ministry of health for a maximum of four years. The scholarship holders have agreed to work in the region for at least five years after completing their studies – whether as general practitioners or specialists, in private practice or in hospitals.
"Today's medical students are tomorrow's doctors", says bavarian secretary of state for health melanie huml about her ministry's initiative. "We want to inspire career starters at an early stage for a later career in the rural area."
Three challenge programs
The scholarship is one of three demand programs of the bavarian state government with a total volume of 15.5 million euro until the year 2014. The second program provides start-up funding of up to 60,000 euros for physicians who set up as general practitioners in rural areas with few young physicians; the third supports innovative care concepts such as joint practices that enable particularly family-friendly working time models.
In the words of HUML, the goal of the challenge programs is to "promote the development of the region maintaining high-quality medical care close to home in the future as well." This is not only an ambitious project, but also an urgently needed one in view of demographic change: of the 9,000 registered general practitioners in bavaria, about one third are 60 years of age or older. When they close their practices, there are often no successors.
The most recent figures are provided by the bavarian association of statutory health insurance physicians (KVB) in munich. Two years ago, when 340 general practitioners retired, one-third of the practices remained unoccupied. "These figures have not changed much for the better", says KVB spokeswoman kirsten warweg. Currently, there is no shortage of general practitioners and specialists in bavaria, but there is a "perceived shortage," especially in rural areas.
The big gap is still to come
But the big gap will only come in the next few years, when many doctors retire, says warweg. "And successors are becoming increasingly difficult to find, especially in rural areas." There are several reasons why this is so for the KVB. First and foremost, it was the unsatisfactory planning reliability of the remuneration system. Particularly in rural areas, the high workload often bears an unfavorable relationship to the possible income from a family practice. Further arguments against "the countryside the workload due to extended office hours and on-call duties, as well as limited opportunities for leisure activities, were the main reasons for the decision. Professional commitments of a partner or the choice of schools are other criteria that play a role in the choice of establishment, he says.
The association of statutory health insurance physicians therefore takes a stand: "it is a task for society as a whole to make rural areas more attractive, says spokeswoman warweg. This includes childcare facilities and schools, as well as cultural offerings and a functioning DSL connection.
In order to increase the attractiveness of a GP practice in the rural area, the KVB has decided on changes to the on-call duty regulations and reduced the frequency of duty. In addition, she is calling for the next generation of doctors through an endowed chair in general medicine at the technical university of munich, run jointly with the bavarian health insurance fund (AOK). It was established in the winter semester of 2009/2010 and is the only chair of general medicine in bavaria.
Chair of general medicine in erlangen
Even throughout germany, the subject is not really institutionalized: according to information from the german society for general and family medicine (DEGAM), there are currently 18 professorships in general medicine at the leading medical universities. Many of these are endowed professorships, as in munich. The friedrich-alexander-university (FAU) erlangen-nurnberg is taking a different approach: it is planning to establish its own new chair of general medicine and thus wants to make a contribution to better family doctor care in rural regions.
By then, student daniel grimm will already be in his seventh semester. After working as a nurse for six years, the 29-year-old began his medical studies in erlangen in 2010 and completed his physics internship last fall. He is currently doing an internship in transfusion medicine at erlanger uniklinik.
His father-in-law, the family doctor, drew his attention to the scholarship from the ministry of health. Grimm applied and was a potential candidate with his plan to enter rural medical practice later in life. After weeks of waiting, he received the acceptance – and in february, for the first time, the 300 euros.
He can put the money to good use, says grimm. Although he also receives a bafog, erlangen is an expensive place to live. "I have to work properly on the side", says the medical student "a lot of time goes into it." Thanks to the scholarship, he can reduce his part-time jobs and now also has weekends off or the opportunity to study.
"Every doctor earns well"
He needs the time as much as the money. Medical studies are demanding – and take time. Grimm needs a total of twelve semesters "and then I'm a doctor, that's all", he says. His planned training as a general practitioner will take another five years, with stations in clinic and practice. Maybe he will finish his doctoral thesis at the same time, then he could have the title written on the sign of his future practice.
Grimm doesn't mind that it's in the frankenwald – he was born in the hofer area. Even the workload does not deter him. He doesn't think he'll ever spend 70 hours in the office like his father-in-law did. "Doctors won't be around much longer. Moreover, the associations of panel doctors can no longer afford such working conditions in the long term" predicts the student.
He currently has only two fellow students who might want to do general medicine as well." Perhaps it is due to the often lamented "bad" conditions in the region earning potential? "Every doctor earns well, says grimm "everything else is nonsense. But the conditions for general practitioners simply have to get better."
Too much paperwork for doctors
Already during his time as a nurse he realized that bureaucracy is a major part of work in medicine. "It can't be", grimm complains "that you study for eleven years and then have to worry about paperwork instead of patients." He hopes that this will change. "I would like to take a stethoscope in my hand and work on the patient. I would also like to be an emergency doctor, and I would rather be in the countryside than in the city", he says and thus sums up his hopes for the future.
His future: still a long way off. "I'm not a general practitioner until 37, says grimm. Nevertheless, his father-in-law is already planning with him. Although the doctor is only 58 – but his practice in the frankenwald will not stand empty after his professional life ends. The new generation is coming, for sure.
Facts about family doctor care in the region
in upper franconia, 761 physicians participate in family doctor care.
In central franconia, 1205 physicians participate in family doctor care.
In lower franconia, 922 physicians participate in the family doctor service.
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