Doctor protest in the dispute over income

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Do doctors receive considerably less wages for a home visit than the plumber?

In the fee dispute with the statutory health insurers, the resident doctors and their associations want to increase the pressure. Protest actions should start in the next few days. The background to this is the dispute between doctors and health insurers that has been raging for weeks about the remuneration for the approximately 150,000 resident doctors and psychotherapists. The National Association of Statutory Health Insurance Physicians had rejected an arbitrator's decision that fees would have risen by almost one percent, and had brought an action before the Berlin-Brandenburg State Social Court. The doctors ask for more.

"The proposed increase of less than one percent describes a disdain for medical work and in no way reflects the high workload and the time spent in everyday practice," says Dr. Annette Grittern, who works as an internist for her patients in rural Dremmen near Heinsberg (NRW). Many of her patients are old and chronically ill, suffer from dementia, are cared for at home or in the home. It is inevitable that the doctor takes care of her patients regularly 54 hours a week. On the weekends she does practice administration and training. In the quarter it comes to 150 home visits, this also at night. "Hardly anyone can imagine the complexity of coordinating good medical care for a seriously ill elderly," says Dr. Annette Grittern. It starts with the lengthy collaboration with specialists, clinics, nursing homes or nurses. Relatives or nursing services must also be instructed and informed. The tools must be checked. “When I see that the rollator is set incorrectly when I go home, I have to do my own thing,” says the doctor. And, like many doctors, they don't know how the future increases in wages, rents, energy or new equipment will be covered.

Whether doctors bring bad news to a cancer patient, show help that requires enormous administrative effort on the part of practice, give consolation to a seriously ill and his family during a home visit - there is only a small flat rate for this - no matter how long and how often the conversation is .

In the current fee negotiations, Professor Dr. med. Rainer Riedel, who heads the master's degree in medical economics at the Rheinische Fachhochschule (RFH) in Cologne, considers it appropriate to at least compensate for the cost increases in personnel and material costs. "And that requires a fee increase of at least 1.5 percent." For Riedel it is clear that with 200 unoccupied general practitioner practices in Germany, the "specialist direction family doctor" must be made more attractive so that care is guaranteed.

"Of course, the earnings of a resident doctor also depend, among other things, on whether and how many private patients he has," Rainer Riedel points out. "Although resident doctors carry an entrepreneurial risk and work an average of 55 hours a week, many earn less than a senior doctor in the hospital," explains Riedel.

But what remuneration is appropriate for extensive medical patient care? A family doctor is usually expected to treat his patients at home at any time, at night and on weekends. "With around 21 euros per house visit, a family doctor gets less than the plumber who comes in to fix the dripping tap," says Riedel. That shouldn't be.

"The eleven percent required by the KBV are certainly a maximum requirement for doctors, which can be explained primarily politically," says the head of the RFH master's program in medical economics. "However, the fee increase should at least cover the increase in practice costs." That was not the case with the previously proposed compromise of 0.9 percent.

Riedel fears that the care sought will worsen our patients' care. If there is to be a good supply of general practitioners and specialists, the work should not be made even less attractive in practice. (pm)

Image: Matthias Preisinger /

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