With the pandemic, people in rural areas are once again reminded of the important work of resident doctors. But people’s supply is fragile – the offspring is missing. a future vision.
Rothenburg – Young woman doing what the vernacular describes as “looking in moderation.” I just moved from Wendorf in Bremen to Bremen-Noord. Brilliant, she must have thought, practicing as a neighborhood doctor, where she could register as a patient. Apart from that, please write an email.
However, you should expect a waiting period of three months. What a young woman experiences is typical: on the one hand, the practices of the family doctor are literally bypassed by willing patients, and on the other hand, more and more doctors are abandoning their work, often for age reasons. No successors in sight – Statutory Health Insurance Physicians Associations, health insurance companies, and scholars have recorded an increased willingness of potential physicians to practice as general practitioners or specialists for years. This problem currently affects less urban centers than rural and suburban areas.
“When filling the doctors’ benches, the magic word is work-life balance,” says Detlev Havke, a spokesman for the Lower Saxony Association of Statutory Health Insurance Physicians (KVN). Those who are faced with the question of taking on an existing practice or even opening a new one today, for example, look to see if a partner can find a “suitable job” nearby. And if there are or are planned children, the school and childcare facilities play a crucial role. According to Hafke, other questions are the pace of on-call work in the evenings or weekends, possibilities to collaborate with other doctors in the area, recreation opportunities, and the expansion of local public transportation.
The area is still well supplied
According to KVN, the Rothenburg region is currently still well supplied with general and specialist practitioners, even if there is still room for improvement. The legal basis for this is what is known as requirement planning. For these there are regional control areas, planning areas. The “population to physician” ratios of the specialty are also important. In addition, there is the question of how high the level of medical care is in the specialty. If that is 110 percent for the population, this area is blocked. This calculation again depends on the ratio. For example, according to Haffke, a family physician should care for 1,609 residents. An ophthalmologist is responsible for approximately 12,460 residents. W: The proportions can vary slightly in individual regions. The lower the level of care, the more doctors in the specialty can settle there. Or in other words: “Supply levels below 100 percent indicate a need.”
According to KVN, GP care is still good for the entire Rothenburg region, but no longer ideal. The need lies in eleven general practitioners. Looks different with specialists. The area is blocked here because the coverage level is over 110 percent. According to KVN statistics, one psychiatrist and 2.5 psychotherapists are needed.
But what can be done so that the supply of the population in rural areas does not turn into a disaster in the medium and long term? This is primarily the case for the Association of Statutory Health Insurance Physicians. Above all, our skeletal chests should, if not cure, at least bring relief. So far, according to its spokesperson, KVN has spent 20 million euros on “branches, recruitment and takeover practices in areas threatened by shortage of supply.” However: “The Rothenburg region is not yet included.”
The shortage of doctors is stark.
But securing the future must start much earlier – even with students. For a long time, representatives of physicians have been calling for an expansion of the number of places offered and for targeted support to general practitioners in the future. However, it is not only financing that is necessary. This also includes addressing students through participation in trade fairs, university consultations, student meetings and excursions. In the Rothenburg region, following the decision of the district council for 2018, six medical students are now supported with a scholarship – on the condition that they work here later as well.
In order to ensure that people in the city and the countryside are provided with enough general practitioners and specialists in the future, Medicare Centers (MVZs) have been set up in recent years – among other things after the closure of the Ostimide clinic in Zeven. There are doctors of different specialties working under one roof. However: MVZ appears to be successful only for specialized medical care. At least, Lars Weissmann, director of theology and press spokesperson for the Agaplesion Diakonieklinikum Rotenburg, suggests this. “The medical care provided by the MVZ has proven itself. Thus we make a significant contribution to ensuring the supply in the region, and we see no point in changing the existing structures again.” The clinic tried to set up a family doctor clinic with a permanent doctor. But this did not work because in these The case was the desire for self-employment was greater.
Good experiences with MVZ
The hospital in the neighboring district of Osterholz also has positive experiences with MVZ – and it has been doing so since 2006. According to hospital director Klaus Vagt, only doctors work in MVZ. Vagt, MVZ sums up a “sometimes large medical gap,” which can “create a connection between outpatient and inpatient care.”
But what comes after MVZ or specialized medical treatment? Here, Wißmann identifies a specific (Rotenburger) problem: aftercare after a patient’s stay at the Diakonieklinikum. Then it becomes particularly noticeable that there is a growing shortage of general practitioners. “The problem also arises in our emergency department when patients file complaints that comprehend the processes and resources that should be allocated to critically ill patients,” the Agaplesion spokesperson added. Wißmann draws a sober budget: “The shortage of doctors is stark.” Politicians urgently need to do more “to improve the framework conditions for the activities of the family doctor in rural areas, among other things.” Hospital Director Vagt from Osterholz-Scharmbeck knows: “You have to look for new concepts.” This could include “opening clinics for certain outpatient services” via the Licensing Act. So far, this has been the sole responsibility of the federal states’ statutory health insurance associations.
A family doctor takes care of about 1,700 people
According to Detlev Hafke, spokesperson for the Lower Saxony Association of Statutory Health Insurance Physicians (KVN), when it comes to supplying GPs, it is done via the so-called central regions – the amalgamation of municipalities. Specialized medical care must be planned for the entire area. Accordingly, there are three general practitioner planning areas in the Rothenburg region:
– Bremervörde with the communities of Alfstedt, Anderlingen, Basdahl, Bremervörde, Stadt, Deinstedt, Ebersdorf, Farven, Gnarrenburg, Hipstedt, Oerel, Ostereistedt, Rhade, Sandbostel, Seedorf and Selsingen. 43,692 people live there, and the family doctor is supposed to treat 1,695 citizens. It currently employs 24 general practitioners, and the coverage rate is 91.1 percent. This means that five GPs can settle until closing.
– Rothenburg with the communities of Ahausen, Bötersen, Bothel, Brockel, Fintel, Hassendorf, Hellwege, Helvesiek, Hemsbünde, Hemslingen, Horstedt, Kirchwalsede, Lauenbrück, Reeßum, Rotenburg, Scheeßel, Sottrum, Stemmen, Vahelwvede. There are 75,604 people living there and the family doctor is supposed to treat 1,708 citizens. 43.5 general practitioners are employed. The coverage level is 98.2 percent, so an additional 5.5 GPs can stabilize until closing.
– Zeven with the communities Breddorf, Bülstedt, Elsdorf, Groß Meckelsen, Gyhum, Hamersen, Heeslingen, Hepstedt, Kalbe, Kirchtimke, Klein Meckelsen, Lengenbostel, Sittensen, Tarmstedt, Tiste, Vierstedt and Vorwerke. 45,327 people live in this central region, and the general practitioner is supposed to treat 1,804 citizens. 26.75 GPs are currently active in the mid-range. The coverage rate is 106.5 percent. There is space for another family doctor to be blocked.
Nothing works with specialists anymore because the level of care is over 110 percent. According to KVN, one psychiatrist and 2.5 psychotherapists are needed.
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