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GERMANY: Lack of doctors on the countryside

The government of North Rhine-Westphalia intends to introduce incentives for medical students to commit themselves to work as country doctors for 10 years. The scheme centres on special admission regulations and generous financial awards.

Everyone wants to work in a hospital

Fewer and fewer graduates from university medicine programmes opt for careers as general practitioners. And only a very small proportion want to become country doctors. To improve healthcare provision in rural regions, North Rhine-Westphalia’s health minister, Christian Democrat Karl-Josef Laumann, has come up with plans to establish a country doctor quota. The aim is to reserve 10% of study places in medicine for students willing to work as general practitioners in rural areas. The scheme is to start off with 7.6% of North Rhine-Westphalia’s roughly 2,200 places for medical students being reserved as of the 2019-20 winter semester for those choosing to work in country surgeries. Medicine is an admissions-restricted subject at German universities. Admission is based on excellent average marks in the German certificate of higher secondary education, the ‘Abitur’. Ahead of the 2017-18 winter semester, there were a total of 9,176 places to apply for to study medicine in Germany and 43,184 applicants.

To become a practitioner is easier

The ‘Abitur’ average mark would not have to be ‘excellent’, although no specifications have yet been made here. Qualified general practitioners can then choose where they wish to work from a total of 160 local communities defined as ‘under-supplied’. Applicants from outside North Rhine-Westphalia can apply but must then work in North Rhine-Westphalia on graduating from university. Applicants awarded a place to study then enter a contract with the state of North Rhine-Westphalia according to which they commit themselves to work as general practitioners in an ‘under-supplied’ region for at least 10 years. Graduates who decide not to work as country doctors will be fined up to €250,000 (US$295,000) for breaching the contract, according to Laumann. Country doctors establishing or taking over surgeries in communities with up to 25,000 inhabitants will be awarded €60,000 (US$70,700). The federal government has been discussing a ‘master plan’ to cope with the insufficient supply of general practitioners in rural areas for some time, although no concrete plan has evolved. According to Laumann, 450 general practitioners go into retirement each year in North Rhine-Westphalia, while just 200 are newly trained. Opinions are divided on his new scheme, with the North Rhine Chamber of Physicians viewing it with scepticism and the state’s other physicians’ chamber, ‘Westfalen-Lippe’, welcoming the idea. The University of Münster comments that it sees a problem in prospective first-year students having to commit themselves to a certain area for such a long period.
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