Family Medicine in Germany 1. Specialization – how to get there in Germany? 2. How do we trainees...
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Family Medicine in Germany 1. Specialization – how to get there in Germany?
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Transcript of Family Medicine in Germany 1. Specialization – how to get there in Germany? 2. How do we trainees...
Family Medicine in Germany
1. Specialization – how to get there in Germany?
Overview I
➲5 years of training
➲Each state has its own curriculum (16!)
➲Curriculums always contain: General Medicine, Internal Medicine, Surgery
➲Courses required: Psychosomatic medicine (80 hours), payable by trainee, not within working hours
Overwiev II➲Some curriculums contain (less in rural areas): Pediatrics, Orthopedics, Anesthesia or Intensive care
➲No formal inscription / organization of the training: each part of the training has to be organized by the trainee himself by applying in the clinic/ practice for the period required (in some states changing to organized training)➲Payment: in hospitals according to other doctors. In practices/ surgeries with support from a program called IPAM. So the practice owner is paying only the social insurance payments but not the full salary!
Overwiev III
➲„Numbers“ to reach in all curriculums: ecg, 24-hours-ecg, 24-hours-bloodpressure, sonography (abdomen, thyroid), duplex (carotis), doppler (iliacal/fermoral veins), proctoscopy, but also for certain situations like emergency situations, dealing with diabetics, vaccinations etc.
➲„log-book“ to certify all this
➲Exam is made of „kollegial“ talk, 30 minutes, 4 examining Gps, common medical problems are examined theoretically
Training in Berlin
➲6 months internal medicine (in hospital)
➲18 months general / family medicine
➲6 months pediatrics
➲6 months surgery
➲6 months orthopedics
➲3 months anesthesia (former intensive care)
➲80 hours-course psychosomatics (50 hours theory, 30 hours Balint-group)
one example: How did I do it?
●6 months geriatrics in hospital
●12 months internal medicine in hospital
●3 months intensive care unit in hospital
●6 months pediatrics in practice
●12 months family medicine in practice
●6 months orthopedics in practice
●4 months internal medicine in practice
●6 months surgery in practice
●6 months family medicine in practice
●Course 80 hours psychosomatics
What is good?
➲Breaks in between are possible
➲Applying in practice / hospital that suits your interests / location / known good teacher etc.
➲Good choice of working places, more posts than trainees due to lack of doctors
What bad?
➲Unemployed times between 2 posts sometimes unavoidable
➲Constantly applying for new jobs is quite stressful: once you start one post you have to apply for the next one.
➲Not all posts have doctors/trainers willing to teach, it´s rather the workforce they want! There is no fixed recruitment requirements concerning the teaching abilities of trainers!
➲No mentor.
How would it be better?
➲Structured application for 5-years specialization would give a security for planing, no unemployed times but also the possibility to learn all you need.
➲Obligatory courses should be free of costs for trainees and during their working-time.
➲Curriculums should contain less times and numbers but competences / skills.
➲Teach the teachers!!
Family Medicine in Germany
2. How do we trainees connect?
Connections between trainees I
➲Special situation since we have no formal registration and individual rotations so we don´t meet our collegues
➲WABe in Berlin: group for trainees was established around 2007 to help each other, to exchange, and - most important: to evaluate training posts!! Now around 350 members online, regular monthly meetings visited by usually 15 to 30 members.
Connections between trainees II
➲In 2009 JADe (= Junge Allgemeinmedizin Deutschland) was founded as a youngsters group of the DEGAM (german professional Family medicine association), now with more than 600 members online.
➲JADe is the german partner of the VdGM = Vasco da Gama Movement, the youngsters organisation of the WONCA.
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Family Medicine in Germany
3. How do Gps/FPs work in Germany?
How do Gps/FPs work in Germany?
➲Always in private practice, responsible (and free to decide!) for equipment, number of nurses, timetable, vacation-time, laboratory, decision if homevisits or no, special interests, (methadone program, manual medicine, acupuncture, sonography...) etc. GP als financial responsible for all the above.
➲Alone or with mainly 2-4 other GPs or other specialists
➲GPs make contracts with communal health companies and get reimbursement for around 90% of patients for that (other 10% of patients have a „private“ health insurance... I won´t talk about that here..)
How do Gps/FPs work in Germany?
➲No patient list! Patients need no registration! Patients can go to any GP or other specialist they want without referral, as often as the want!
➲GPs get paid for the face-to-face-contacts with one patient within a 3-month period (jan-march, april-june...), but get paid only once in these 3 months, even if patient comes 10 times or more!
➲On average a GP gets to see around 900 patients in 3 months (but some several times, we have on average around 14 dr-patient-contacts per year!)
➲Reimbursement ist more for older patients, children and patients with chronic diseases
How do Gps/FPs work in Germany?
➲Reimbursement (for 3 months) is around 50€ for any patient (more for elderly ~ 60-70€, and children), extra 20-30€ for chronic patients.
➲Extra payments for vaccinations, psychocomatic intervention, important-live-change-talk, chronic-disease-programs and some preventions.
➲Consultations and all investigations referred to by the GP are free of costs for the patient.
➲Patients need to pay 5 to 10 € for recipies for medication and physical treatment (max. 2% of their yearly income per year).
