Doctors in private practice are demanding more money

Doctors in private practice are demanding more money

A blood draw in the practice of Dr. Mark Sajthy in Mainz. Three ampoules for a small blood count, the small tubes get their labels and the blood goes to the laboratory by courier. A routine that has become significantly more expensive for the nephrologist in the past year. Practically all suppliers and service providers have increased their prices significantly, as Sajthy explains.

The specialist shows a folder with corresponding letters from his partners: the laboratory is increasing prices by 7.5 percent, a drug manufacturer is charging 20 to 110 percent more for its products depending on the ingredient, the maintenance of the ultrasound device is 6.2 percent more expensive, the practice rent increases by 21 percent.

Sajthy calculates: “On average, the costs of a treatment have increased by at least ten percent for us.” During the same period, income increased by only two percent.

federal association speaks of “broken savings”

Not an isolated case, according to the National Association of Statutory Health Insurance Physicians (KBV). At the crisis meeting on Friday in Berlin, the main focus will therefore be on the demand for more money. Minister of Health Karl Lauterbach and his ministry promised doctors a lot, but did not keep these promises, so the accusation. For younger doctors in particular, having their own practice is becoming increasingly unattractive, especially in comparison to a permanent position in a clinic.

The KBV chairman Andreas Gassen therefore warns of a collapse: “Politicians must be clear: the future of local, nationwide outpatient care by doctors and psychotherapists is acutely endangered.”

Mark Sajthy examining a patient.

Ministry of Health puts the numbers into perspective

The Ministry of Health defends itself against the accusation of “breaking savings” and calculates for its part: In the past ten years, spending on outpatient medical care has increased enormously, says a ministry spokesman. In 2013, the statutory health insurance (GKV) would have paid around 32 billion euros, in 2022 it would have been around 46 billion – an increase of 44 percent.

From the point of view of the Ministry, medical practices can continue to be operated economically in the future. This applies above all with regard to the recently significantly increased operating costs of the practices.

The National Association of Statutory Health Insurance Funds sees little financial leeway

The majority of the sponsors for the doctors in private practice are the GKV. Every year, the expenditure for outpatient care is renegotiated and, if necessary, increased. Last year, increases of two percent were enforced with an arbitral award because the GKV and KBV could not agree.

This year, the National Association of Statutory Health Insurance Funds is offering a similar increase. “This year, an increase of 2.1 percent is appropriate from our point of view,” explains a spokesman for the umbrella organization. “This results in additional costs of around one billion euros, which would have to be paid by contributions from those with statutory health insurance.” It should not be forgotten that contributors would also suffer from the burden of inflation.

Earn that much established doctors

Impending collapse or whining at a high level? For the year 2020, the Central Institute for Statutory Health Insurance Physician Care in Germany has calculated how high the income of a resident doctor actually is.

After deduction of all running costs, the study results in an average annual surplus of 172,000 euros per practice owner. After deducting all taxes, insurance and pensions, the result is a disposable annual net income of 86,000 euros, i.e. around 7,150 euros per month, according to the results of the study. Since costs have risen much more sharply than income since 2020 due to inflation, this amount is likely to have decreased somewhat.

expert sees rather negotiation tactics as collapse

Wolfgang Greiner is a health economist and health scientist at Bielefeld University. He also rates the last increase of two percent as rather low in view of the rising operating costs.

With a view to terms such as “collapse” or “save broken”, he points to the current negotiations between the GKV and the KBV. In principle, these are something like collective bargaining, says Greiner. “It gets loud and very demonstrative, it’s basically no different with doctors and health insurance companies than with IG Metall and employers’ associations, only the means are different.” He expects a more significant increase for the coming year than the 2.1 percent currently offered.

Still a dangerous trend

“Since doctors are known to be in short supply, they will continue to receive a comparatively attractive income,” explains the health economist. For young doctors in particular, it is not just the net salary that plays a role, but also softer factors such as the workload and the amount of bureaucratic work involved.

Business risk also plays a role. That’s why there is currently a strong trend, instead of going into self-employment, preferring to work on an outpatient basis as a employed doctor – i.e. like in a hospital, only usually without night shifts.

This is also a concern of the National Association of Statutory Health Insurance Physicians. In order to make the job in one’s own practice more attractive, the KBV calls for better pay as well as a reduction in bureaucracy and more support for digitization. This not only causes more costs, but also a further high amount of work outside of the medical work. The frustration of the colleagues is great, KBV chairman Gassen is sure.

Frustration, but no solution in sight

Sajthy also talks about frustration again and again in his kidney specialist practice in Mainz. But it still has to go on. He doesn’t have a real solution to the problem. “Because if everything were implemented that we would see as appropriate for our work, then the system would probably collapse.”

On the other hand, dissatisfied doctors and practice staff could not be in the interest of society.

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