North Rhine-Westphalia wants to continue to rely on its “rural doctor quota” against the threatened medical undersupply of villages and small towns. This was announced by NRW Health Minister Karl-Josef Laumann at the turn of the year. The CDU politician had fought an initially controversial law three years ago, according to which every 13th medical study place in the most populous federal state is reserved for applicants who, after completing their training, work as a general practitioner in an area threatened by the shortage of doctors for at least ten years commit. In the meantime, eight other federal states, including Bavaria and Baden-Württemberg, have introduced regulations that future country doctors prefer when allocating study places.
With its quota regulation, NRW had responded to forecasts at the end of 2018, according to which a dramatic undersupply was becoming apparent in mostly rural regions such as the Sauerland, in East Westphalia, but also in individual cities on the edge of the Ruhr area. Currently, more than half of around 11,000 general practitioners in the state are over 55 years old. By the year 2030, there is a risk that the number of general practitioners, internists and paediatricians in several NRW communities will drop to less than half of the need. However, the quota only has a long-term effect: including the specialist training, the course lasts twelve years, the first quota doctors are likely to take over their practices after 2030.
Three years after the introduction of the NRW country doctor quota (LAQ), Laumann now drew an initial interim balance. The funding program “got off to a very successful start” and has established itself. The rush was great, for each of the 180 study places reserved annually by quota, an average of seven young applicants had registered, 63 percent were women. Currently, 473 students are enrolled according to the rules of the Country Doctor Act. According to Laumann, he was “proud” of that.
Obviously, the rural doctor quota attracts applicants who previously had no chance due to being awarded purely on the basis of their Abitur grades (in North Rhine-Westphalia a numerus clausus of 1.0 applies to medicine). Different rules apply to the country’s country doctor program: In a first selection stage, in addition to the Abi grade (30 percent) and the result of the (more theoretical) “medical test” (TMS), it also takes into account whether the candidates are, for example, caregivers, Nurse, paramedic or physiotherapist have gained practical experience, empathy and drive for the medical profession.
Anyone who decides differently after completing their studies can expect a fine of up to 250,000 euros
In fact, 45 percent of applicants had such (often several years) work experience. This is one of the reasons why prospective country doctor students, at almost 24 years of age, are significantly older than their fellow students. However, the new report by the NRW government regrets that the proportion of female applicants with such “experience in professions related to medicine” has recently declined: Hopes that the quota could change the profile of the typical medical student do not seem to be growing.
The real acid test for the success of the NRW program lurks in 2027: Only then will the first students who committed themselves to at least ten years of work as a country doctor take their state examination and begin training as a specialist. According to the contract, they then have to choose a career as a general practitioner, internist or pediatrician. If they do not do this, they face a fine of 250,000 euros. Anyone who renounces their dream of becoming a doctor before, i.e. during regular medical studies, can get away with this penance.