My 19-year-old godson Sebastian wants to become a doctor. He should carefully consider his decision – he may be threatened with a “doctor glut”. An open letter.
Does anyone remember the “doctor glut”? Yes, there used to be, and I was right in the middle of it. Dear godson Basti, if I’m telling you about this today, it’s because you’re about to study medicine. And because the career opportunities couldn’t be more excellent, after all, there have been complaints about a “shortage of doctors” for years. Federal Health Minister Karl Lauterbach recently made drastic predictions: 50,000 too few doctors have been trained in the past ten years. “Therefore, we will be lacking family doctors across the board in the next few years,” he said.
One wonders, how did it come to this? We’re all still here and working. We Boomers, who have always been too many of us. Because we persevered, despite all the gloomy predictions. There was no other choice: the “teacher glut” wasn’t over yet; there was even a “engineer glut” during my studies. Everything has long been forgotten; there is also supposedly a dramatic shortage of workers in these professions today. But the “bulk of doctors” is an excellent way to explain how questionable all of these long-term prognoses based on an acute situation are. Now also the “shortage of doctors”, but more on that later.
Medical studies back then: “A third of you will never be able to work in this profession”
So what was it like during the time of the floods? I remember several events in the first semesters in which we were told: There are too many of you. A third of you will never be able to work in this profession. Find something else while you still can.
Looking back, the coinage “doctor glut” was a lot of nonsense. It cannot be found in the statistics. A quick look back: In 1980, shortly before it supposedly began, 173,346 doctors were working in Germany. In 2002, when it supposedly ended, there were 301,060. In between, their number rose steadily, and nowhere is there a bulge in the bar graphs that graduates like me, who entered the labor market at the historic peak of the medical glut in 1997, fit into – just like your mother, Basti, who is now a pediatrician and She has to be there for 80 little patients in her practice, and she only has a few minutes for each one.
In January 1997, the Federal Labor Office recorded exactly 10,594 doctors who were registered as unemployed, and the trend was supposedly increasing rapidly; even specialists were affected. In 1998, the “Deutsche Ärzteblatt” headlined: “Medical unemployment: From a foreign word to a long-term problem.” Five years later, when the glut of doctors had just been officially declared over, an article appeared under this line: “Shortage of doctors: The next generation is disappearing”.
Shortage of doctors? The number of doctors has increased significantly since 1980 – but there are still not enough
Oops. The situation changes so quickly. And there has been a shortage of doctors in Germany for so long. And this despite the fact that their number is constantly increasing today, we are now at a good 428,000. More than a doubling since the beginning of the “doctor glut” – and yet hospitals all over the country are desperately looking for doctors, and yet one family doctor’s practice after another is closing in the countryside.
So we really are dealing with a shortage of doctors, you might say – right? Hmmh… nope. Let’s first make an international comparison: When it comes to the so-called “doctor density”, the Germans still occupy one of the top places with 453 doctors per 100,000 inhabitants, far ahead of countries like France, Belgium or Hungary. And this despite the fact that people in this country are known to be neither healthier nor live longer.
But the pure numbers say little. In Germany, there is often a shortage of doctors in the countryside, while specialists are concentrated in the big cities. They often prefer to give appointments to private patients; quite a few do not have health insurance approval. Germany affords the expensive luxury of a “double specialist track” of residents and hospital doctors, both of whom want to earn well. Compared to other European countries, Germans may be more complaining, and in any case they go to the doctor more often than their European neighbors. The perceived shortage of doctors also includes overcrowded emergency rooms and hopelessly overworked hospital doctors – which is due to excessive bureaucracy, an inadequately positioned private practice sector in many places and the now well-known billing system based on “case flat rates”, which still rewards clinics that treat as many patients as possible in the shortest possible time Pass through time.
But now we come to the crucial question: Should I advise you to study medicine? You’ve already completed three months of nursing internship. In a few days you will take the “medical test”. With a high school diploma of 1.2 and your great talent for natural sciences, there is no doubt: you will get your place at university.
“The next glut of doctors has already been determined”
When I say something like “follow your gut feeling,” that’s of course always true. But maybe you also think pragmatically. And that raises the question: Will there still be a shortage of doctors in 2030 – or perhaps a glut of doctors again? The latter seems unimaginable, after all we are all getting older and more in need of medical care, and many doctors are now close to retirement age. Nevertheless, the consulting firm Dostal & Partner, which specializes in dealing with the shortage of general practitioners, dared to make this prediction six years ago: “But the next glut of doctors is already predetermined.” The arguments mentioned are still valid today: By the time a massive expansion of medical study places, as is now being called for again, will lead to more graduates, we will have passed the year 2030. There will be modern and more efficient structures. There is probably no longer a per-case flat rate system. Digitalization will be well advanced and AI will support doctors in their work. They will probably also be joined by academically trained community health nurses and particularly qualified medical assistants who can take on many routine treatments and even write prescriptions. This “delegation” of medical tasks to such specialists is already stipulated in the current coalition agreement. There is basically no alternative, even if the doctors are still resisting it.
5000 years of medicine
Time travel through the history of anatomy – how we learned to understand our bodies
What I want to tell you, Basti: By the time you finish your studies, you could be faced with a completely different job market situation.
At that time, being a doctor on an internship also meant: a third of the position for a third of the assistant doctor’s salary, i.e. 500 marks per month
But what could that mean for you? Maybe it will happen to you like it did to us back then. At that time, the “doctor in internship” was introduced as a means of combating the “bulk of doctors”. The idea behind it: (almost) full medical responsibility, depending on the specialty, two to ten nights and weekend shifts per month, but only a third of the salary of an assistant doctor. At that time it made around 1500 marks. Little, do you think? At a clinic in my university town of Bochum, three graduates in my chosen subject of neurology shared a position – they worked full-time, for a third of 1,500 marks. When I complained about it, my godfather Herbert, a practicing internist with a large villa, a collection of paintings and a swimming pool, shocked me. He said: “After the war there was no money at all. I worked for free for a year and did research. I was happy to do that.” That means: It could even be worse than what my generation experienced.
For you this means: If you really want it, do it. But be capable of suffering. And be prepared that your career prospects may no longer be as rosy as they seem now. But even then, of course, that doesn’t mean that you will be on the street as a graduate: In fact, I don’t know anyone who would have had that happen to them because of the alleged glut of doctors. My fellow students quickly found work, worked 60 hours a week as assistant doctors, achieved respect and wealth, and most of them feel fulfilled in their jobs.
One final note, Basti, if you are still considering whether teaching would be an alternative to being a doctor. We know that there is a dramatic shortage of them too – right? Well – a current Bertelsmann study predicts that next year there will be more teachers available for primary schools than there are positions to be filled. Maybe the glut of teachers will come back.
So just go where your heart takes you and don’t let predictions guide you.