Medical care: With medical centers against the rural exodus

Too few doctors, older people – many rural regions are suffering from this development and are therefore losing their attractiveness. Kirtorf in Hesse now wants to bring life back to the town with a new medical center.

Heavy excavators roll through the main street of the small town in the Vogelsberg district with its 3,000 inhabitants, right next to the historic market square. Cranes tower over the – for the tranquil conditions here – huge construction site. Something is clearly happening in Kirtorf. And that is also urgently needed. Because in the years between 2000 and 2017, the number of residents fell steadily here. Many younger people couldn’t find work and didn’t want to stay here anymore. They left their village, which is officially considered a country town, because the town center was becoming increasingly neglected.

A small town struggles to survive

“It’s depressing,” agrees Karsten Jost, who grew up on exactly this street in Kirtorf. “It’s not nice when you walk past decaying, empty half-timbered houses for decades,” says the 50-year-old, who has been a city councilor here for years: “We looked at and saw both the age structure and the ownership structure of the houses here that the center of town is basically dead,” says Jost with a worried look. He speaks of “essential basic problems in the countryside” – and by that means not only infrastructure problems but also the “dying out of rural doctors”, which worries Kirtorf, like many other small communities in Germany.

In Kirtorf there is only one general practice with four doctors and two assistant doctors. Together they treat more than 4000 patients per quarter, who come not only from the village itself, but also from the surrounding 20 neighboring villages. The catchment area has continued to expand in recent years. “At some point we reached our limits,” says general practitioner Michael Buff. Overall, medical care in Kirtorf is still good. But the group practice where Buff works is almost always overcrowded – he and his colleagues are constantly stressed. Above all, there is a lack of more space to be able to increase staff. The infectious patients have already been quartered here – as a kind of emergency solution, they have to be treated in a blue construction container in the yard of the practice. “Something had to happen,” summarizes family doctor Buff. Because medical care is a core issue for the people here.

Medical center as a new beginning

In 2016, the idea arose in Kirtorf to counteract the negative development with a major project in the middle of the town. “Either you accept the fact that you have fewer and fewer inhabitants and are becoming less and less interesting. Or you say: we want to do something,” says the current mayor of Kirtorf, Andreas Fey, looking back.

His community decides to take action and is launching what he calls a “lighthouse project” covering more than 5,000 square meters. A real fresh start. The key to this is said to be a new medical center that will ensure permanent medical care in the village and in the surrounding area.

There are already six years between the start of the project and its realization, but the first shells are now in place. In two of the seven buildings, some of which have been renovated, some of which have been newly built, family doctors and specialists, a physiotherapy practice, an intensive care facility and a pharmacy, among other things, are planned to move in next year. There are also cafés, co-working offices and new living space. In other words: a completely new infrastructure for the inner city.

Medical care as a basic building block in the village

“This means that a vacancy is now being activated again, that’s a really great story,” says Doctor Buff, who and his colleagues will be occupying an entire floor in one of the two buildings in Kirtorf’s new medical center. Instead of the previous 200 square meters, there will be 360 ​​square meters of space for family doctors in the future. “Medical care is a basic building block for a functioning social structure here in Kirtorf, too,” says Buff.

And the city councilor Karsten Jost is also very happy: “First of all, this fundamentally changes the supply situation”, while at the same time the health offer can be significantly expanded. In addition, the long-term perspective is changing, because the Kirtorf family doctor’s practice, for example, can be maintained in the long term – even when family doctor Buff and his colleagues retire. “Young doctors are more willing to go into a practice in a center like this compared to the old structures,” Jost is certain and receives approval from family doctor Buff. And just as important: The center should create many new jobs here, which were recently lacking.

The concept of the so-called “med centres” with holistic concepts, in which doctors, physiotherapists and health studios work closely together, is also gaining acceptance elsewhere and is not only becoming the heart of the revitalization of rural areas in Kirtorf. There are already 43 of these centers across Germany, and another twelve are currently under construction, including the Kirtorf location. “We have an aging, tendentially more morbid society that we have to provide with fewer medical workers,” explains Alexander Bechtler, initiator of the Medzentrum concept. Medical staff, above all doctors, would increasingly prefer to be employed than set up their own practice. Therefore, there is a need for relief facilities – “and we can only create them in such medical and health centers,” says Bechtler. For him, this is the “practice structure of the future”.

Exemplary for municipalities in crisis

Kirtorf is investing over 20 million euros in its entire infrastructure project. This is only possible with the help of private investors and funding from the village development program of the state of Hesse amounting to 2.7 million euros. The small municipality itself paid 5.5 million euros. Even if Mayor Fey describes the whole thing as “a bureaucratic monster that gives us a lot of trouble,” he also emphasizes that it’s worth it. The population has already increased again. “We want to be significant again and attractive to our fellow citizens and young families,” emphasizes Fey. Here, Kirtorf can also serve as an example for other rural communities.