Without a pediatrician, Dr. Reinhold Jansen would collapse the supply system in Daun in the Vulkaneifel. He treats 2000 patients in his practice, for many he is not paid. He warns: “If I don’t care, nobody cares.”
by Lauren Ramoser
This article first appeared on RTL.de
“If I don’t care, no one cares,” says Dr. Reinhold Jansen from Daun in the Vulkaneifel about his overworked pediatric practice. The 73-year-old and his team take care of 2000 small patients – but he only gets paid part of the ten-hour days. And that is due to the complicated calculation system for panel doctors.
Shortage of doctors: pediatrician Jansen treats 2000 patients in his practice
In 2011, at the age of 62, the experienced pediatrician Dr. Reinhold Jansen opened a pediatric practice in Daun, in the Vulkaneifel, for which no other doctor was found. “I thought I’d do two or three years here and then we’d find a successor for the practice,” explains Dr. Jansen in conversation with RTL. “I want to prevent the pediatric care of an entire region from collapsing.” But the lack of paediatricians thwarts his plans.
Nationwide there is a lack of paediatricians, the remaining practices are hopelessly overcrowded. For the doctors, this means piecework, a lot of responsibility and poor pay. Doctors with patients who have statutory health insurance receive a fixed flat rate per patient and quarter – regardless of how complex and lengthy the treatment is. The more often a patient visits, the less doctors earn from him. for dr Jansen means that very matter-of-factly: “If I don’t care, nobody cares.”
“Medical care, especially in rural areas, is incomplete. In the long term, there will be huge damage and also costs for the health insurance companies, due to consequential damage and diseases discovered too late or behavioral problems discovered too late,” says Dr. Jansen the dramatic situation in the country.
Some patients drive 40 kilometers – without Jansen, the supply system around Daun would collapse
The parents would sometimes drive 40 kilometers with their children if they got an appointment in Jansen’s practice. Almost half of his patients come from the neighboring counties.
And that is also a political problem. Because for each district, the number of doctors, in this case paediatricians, that are needed for the children living there is calculated. For Daun, this key works – so from a political point of view there is no problem. But in reality – i.e. Dr. Jansen’s waiting room – looks different. Because there are no longer any paediatricians in many of the surrounding districts, the parents ask Jansen’s practice. “Crying parents contact us and ask for appointments.” In addition to the actual care area, the practice looks after large parts of the neighboring districts in which there are no longer any paediatricians.
Because the undersupply of paediatricians worries parents. Even if they want to, they often cannot find a doctor, not even for the mandatory medical examinations.
“But I can’t send the children away, they have to be taken care of urgently. They need their provisions, because they are state-controlled,” explains Dr. Jansen the dilemma. “Otherwise the youth welfare office will come and check with the parents to find out why the child hasn’t taken part in the medical check-up. That means the parents have been put under tremendous pressure, but have had no opportunity to present their child anywhere.”
Jansen is left with the costs for new patients
For the acquired practice, Dr. After a long search, Jansen finds a pediatrician with whom he can share the ever-increasing number of small patients. However, the practice may not calculate more points than the individual practice of Dr. Jansen – according to the rules of the Association of Statutory Health Insurance Physicians. There is no fee for new patients. The two doctors still refuse to have children.
But after some time, the colleague becomes pregnant, is expecting twins, has to go on maternity leave early and then moves away. “The whole cost structure with employees and rent continues to run, but no more services are provided,” explains the doctor. “I took over at that moment. I had to, to take care of the people.”
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However, this has fatal consequences for his payment from the Association of Statutory Health Insurance Physicians (KV): After the colleague stopped working, the points on which the calculation is based were halved for the practice. Because there was only one doctor working in the same place. “And that was the upper limit, which then came into effect again. Everything that was above that was graded and only half of it was paid for,” says Dr. Jansen.
“The practice is now heavily in debt”
“There is no more money for the treatment of the children in the third quarter month! However, the rent and salaries of the eight employees, energy costs and equipment costs continue. The practice is now heavily in debt.” The now 73-year-old fears that he will not be able to find a successor for his practice under these precarious financial circumstances.
When asked about the National Association of Statutory Health Insurance Physicians, a spokesman said: “The fundamental problem is the budget – for all groups of doctors, by the way. We have an unlimited promise of benefits in statutory health insurance, but only a limited amount of money for these services.”
In the long run, this system primarily harms patients. Because when the budget provided by the KV is reached, many doctors close because they would otherwise work for free. Despite existing capacities, patients are then faced with closed doors. For pediatrician Dr. That’s not an option for Jansen. The RS virus has been rampant among children since the end of the year, and many of the little patients urgently need intensive care.