Doctors protest in the dispute over income

Doctors receive significantly less pay for a home visit than the plumber?

12/09/2012

In the fee dispute with the statutory health insurance, the physicians in charge and their associations want to increase the pressure. Protests are scheduled to start in the next few days. The background to this is the raging dispute between physicians and health insurances over the remuneration of some 150,000 physicians and psychotherapists. The Kassenärztliche Federal Association had a conciliation decision, according to which the fees would have risen by just under one percent, rejected and complained against the Landessozialgericht Berlin-Brandenburg. The doctors are demanding more.

“The proposed increase of less than one percent describes a disdain for medical work and in no way reflects the high workload and the time spent in everyday practice“, thinks Dr. Annette Grittern, who as an internist provides primary care to her patients in rural Dremmen near Heinsberg (NRW). Many of their patients are old and chronically ill, suffer from senile dementia, are cared for at home or in the home. So it is not enough that the doctor regularly takes care of her patients 54 hours a week. On weekends she does practice administration and training. In the quarter she comes to 150 home visits, this also at night. „Hardly anyone can imagine the complexity of coordinating good medical care for a seriously ill elderly person“, annoys Dr. Annette Grittern. This begins with the lengthy collaboration with specialists, clinics, homes or carers. But also relatives or care services must be guided and informed. The aids must be checked. „When I see on home visit that the rollator is set wrong, I have to stop myself hand“, says the doctor. And as in the future, the increased tariff costs for wages, rents, energy or new equipment to be covered, they and many doctors do not know.

Whether physicians bring a bad message to a cancer patient, show help that requires enormous administrative effort on the part of the practice, comforting a seriously ill patient and his family during a home visit - there is only a small lump sum - no matter how long and often the conversation is.

In the current fee negotiations, Professor dr. med. Rainer Riedel, who heads the master's program in medical economics at the Rheinische Fachhochschule (RFH) in Cologne, considers it appropriate to at least offset the cost increases in personnel and material costs. "And at least a fee increase of 1.5 percent is needed." For Riedel, it is clear that with 200 unoccupied GP surgeries in Germany, the "general practitioner specialist doctor" must be made more attractive, so that the supply remains guaranteed.

"Of course, the merit of a registered doctor depends, among other things, on whether and how many private patients he has," Rainer Riedel points out. „Although general practitioners run an entrepreneurial risk and work on average 55 hours a week, many earn less than a senior physician in the hospital“, Riedel explains.

But what compensation is appropriate for comprehensive medical patient care? A family doctor is usually expected to treat his patient at home, at any time, at night and on weekends. "At about 21 euros per home visit, however, a family doctor gets less than the plumber who comes in to fix the dripping faucet“, says Riedel. That should not be really.

„The eleven percent demanded by the KBV is certainly a maximum requirement of the doctors, which is mainly to explain politically“, says the head of the RFH master's program in medical economics. „The fee increase should also cover at least the increase in the costs of the practice.“ That was not the case with the previously proposed compromise of 0.9 percent.

Riedel fears that the supply of our patients worsened by the desired measure. If there should be a good supply of GPs and specialists, the practice should not be made even more unattractive. (Pm)

Picture: Matthias Preisinger