Shortage of General Practitioners: Comparison
View Latest Version
Please note this is a comparison between Version 2 by Rita Xu and Version 1 by Julian Wangler.

The shortage of general practitioners (GPs) and the fact that country doctors’ practices are vanishing—a situation that is currently taking a turn for the worse in some regions of Germany—are issues that have been dealt with in the media as a topic of specific discussion for some time now.

  • shortage of general practitioners
  • country doctor
  • country doctors’ practice

1. The Phenomenon of the Shortage of General Practitioners

The loss of GP practices has been an intensively discussed topic in the European Union for some time. In particular, shortages in GP care in rural regions have been intensively addressed for many years (Herrmann et al. 2019; Korzilius 2008; Süßmith 2013; Van den Bussche 2019). In other regions of the Western world, such as the USA, a considerable decline in the number of primary care doctors is also predicted (Allen et al. 2018; Famira-Mühlberger et al. 2020; European Data Journalism Network 2018; Theres 2021). The causes of this are complex and frequently connected with country-specific problems; demographic changes, an increasing disparity between structurally strong and structurally weak regions, and changing requirements in modern GP care (Kaduszkiewicz et al. 2018; Starfield et al. 2005) play an important role here.
This trend is apparent in an acute form in the Federal Republic of Germany. In Germany, every third GP currently working is 60 years old or older (KV A 2020). Consequently, in a European comparison, Germany leads the countries with a rapidly ageing medical profession (Kringos et al. 2015). According to the Federal Association for Statutory Health Insurance Physicians, in 2020 there were about 4200 vacancies for GPs nationwide for approximately 45,000 GPs in total (KV B 2019). According to calculations, an annual loss of about 1700 GPs compares with an inflow of specialist medical qualifications in primary care of about 1300 per year (Kopetsch 2010; Robert Bosch Stiftung 2021). This is also related to the fact that many young GPs increasingly prefer part-time models and tend to avoid the risk of self-employment (Ramakrishnan et al. 2014). As a result, by 2025, it is possible that there will be a lack of about 20,000 GPs, especially in rural districts (Advisory Council on the Assessment of Developments in the Health Care Sector 2018; Robert Bosch Stiftung 2021).
Regardless of such projections, there is no commonly accepted definition of the term ‘GP shortage’ (Van den Bussche 2019). Therefore, it has not been determined when the situation of medical care provision can actually be considered a shortage. It is also debatable whether locally or regionally occurring shortages are always to be viewed as structural shortages or whether they simply represent a (temporary) fluctuation in the density of doctors.
However, it must be noted that there are regions with a scarcity of GPs, at least in the perception of the patients. The causes for such a shortage are usually multifaceted. In addition to the long-term trend towards the drop in the number of doctors choosing advanced training as general practitioners, there has also been a noticeable decline in the willingness to establish a practice and to work full-time (Beeger 2019; Buddeberg-Fischer et al. 2008; Korzilius and Maybaum 2018; Maiorova et al. 2008; Roick et al. 2012). Parallel to this, the depopulation noted in rural and structurally weak areas means that the appeal of working as a GP in these areas is decreasing and that it is increasingly difficult for GPs with existing practices to find a successor (Herrmann et al. 2019; Nützel 2017). In light of these problems, doctors currently working in primary care are also increasingly considering changing their field of activity in the medium and long term (Fletcher et al. 2017).
For patients, this means increasing waiting times and sometimes problems finding a GP at all. There may be delays in therapy and gaps in care. The remaining doctors, in turn, are increasingly suffering from physical and mental stress because they must look after an increased number of patients (Kopetsch 2010; Robert Bosch Stiftung 2021). There are studies that show signs of an increased burnout trend among resident doctors (Fletcher et al. 2017; Van den Bussche 2019).

2. Proposals or Interventions to Strengthen Primary Care

Over time, various approaches have been proposed or partially initially implemented to strengthen primary care (Allen et al. 2018). One conceptual focal point targets a structural upgrading of primary care, such as in the form of multiprofessional outpatient centres (Gronseth et al. 2020) or by introducing a primary care physician system, which could result in making general practice more attractive as a profession (Van den Bussche 2019). In a primary care physician system, every health-insured person registers with a GP who exclusively regulates access to specialists. In addition, new task shifting models could relieve GPs and make provision more effective (Riisgaard et al. 2016). Strategies have also been pursued to set up GPs in rural and structurally weak areas. These actions include start-up aid, stipends, or structured training (Holte et al. 2015; Van den Bussche et al. 2018). A further focus relates to creating a broader recruitment basis for GPs. There are proposals to set quotas for specialist training or to promote lateral entry (recognition of equivalent medical training in specialist areas based on medical training regulations) (Riisgaard et al. 2016). Beyond the introduction of rural physician quotas, there are proposals to revise curricula in higher medical education and to change admissions criteria (Kaduszkiewicz et al. 2018). In addition, expert opinions suggest changes in specialist medical training and its consistent alignment with practical general practice (Van den Bussche et al. 2018).

3. Shortage of General Practitioners in the Media

Media coverage takes up and communicates the shortage of general practitioners as an increasing challenge for the German healthcare system (Bertelsmann Stiftung 2015). On the one hand, the press coverage can be considered an indicator of the social debate, in the sense that phenomena, such as the decrease in the number of practices, are publicly negotiated via news media, and awareness of the topic is raised. On the other hand, media work by gaining attention through compression and escalation so that certain aspects of a topic are selected and accentuated, while others are addressed with less emphasis or left out. In this way, coherent, recurring depiction patterns, so-called frames, emerge in reporting (Matthes 2014; Wangler and Jansky 2021, 2023b). This results in specific perceptual and interpretative blueprints for recipients, which are decisive in the determination of how this phenomenon is experienced and what conclusions are drawn from it. This may then have an effect on the course of the societal discourse, political decisions, or the willingness of medical professionals to decide on advanced training as general practitioners or to establish a practice.

References

  1. Herrmann, Markus, Heike Ohlbrecht, and Astrid Seltrecht, eds. 2019. Häusärztemangel Auf Dem Land. Einblicke in Die Ländliche Primärversorgung . Frankfurt: Mabuse.
  2. Korzilius, Heike. 2008. Hausärztemangel in Deutschland: Die große Landflucht . Deutsches Ärzteblatt 105: 373–74.
  3. Süßmith, Arne. 2013. Sicherstellung der Gesundheitsversorgung im Ländlichen Raum: Handlungsfelder und Chancen der Kommunalpolitik . München: Akademische Verlagsgemeinschaft.
  4. Van den Bussche, Hendrik. 2019. The future problems of general practice in Germany: Current trends and necessary measures. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 62: 1129–37.
  5. Allen, Luke N., Shannon Barkley, Jan De Maeseneer, Chris Van Weel, Hans Kluge, Niek de Wit, and Trisha Greenhalgh. 2018. Unfulfilled potential of primary care in Europe. BMJ 363: k4469.
  6. Famira-Mühlberger, Ulrike, Matthias Firgo, and Gerhard Streicher. 2020. Ärztliche Versorgung und der demographische Wandel . WIFO Monatsbericht 8/2020: 609–618.
  7. European Data Journalism Network. 2018. Europe Has a Shortage of Doctors. Available online: https://www.europeandatajournalism.eu/cp_data_news/Europe-has-a-shortage-of-doctors/ (accessed on 15 July 2023).
  8. Theres, Mathä. 2021. Ärztemangel? Eine Systematisierung . Linz: Johannes Kepler Universität Linz. Available online: https://epub.jku.at/obvulihs/download/pdf/6235192?originalFilename=true (accessed on 15 July 2023).
  9. Kaduszkiewicz, Hanna, Ute Teichert, and Hendrik van den Bussche. 2018. Shortage of physicians in rural areas and in the public health service—A critical analysis of the evidence on the role of medical education and training. Bundesgesundheitsbl 61: 187–89.
  10. Starfield, Barbara, Leiyu Shi, and James Macinko. 2005. Contribution of primary care to health systems and health. The Milbank Quarterly 83: 457–502.
  11. Federal Association for Statutory Health Insurance Physicians A . 2020. Requirements Planning 2019. Available online: http://www.kbv.de/html/bedarfsplanung.php (accessed on 15 July 2023).
  12. Kringos, Dionne S., Wienke G. W. Boerma, Allen Hutchinson, Richard B. Saltman, and World Health Organization, eds. 2015. Building Primary Care in a Changing Europe: Case Studies. Observatory Studies Series; Copenhagen: European Observatory on Health Systems and Policies, vol. 40.
  13. Federal Association for Statutory Health Insurance Physicians B . 2019. Versichertenbefragung der Kassenärztlichen Bundesvereinigung 2019. Ergebnisse einer repräsentativen Bevölkerungsumfrage, März/April 2019 . Available online: https://www.kbv.de/media/sp/Berichtband_Ergebnisse_der_Versichertenbefragung_2019.pdf (accessed on 15 July 2023).
  14. Kopetsch, Thomas. 2010. Dem deutschen Gesundheitssystem Gehen Die Ärzte Aus! Studie Zur Altersstruktur-Und Arztzahlentwicklung . Berlin: KBV.
  15. Robert Bosch Stiftung. 2021. Health Centers for Germany. How a Fresh Start in Primary Care Can Succeed. . Available online: https://www.bosch-stiftung.de/sites/default/files/publications/pdf/2021-05/Studie_Primaerversorgung_Gesundheitszentren-fuer-Deutschland.pdf (accessed on 15 July 2023).
  16. Ramakrishnan, Aditi, Dana Sambuco, and Reshma Jagsi. 2014. Women’s participation in the medical profession: Insights from experiences in Japan, Scandinavia, Russia, and Eastern Europe. Journal of Women’s Health 23: 927–34.
  17. Advisory Council on the Assessment of Developments in the Health Care Sector . 2018. Needs-Based Control of Health Care. . Available online: www.svr-gesundheit.de/fileadmin/Gutachten/Gutachten_2018/Gutachten_2018.pdf (accessed on 15 July 2023).
  18. Beeger, Von Britta. 2019. Warum sind Jungärzte nur solche Praxismuffel? . Available online: https://www.faz.net/aktuell/karriere-hochschule/trend-unter-medizinern-warum-sind-jungaerzte-praxismuffel-16033133.html (accessed on 15 July 2023).
  19. Buddeberg-Fischer, Barbara, Martina Stamm, Claus Buddeberg, and Richard Klaghofer. 2008. The new generation of family physicians careermotivation, life goals and worklifebalance. Swiss Medical Weekly 138: 305–12.
  20. Korzilius, Heike, and Thorsten Maybaum. 2018. Ärztestatistik 2017: Immer mehr angestellte Ärzte in den Praxen . Deutsches Ärzteblatt 115: 692–94.
  21. Maiorova, Tanja, Fred Stevens, Jouke Van der Zee, Beppie Boode, and Albert Scherpbier. 2008. Shortage in general practice despite the feminisation of themedicalworkforce: A seeming paradox? A cohort study. BMC Health Services Research 8: 262.
  22. Roick, Christiane, Dirk Heider, Olaf-Heinz Günther, Brigitte Kürstein, Steffi Gerlinde Riedel-Heller, and Hans-Helmut König. 2012. Factors Influencing the Decision to Establish a Primary Care Practice: Results from a Postal Survey of Young Physicians in Germany. Gesundheitswesen 74: 12–20.
  23. Nützel, Von Nikolaus. 2017. Hausärzte werden knapp. Von der Schwemme zum Mangel . Available online: https://www.deutschlandfunk.de/hausaerzte-werden-knapp-von-der-schwemme-zum-mangel.724.de.html?dram:article_id=385972 (accessed on 15 July 2023).
  24. Fletcher, Emily, Gary A. Abel, Rob Anderson, Suzanne H. Richards, Chris Salisbury, Sarah Gerard Dean, Anna Sansom, Fiona C. Warren, and John L. Campbell. 2017. Quitting patient care and career break intentions among general practitioners in South West England: Findings of a census survey of general practitioners. BMJ Open 7: e015853.
  25. Gronseth, Inga Marthe, Kirsti Malterud, and Stein Nilsen. 2020. Why do doctors in Norway choose general practice and remain there? A qualitative study about motivational experiences. Scandinavian Journal of Primary Health Care 38: 184–91.
  26. Riisgaard, Helle, Jørgen Nexøe, Jette V. Le, Jens Søndergaard, and Loni Ledderer. 2016. Relations between task delegation and job satisfaction in general practice: A systematic literature review. BMC Family Practice 17: 168.
  27. Holte, Jon Helgheim, Trine Kjaer, Birgit Abelsen, and Jan Abel Olsen. 2015. The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice. Social Science & Medicine 128: 1–9.
  28. Van den Bussche, Hendrik, Sarah Nehls, Sigrid Boczor, Stephanie Siegert, Rüya-Daniela Kocalevent, and Martin Scherer. 2018. What is Known About the Real Length of Postgraduate Medical Education in Germany? Deutsche Medizinische Wochenschrift 143: 152–58.
  29. Bertelsmann Stiftung. 2015. Spotlight Gesundheit 03/2015: Daten, Analysen, Perspektiven. Ärztedichte. Neue Bedarfsplanung geht am Bedarf vorbei . Available online: https://www.bertelsmann-stiftung.de/fileadmin/files/BSt/Publikationen/GrauePublikationen/Spotlight_Gesundheit_Thema_Aerztedichte_03-2015.pdf (accessed on 15 July 2023).
  30. Matthes, Jörg. 2014. Framing. Baden-Baden: Nomos.
  31. Wangler, Julian, and Michael Jansky. 2021. What effects do media-mediated images of old age have on older people? Results of a reception study. Zeitschrift für Gerontologie und Geriatrie 54: 676–84.
  32. Wangler, Julian, and Michael Jansky. 2023b. Media portrayal of old age and its effects on attitudes in older people: Findings from a series of studies. Humanities and Social Sciences Communications 10: 165.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
ScholarVision Creations
Feedback