Shortage of General Practitioners: History
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Contributor:
Julian Wangler
,
Michael Jansky

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.

This entry is adapted from the peer-reviewed paper 10.3390/journalmedia4030056

References

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