Germany's health system is a troubled soul. The winces of pain elicited by the financial incision of reform may be beginning to fade, but the laments of young doctors are growing louder and many are leaving for Britain.
German hospital structures could use a shot of sensitivity
In its guidelines to foreign doctors considering applying for junior positions in British hospitals, the UK Academy of Medical Royal Colleges warns against premature optimism.
"Although the UK welcomes and will always welcome overseas graduates, levels of competition for junior posts are very high and applicants may spend long periods of time unemployed."
The message is clear enough. Try it if you will, but expect nothing. In the context of employment, this kind of communiqué would normally act as a de facto deterrent to Germans, who infinitely prefer the security of the job-for-life scenario over the uncertainty of anything less. But in the case of Britain's national health system (NHS), dissatisfied German doctors appear undaunted.
German medics love the UK
As of the start of this month, there were more doctors from Germany on the British General Medical Council's books than from any other European country. Although it is not clear how many are actually gainfully employed, 3,401 German doctors are registered to practice in the UK, compared with 2,281 from Ireland, 2,053 from Greece and just 565 from France.
Is Britain the medicine for sickened German doctors?
It is evidence of an ongoing migratory trend from a country which, although experiencing relentlessly high rates of unemployment, cannot lure enough home-grown doctors to fill its medical vacancies.
At the start of the German Medical Association congress last week, Health Minister Ulla Schmidt expressed sympathy for the modern medic. "When I speak to young doctors, they tell me over and again that they want to work as a team. They are not all leaving just for financial reasons, but also because of the flatter hierarchies and better working conditions abroad."
Dr. Vincent Everard Jerome Braganza is originally from England, but works as a head doctor in a small German hospital. He's been here for 25 years and understands only too well the gripes of young doctors in today's work climate.
The business of medical multitasking
"Doctors in Germany are required to do a number of things they would not have to do in Britain. If a patient comes to a small hospital at night, it is the doctor who lets them in, takes their particulars and insurance details, fills out the X-ray forms, stitches any wounds, locks up the ambulance and so on. The doctor is the porter, the secretary, and the nurse before he even starts being the doctor. Such misuse would never occur in that way in the UK," he said.
Misuse is a word which comes up again and again among German doctors talking about their working conditions. And it is not only remuneration -- on average 25 percent lower than that offered by the NHS -- but the structures on the hospital landscape which they collectively aggrieve.
After several years working for the NHS, Dr. Julia Bartley returned to her native Germany to work as a consultant at a hospital in Berlin. With experience on both sides of the Channel, she is in no doubt about the advantages of the British system.
"Firstly you get an excellent training in Britain, but there are other issues such as the reduced hierarchy which means that when you have a good idea it doesn't matter how high up you are, people listen and take you seriously," Bartley said.
She says it was largely the atmosphere in the hospital which made her want to leave Germany when she did. "Young doctors are shouted at, reduced to tears and generally treated badly. Their superiors were put through the same thing and they see no problem in handing down what was dished out to them."
Spreading the load
It might sound like an average rookie complaint, but Braganza insists that the structures in German hospitals are more despotic than democratic. While in the UK, there is an average of one consultant for every 20 hospital beds, in Germany the departmental head can be in charge of more than 100 patients, delegating at will.
"In Britain, the top level is more widely spread. Consultants are very independent and the system is fed sensibly. But in Germany, even the very senior doctors, who are specialists in their own right, have to kowtow to the head doctor, who can make life miserable for anyone he chooses," Braganza said.
Another factor which feeds into the equation is that Germany has twice as many doctors per 100,000 patients as the UK.
Braganza sees that simple fact as a ticket to both bad behavior in the upper ranks of German hospitals and to slow career progress. "In the UK, junior doctors are allowed to do many things because there are not as many doctors, whereas in Germany only the top people get to perform," he said.
Although the conditions in the UK seem enticing for young German graduates, Braganza says there is no doubt that what they would really like is to see conditions at home improve, thus removing the need to work overseas.
In her message to the nation's doctors last week, Ulla Schmidt made it quite clear that she was open to suggestion.