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Germany's future doctors forced to seek training abroad

Germany's top court has ruled that selecting medical students based only on grades is partly unconstitutional. Until now, for most prospective German doctors, going abroad has been the only way to study medicine.

Medical students in Halle-Wittenberg University (picture-alliance/dpa/W. Grubitzsch)

These fortunate students were granted the few coveted spots to study medicine in Germany

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The classroom is pitch-black — save for the schematic image of a human arm, projected onto a screen. Lecturer Aleksandra Gawrilowska explains its anatomy as some 30 students sitting along two long tables eagerly take notes.

This is an anatomy class for first-year students at the Pomeranian Medical University in Szczecin. Classes are taught in English, and about half of all foreign students enrolled here are from Germany.

"I simply don't have the necessary grades to study in Germany," says Aaron. That's why he applied to Pomeranian Medical University after earning his "Abitur" – Germany's high school diploma required for university admittance.

His fellow student Luise had initially planned to wait until she is admitted to German med school. She passed the time working as a paramedic, then trained to become a physiotherapist and took practical nurse training. Then, at 25, she changed her mind and decided to move abroad.

"Nobody could tell me if I'd have to wait another two years, two-and-a-half or even three years," Luise recalls. "That was just too much uncertainty for me. I wanted to get started on my studies."

In Germany, there are about five applicants for every place offered in medical school. As a result, only students with a certain Abitur grade are admitted.

In most of Germany's federal states this grade threshold, the so-called "numerus clausus," lies at 1.0 (roughly equivalent to a British A level grade of A*AA, or 4.0 grade point average in the US). This means only students with excellent high school grades have a chance of getting into med school – without having to wait for a long time, that is.

Court decision to shake up university system

On Tuesday, however, Germany's top court ruled that the selection process was partly unconstitutional, as it violates equal opportunity laws. The federal government is henceforth to regulate the criteria used for offering places. However, the precise ways in which it will do so remain unclear. 

Prior to Tuesday's decision, the system was organized such that of the 9,000 available places in med school, 20 percent go to the cohort with the best high school grades. The remaining 60 percent of places are now filled on the basis of other criteria set out by each university, even though prospective students' Abitur grades still carry great importance.     

The remaining places go to those who have been patient enough. Currently, those without stellar Abitur grades must wait six and a half years until they're admitted to med school.

Medical students in Sczeczin, Poland (DW/Erik Albrecht)

Foreign students in Sczeczin's medical school, where half of all foreign students hail from neighboring Germany

10,000-euro annual university fee

This why those with deep pockets opt to study in other European countries. At Pomeranian Medical University in Szczecin, students need to shell out 10,000 euros in fees per year.

Luise, who studies here, admits that "without the support of my parents this wouldn't be possible."

She says that moving to Poland and effectively buying her way into med school gave her a guilty conscience. "But I should have a right to study."

Luise and Aaron recognize that simply not every applicant can expect to get a coveted place in med school in Germany. But they find it unfair that those waiting to be admitted are judged only on the basis of their Abitur grade – instead of also considering relevant work experience. 

Tending to patients – aided by an interpreter

Szczecin, Poland (public domain)

For those who can afford pricey tuition fees, studying just across the German-Polish border is an ideal solution

Leszek Domanski, the dean of Pomorzany teaching hospital, briskly walks down the hallway. The hospital is one of three affiliated with Pomeranian Medical University. Back in the day, Domanski studied in Rostock in what then was still the German Democratic Republic (GDR). But times have changed and now, Germans are heading eastwards to study in Poland.

To left and right of the hallway, doors lead to hospital rooms. Here, foreign students tend to patients – with the help of interpreters. Because often, the students are not sufficiently proficient in Polish to provide professional council in this language. So working in groups of four works well, says Domanski.

Studying in Poland, practical experience in Germany

As numbers of German medical students have been on the rise, Domanski's faculty began cooperating with private German hospital operator Asklepios several years ago: First, students attend classes at Pomeranian Medical University. Then, they move to Germany to receive practical training at one of the Asklepios hospitals.

"It's really something different when you can actually talk to patients," says medical student Leon Heinemann. "In Poland, it would have been unthinkable to be sent to get a blood sample from a patient." As part of his degree, Heinemann is currently working in the psychiatric ward of a Asklepios hospital in the town of Teupitz, just south of Berlin. His fellow student Thomas Heiduk wants to work in Germany once he's completed his degree. His university's cooperation with Asklepios is giving him valuable insights into the everyday workings of a German hospital, says Heiduk.

Addressing the shortage of doctors

"Germany simply isn't training enough doctors," says chief physician Stefan Kropp. And Germany's medical trade union Marburger Bund has for a long time been calling for additional places at German med schools. Now, Asklepios is addressing this issue through its partnership with the Pomeranian Medical University in Szczecin. 

Kropp doesn't think a student's Abitur grade says anything about whether that individual will make a good doctor. Kropp, too, had to wait for two years until being admitted to med school. "What we need are young and highly-motivated doctors – even if they don't have straight As."

Medical students training in Sczeczin (DW/Erik Albrecht)

Young physicians in Szczecin and elsewhere in Poland have protested for better working conditions

Poland lacks doctors, too

Kropp has mixed feelings about German hospitals hiring Eastern European doctors to make up for the lack of German physicians. He says they are just as professional as their German peers. However, "this will result in other countries also facing a shortage of doctors," Kropp thinks. "So we have a certain duty in this respect."

Dean Domanski thinks his university's English-language medical program is one way to help address Germany's shortage of doctors. He likes training prospective German doctors and hopes that "they will help improve the situation". That way, Polish doctors could remain in their home country, he thinks. After all, Poland lacks twice as many physicians as its western neighbor Germany. In the summer, young physicians in Szczecin and elsewhere in Poland protested for better working conditions.

Financially speaking, however, Germany benefits from students flocking east to attend Polish med schools and then returning home. In Germany, every additional place at med school would cost the state approximately 32,000 euro. Med students in Poland, however, foot their own bill.

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