Poor prospects in Germany and an EU labor market that makes mobility easy has increased the incidence of "brain drain," where specialists leave home to work abroad. The latest German export: dentists.
Eastern Germany needs dentists, but they're flocking to Norway
Katja Georgiev was one of only 16 of her 120 fellow students to complete her degree program in dentistry at Berlin's Humboldt University on schedule. She then immediately started an internship at her parents' dental practice, where she did well. But in the end, she decided to pursue a career in Norway. She already has a state-run hospital in the coastal city of Kristiansund in sight.
It was her time in her parents' practice that made her decide for Scandinavia, she said. Especially when her mother would often tell her to complete a procedure more quickly, since the next patient was already waiting. She didn't like sacrificing quality for quantity.
"Up there [in Norway] I could take an entire hour for a filling, which means the quality is higher," she said. "At night I can sleep easily knowing that filling will last another 20 years."
She's not alone among professionals in seeking her fortune, and future career, beyond Germany's own shores. In 2004, Germany's Federal Job Agency referred 3,389 specialists to positions abroad.
While Germany's dentists have in the past largely been immune from the country's unemployment sickness, that is no longer the case. There are some 900 dentists in Germany who cannot find work. In 2001, 170 of them went to Norway to work.
Little wonder, since the quality of dental care in Scandinavia is among the best in Europe. The work pace and hours make the northern country an attractive destination, to live and to work. In Berlin, a new graduate working as an assistant in a dental office might bring home 1,000 euros a month. In Norway, the take-home pay for the same work would be 2,700 euros.
While the cost of living in Norway is higher, the quality of life in Kristiansund, where Georgiev wants to work, is also far superior to that in eastern Germany, where there is now an acute shortage of dentists.
According to Georgiev, one cannot compare Kristiansund, with its 17,000 inhabitants, with a corresponding town in Germany with the same population.
"[In Kristiansund] there's an airport, it has its own theatre, an opera, a good nightlife," she said. "You don't have the feeling you're in a small town."
There are other factors that work against eastern Germany when it comes to attracting German dentists. In the states of Brandenburg, Saxony or Saxony-Anhalt, patients sometimes have to drive 80 kilometers to reach the next orthodontist.
Few want to risk setting up shop in such a sparsely-settled region. Even if the will is there, the means are often not. It can cost upwards of 500,000 euros to start a new practice. Few new dentists have those kinds of resources at their disposal.
Empty towns, absent patients
Another problem is emigration. The bad economy and lack of jobs have forced many easterners to leave the region. In the eastern border town of Görlitz, over 50,000 people have left over the past few years.
Magdeburg in the state of Saxony-Anhalt
Even if new dentists had the desire to open a practice there, they would have to face the real danger that their patient base would continue to shrink.
There are other issues that discourage doctors from settling down in the east. Medical professionals in eastern Germany are still paid less than their colleagues in the west.
"Recent health care reforms also aren't exactly cause for motivation or enjoyment at work," said Wolfgang Schmiedel, an orthodontist and president of a dentists' association in Berlin.
He cites the increasing amount of bureaucracy dentists have to wade through, paperwork that can take up to 40 percent of the working day. The new 10-euro fees that the reforms put into place as well as welfare reforms have made many people reconsider making an appointment to have their teeth checked.
"Especially older people, who don't have the money, avoid coming in," Schmiedel said. "My practice is really feeling it."
He estimates that from 10 to 15 percent of Berlin doctors' practices are just barely making it financially. When younger people see that, they think twice about their futures and more stable careers like those on offer in Norway, start to look very attractive.