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German doctors on strike at the height of COVID, flu season

December 28, 2023

Thousands of medical professionals are protesting low earnings and stifling bureaucracy. The move has sparked a debate over health care challenges, but the Health Ministry has rejected the doctors' demands.

Sign dangling on a door: "Streik! Praxis geschlossen!" (On Strike! Practice closed!)
Many medical practices and small clinics will stay closed across Germany for three daysImage: Christian Ohde/CHROMORANGE/picture alliance

Thousands of German doctors' offices and small clinics are staying shut this week — during a spike in COVID-19 and flu cases. General practitioners and specialists are protesting the government's health policies, which they say are increasing costs, lowering earnings and burdening them with more and more bureaucracy.

Patients are being advised to rely on emergency medical services as more than 20 doctor associations have joined the three-day strike. Since January 1 is a public holiday in Germany, most of the participating practices won't be open until January 2.

"I don't understand why there is a strike," said Health Minister Karl Lauterbach, speaking with public broadcaster ZDF on Wednesday evening. "We have a huge wave of sickness in the population at the moment. The doctors' demands for more money are also well-known — this strike doesn't get us anywhere."

Karl Lauterbach looking puzzled
Health Minister Lauterbach has said he doesn't understand why doctors are on strike right nowImage: Annegret Hilse/REUTERS

That sentiment was echoed by Eugen Brysch, chairman of Deutsche Stiftung Patientenschutz, a foundation that advocates for the interests of patients. "Every profession can go on strike for its interests, but this strike is hitting the wrong people," Brysch told DW.

"In rural areas in particular, the actions mainly affect the old and vulnerable. The doctors need to take their issues where they can actually change something — to the ministries, to Karl Lauterbach, or to the insurance companies."

Doctors: 'We have neither enough staff nor money'

The associations participating in the strike have argued that the shutdown is meant to protect patients' well-being in the long term, describing the current action as a "lesser evil." They argue that more and more practices are being forced to shut down, and more and more doctors are retiring early rather than working for low pay, a result mainly of the "budgetization" imposed on them by health insurers.

This budgetization measure, introduced in 1992, fixes a budget on all different kinds of health expenses in the system so that health insurers maintain control of their payouts. The doctors' associations, who are calling for the 1992 measure to be scrapped, have said this means that if they put in more time for individual patients and continue treating people beyond a certain budget — especially in crises such as pandemics — they effectively have to work for free.

"The situation in doctors' offices has become very dramatic indeed because the limitation by budget means that many practices can't afford to pay their specialist staff as much as they should," said Dirk Heinrich, an ear-nose-throat specialist and chairman of the Virchowbund association, which is leading the campaign.

"At the same time, we are forced to cut back on treatments, because we have neither enough staff nor money. This leads to long waiting times, and patients not being able to find doctors with capacities to see them," he told DW.

Doctors and pharmacists protest in Dortmund in November 2023
For months, doctors and pharmacists have taken to the streets across Germany complaining of bureaucracy, rising costs and takeovers by private investors.Image: D. Kerlekin/Snowfield Photography/picture alliance

But the Health Ministry has shown little sign of giving in on this point, pointing out that doctors are relatively well-paid in Germany, compared with elsewhere in Europe.

"I don't consider the call for more money as justified," Lauterbach said, though he added that reforming the budgetary measure among general practitioners would be addressed. "There are other professions in the health care system, such as care workers, where there is a greater need."

Burgeoning bureaucracy in medicine

Lauterbach has shown himself more amenable to the other major problem that doctors want addressed: the burden of bureaucracy. Some doctors have reported that they are so overwhelmed with forms to fill out from health insurers that it makes no sense to open all the letters.

"De-bureaucratization is a justified demand that should have been fulfilled years ago," Lauterbach told ZDF. "We have been working on a law to reduce bureaucracy for months now."

Lauterbach has promised a summit with the doctors in the new year to address their concerns, though he warned that simply pouring more money into the system wasn't on the table.

Why is there a shortage of care workers in Germany?

Despite these imminent talks, Heinrich insisted that the strike was necessary. "He also says that the problems are all well-known — well, sorry, if they're well-known, why hasn't he done anything?" he said. "That's the problem: He keeps announcing something, and we talk and talk, but nothing happens. So we have to maintain the pressure."

German health care system 'works very well'

Germany's non-hospital health care system relies on a network of general practitioners and specialists who run private practices, but who are paid by health insurers, either state or private. This marks it out from the systems in other European countries like the United Kingdom, where the main health care system is publicly run, and where waiting times for appointments have grown longer and longer.

Heinrich said the German system worked comparatively well, but said doctors at the front lines needed more support so that system can be maintained.

"It's not like we had a system that wasn't functioning — our German system works very well," he said. "We have very low-threshold and quick access to general and specialist medicine, we have a dense network of specialist practices. That's a prime feature of the German health care system and we are fighting to maintain it."

Edited by: Rina Goldenberg

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Benjamin Knight Kommentarbild PROVISORISCH
Ben Knight Ben Knight is a journalist in Berlin who mainly writes about German politics.@BenWernerKnight