It's tough to find young doctors willing to practice medicine in small towns and villages. Several German states are offering enticing incentives to recruit new doctors to work in the countryside.
Recruiting doctors to the countryside is notoriously difficult - not just in Germany, but all over the Western world. To get into medical school, students have to have very high marks, which means they're intellectually gifted - and such folks generally have urban and urbane interests. Yet the populations of small towns and countryside villages have as much need of medical care as urban populations. What is to be done?
In Germany, education is the constitutional responsibility of the Länder, or federal states, not of the federal government. Accordingly, various German states have adopted a variety of different strategies to incentivise young medical students to choose country-doctor careers.
North Coast idyll
The northeastern state of Mecklenburg-Western Pomerania, for example, offers special subsidies for students at the state's two medical schools who contractually agree to spend at least five years after graduation working either as country doctors, or in the state's public health service. The subsidies amount to a stipend of 300 euros per month and can run for a maximum of four years and three months. The extra bit of income can make a substantial difference to a student's quality of life.
The two medical schools are in charming medium-sized cities, Rostock and Greifswald (picture at top: the old central marketplace of Greifswald). The two cities boast northern Germany's oldest and second-oldest universities.
The main building of the University of Rostock. The university was founded in November 1419, and is the second oldest university in Germany after the University of Heidelberg, but this building was built between 1867 and 1870.
The state's small towns and villages may not be urban, but they're pretty, embedded as they are in a landscape of rolling agricultural lands, forests, lakes and rivers. The northern boundary of the state encompasses most of Germany's North Sea coast. For an outdoorsy young doctor, it's not a sacrifice to live and work here.
New medical faculty
North Rhine - Westfalia (NRW) is a heavily industrialised state in northwest Germany bordering on northern Belgium and the southern Netherlands. NRW encompasses the cities of Aachen, Bonn, Cologne, Düsseldorf, Essen, Dortmund, Münster and Bielefeld, among others. Several of these cities are effectively contiguous, and together constitute Germany's largest conurbation, the Rhine-Ruhr metropolitan region, which has about 11 million residents in total.
Although it's heavily urbanised, the state also includes small towns and countryside areas, and the state government wants to ensure those regions are properly serviced by medical professionals. Recently it decided to establish a new medical faculty at the University of Bielefeld in the northeast of the state. Starting in 2021, the new med school will train about 300 students a year in the healing arts.
Medical practice isn't for the faint of heart. Here, a donated human heart is being prepared for removal of its heart valves for surgical emplacement in a cardiac patient, at a clinic in Rostock.
Getting into medical school is highly competitive in Germany. The biggest factor that decides which applicants get accepted to med school is the marks attained by students in their pre-university exams, but other factors can be taken into consideration as well.
NRW's government has decided to reserve ten percent of the available studentships at the new Bielefeld med school to students willing to commit to spending ten years as country doctors. No doubt government planners expect that after a young doctor has spent ten years in a small town or village, made a home, and perhaps started a family, there's a very good chance the doctor will stay there for the rest of his or her career as well.
Bavaria, too, offers young doctors substantial incentives to practice in the countryside. The Bavarian health ministry offers 60,000 euros in set-up subsidies to young doctors willing to establish new practices in towns of no more than 20,000 residents. In addition, there's a subsidy program for medical students willing to absolve their final-stage practical training in countryside practices, and to stay there for five years after graduation.
Moreover, the Bavarian state intends to introduce a quota for country doctors. In future, up to five percent of medical school places will be reserved for students willing to commit to working as general practitioners in regions identified by the state as medically underserved.
Country doctor Wolfgang Dinslage on a house call with an elderly patient, in the small town of Düren, between Aachen and Cologne, 2012. Older doctors like Dinslage are having trouble finding young doctors to take over their practices and patients.
State by state
Mecklenburg - Western Pomerania, North Rhine - Westfalia, and Bavaria are not the only states that have introduced incentives for young doctors to plan careers as country doctors. The states of Saxony Anhalt, Schleswig Holstein, Thuringia, Hessen, and Rhineland Palatinate also have incentives in place. The latter even has a "master plan" for improving medical care in underserved regions that will include a subsidised re-integration course for people who completed their medical studies in the past, but have not been working as doctors.
In a nation whose population is ageing, and in which young people tend to migrate from the countryside into cities, most country doctors will have to be particularly well-versed in taking care of older patients.
dpa / nz