Manpower -What kind of Change do we see?- Dr. med. Joachim Wichmann, MBA Germany

European Systems General practitioner Specialist Tax financed Contribution Financing SVR-Gutachten zur Bedarfsplanung 2018

Ambulatory System Germany SVR-Gutachten zur Bedarfsplanung 2018

Germany – Financial Structure financed by contribution (50% each through employer and employees) self organisation between public insurance companies and medical associations (KBV) under legal supervision of the ministry of health (executive role) due to self government no medical supervision (aka: free profession) GPs and specialists are either self employed or employed Globalisation and industry like organisation start shifting into more employed than self employed

Average Age of ENT 1.7.2017 30% above 60 and ca. 15% above 65 years   Anzahl nach Altersjahren Ärzte in Köpfen (Anzahl gesamt) <35 35-39 40-44 45-49 50-54 55-59 60-64 65-69 >69 544 4 33 55 110 94 95 81 50 22 0,7 6,1 10,1 20,2 17,3 17,5 14,9 9,2 4,0 30% above 60 and ca. 15% above 65 years Taking over an office seems more difficult (GenY)

Need for Doctors in the Ambulatory Sector in Germany SVR-Gutachten zur Bedarfsplanung 2018

Need for ENT in 2025 SVR-Gutachten zur Bedarfsplanung 2018

Need for ENT in 2035 SVR-Gutachten zur Bedarfsplanung 2018

Government/Military: 83 ENT specialist Total Amount ENT: 8529 ENT private practice: 4431 3788 selfemployed 643 employed ENT hospital based: 1542 in 37 Universities / 185 ENT clinics Government/Military: 83 Different: 239 Unemployed: 2234 -Retired: 1871 Total Amount of new ENT Specialist : 2012: 218 2013: 176 2014: 240 2015: 205 2016: 190 2017: 201 In 2025 and 32% replacement: Need for 1418 ENT In 2025 and 32% replacement: Need for 494ENT Data based on BÄK Report 2017

Development from 2007-2016 SVR-Gutachten zur Bedarfsplanung 2018

Employment Structure of ambulatory Care in Germany SVR-Gutachten zur Bedarfsplanung 2018

Attending Physicians 1380 ENT specialists in 487 small ENT Units/Hospitals

ENT Departments 1541 ENT specialists in 185 university and municipital hospitals (decreasing number of hospitals and beds!)

ENT Specialists: Clinic vs own Private Practice

ENT Specialists: Clinic vs Own Private Practice

Outpatient: ENT Specialists vs All Physicians

What happened in the last decade Within the last 20 years due to European work policy a lot more clinical jobs have been created Is experience (learning by doing) reduced due to that? Willingness to leave a clinic toward own private practise is to be questioned

Are there enough young ENT ? Political dimensions Aging society Need for ENT (swallowing disorders, Hearing aids) Reduction of Medical students Generation Y / Work life balance Family is a focused option Is the option for entrepreneur still cool?

Example Germany After reunification ca. 16000 medical students Today ca. 10000 students medical studies Drop out rate ca 10-15% 70-80% of the 1. academic year are female 10 years after 90% of male are still in medicine only 30% of female (specialist)

Arztberuf: Die Medizin wird weiblich Dtsch Arztebl 2008; 105(12): A-609 / B-539 / C-527 Hibbeler, Birgit; Korzilius, Heike  

Structural issues Beeing on its own is not for everybody Collegial exchange is wanted Create double or more „seats“ in one office Financial outcome is fragile and volatile Raising children is more an issue for both parents

Questions for the future How do we meet the need for ENT? Less Doctors but still increasing and aging society Is the self employed system still attractive? Modern forms of occupation / employment Do we need to reduce the standards?