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

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

3. Ambulatory System Germany
SVR-Gutachten zur Bedarfsplanung 2018

4. 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

5. 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)

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

7. Need for ENT in 2025
SVR-Gutachten zur Bedarfsplanung 2018

8. Need for ENT in 2035
SVR-Gutachten zur Bedarfsplanung 2018

9. 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

10. Development from
SVR-Gutachten zur Bedarfsplanung 2018

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

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

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

14. ENT Specialists: Clinic vs own Private Practice

15. ENT Specialists: Clinic vs Own Private Practice

16. Outpatient: ENT Specialists vs All Physicians

17. 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

18. 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?

19. Example Germany After reunification ca. 16000 medical students
Today ca 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)

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

21. 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

22. 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?