1. Family Medicine in Germany 1. Specialization – how to get there in Germany? 2. How do we trainees connect? 3. How do Gps/FPs work in Germany? Anna Klimiuk Berlin

2. Family Medicine in Germany 1. Specialization – how to get there in Germany?

3. Overview I ➲ 5 years of training ➲ Each state has its own curriculum (16!) ➲ Curriculums always contain: General Medicine, Internal Medicine, Surgery ➲ Courses required: Psychosomatic medicine (80 hours), payable by trainee, not within working hours

4. Overwiev II ➲ Some curriculums contain (less in rural areas) : Pediatrics, Orthopedics, Anesthesia or Intensive care ➲ No formal inscription / organization of the training: each part of the training has to be organized by the trainee himself by applying in the clinic/ practice for the period required (in some states changing to organized training) ➲ Payment: in hospitals according to other doctors. In practices/ surgeries with support from a program called IPAM. So the practice owner is paying only the social insurance payments but not the full salary!

5. Overwiev III ➲ „Numbers“ to reach in all curriculums: ecg, 24-hours-ecg, 24- hours-bloodpressure, sonography (abdomen, thyroid), duplex (carotis), doppler (iliacal/fermoral veins), proctoscopy, but also for certain situations like emergency situations, dealing with diabetics, vaccinations etc. ➲ „log-book“ to certify all this ➲ Exam is made of „kollegial“ talk, 30 minutes, 4 examining Gps, common medical problems are examined theoretically

6. Training in Berlin ➲ 6 months internal medicine (in hospital) ➲ 18 months general / family medicine ➲ 6 months pediatrics ➲ 6 months surgery ➲ 6 months orthopedics ➲ 3 months anesthesia (former intensive care) ➲ 80 hours-course psychosomatics (50 hours theory, 30 hours Balint-group)

7. one example: How did I do it? ● 6 months geriatrics in hospital ● 12 months internal medicine in hospital ● 3 months intensive care unit in hospital ● 6 months pediatrics in practice ● 12 months family medicine in practice ● 6 months orthopedics in practice ● 4 months internal medicine in practice ● 6 months surgery in practice ● 6 months family medicine in practice ● Course 80 hours psychosomatics

8. What is good? ➲ Breaks in between are possible ➲ Applying in practice / hospital that suits your interests / location / known good teacher etc. ➲ Good choice of working places, more posts than trainees due to lack of doctors

9. What bad? ➲ Unemployed times between 2 posts sometimes unavoidable ➲ Constantly applying for new jobs is quite stressful: once you start one post you have to apply for the next one. ➲ Not all posts have doctors/trainers willing to teach, it´s rather the workforce they want! There is no fixed recruitment requirements concerning the teaching abilities of trainers! ➲ No mentor.

10. How would it be better? ➲ Structured application for 5-years specialization would give a security for planing, no unemployed times but also the possibility to learn all you need. ➲ Obligatory courses should be free of costs for trainees and during their working-time. ➲ Curriculums should contain less times and numbers but competences / skills. ➲ Teach the teachers!!

11. Family Medicine in Germany 2. How do we trainees connect?

12. Connections between trainees I ➲ Special situation since we have no formal registration and individual rotations so we don´t meet our collegues ➲ WABe in Berlin: group for trainees was established around 2007 to help each other, to exchange, and - most important: to evaluate training posts!! Now around 350 members online, regular monthly meetings visited by usually 15 to 30 members.

13. Connections between trainees II ➲ In 2009 JADe (= Junge Allgemeinmedizin Deutschland) was founded as a youngsters group of the DEGAM (german professional Family medicine association), now with more than 600 members online. ➲ JADe is the german partner of the VdGM = Vasco da Gama Movement, the youngsters organisation of the WONCA..

14. Family Medicine in Germany 3. How do Gps/FPs work in Germany?

15. How do Gps/FPs work in Germany? ➲ Always in private practice, responsible (and free to decide!) for equipment, number of nurses, timetable, vacation-time, laboratory, decision if homevisits or no, special interests, (methadone program, manual medicine, acupuncture, sonography...) etc. GP als financial responsible for all the above. ➲ Alone or with mainly 2-4 other GPs or other specialists ➲ GPs make contracts with communal health companies and get reimbursement for around 90% of patients for that (other 10% of patients have a „private“ health insurance... I won´t talk about that here..)

16. How do Gps/FPs work in Germany? ➲ No patient list! Patients need no registration! Patients can go to any GP or other specialist they want without referral, as often as the want! ➲ GPs get paid for the face-to-face-contacts with one patient within a 3-month period (jan-march, april- june...), but get paid only once in these 3 months, even if patient comes 10 times or more! ➲ On average a GP gets to see around 900 patients in 3 months (but some several times, we have on average around 14 dr-patient-contacts per year!) ➲ Reimbursement ist more for older patients, children and patients with chronic diseases

17. How do Gps/FPs work in Germany? ➲ Reimbursement (for 3 months) is around 50€ for any patient (more for elderly ~ 60-70€, and children), extra 20-30€ for chronic patients. ➲ Extra payments for vaccinations, psychocomatic intervention, important-live-change-talk, chronic- disease-programs and some preventions. ➲ Consultations and all investigations referred to by the GP are free of costs for the patient. ➲ Patients need to pay 5 to 10 € for recipies for medication and physical treatment (max. 2% of their yearly income per year).

18. Thank you ➲ For questions: ➲ Anna.Klimiuk@gmx.de ➲ wabe-info@gmx.de