German Brain Drain: Sick of Bad Pay, Doctors Flee Germany

By Udo Ludwig

German doctors are packing their scalpels and seeking their fortunes abroad, lured by the prospect of far higher pay and driven away by stifling bureaucracy in their country's health service.

A young doctor at Berlin's prestigious Charite hospital distributes leaflets in a Berlin book store during a demonstration.
DPA

A young doctor at Berlin's prestigious Charite hospital distributes leaflets in a Berlin book store during a demonstration.

A little tower adorns the roof, and ivy surrounds the entrance to the elegant manor house in the northern English town of Chorley. From outside, there is nothing to indicate that Euxton Hall is a working hospital rather than a place of contemplation, tea and bridge. If it weren't for the old man on crutches struggling to get into a taxi with the help of a nurse.

Markus Fröhling, 49, the hospital's orthopedic surgeon, watches the scene. "Patients in England are tougher than in Germany," he says. In Germany a patient would have insisted on being taken home in an ambulance, he's sure of that.

Fröhling keeps noticing differences between the British and German health systems. In Euxton Hall hospital, an hour's drive north of Manchester, the walls are covered with flower-patterned tapestries, there's a cappuccino machine for guests, everything appears welcoming and civilized. Above all, it's quiet, there's a very British atmosphere of calm. "You'll never get a bellowing chief physician around here," says Fröhling, and he looks relieved about that.

But the comfortable atmosphere ends in the operating theater. When the muscular German grabs his scalpel, he starts working as if he were on a production line. The expert in hip surgery rams up to five new joints into the thighs of his patients each day. In Germany he rarely had to conduct two of these complicated operations a day.

Fröhling has been working in England for over a year, he's one of 2,600 German doctors in Britain who escaped from the woes of their country's health service to greener pastures. Away from Germany, the land of bad pay, long working hours, all-encroaching bureaucracy and rigid organization.

Doctors taking to the streets

He operated on over 2,000 knees, hips and spines in Germany before he made up his mind. Like all guest workers, it was the money that initially lured him away. But escaping the insufferable self-importance of his superiors was almost as important, as well as fleeing the creeping loss of status of his profession in Germany. These days, the former demi-gods in white have to take to the streets like the steel workers to demonstrate for improved working conditions and better pay. In the old days, young doctors would allow themselves to be exploited during their training because they knew they could make big bucks later on. Now, it's no longer worth it.

Doctors used to tolerate the condescending treatment at the hands of their bosses because they hoped to be giving the orders themselves one day. But the chances of getting lucrative positions further down the line are steadily waning. That's why many trainee doctors end their careers before they even start. Only just over half of students starting medical degrees will end up as practicing doctors in Germany. Many become bureaucrats in the health service, find jobs in industry or emigrate.

Fröhlich comes from a family of doctors. When he started as an assistant doctor in a hospital in the northern city of Bremen in 1982, he still believed in "the healing function of my profession". But after just a few shifts he came to the sobering realization that in everyday hospital life, the interests of the patients come last -- that is seen as the job of the head physician who "rules like a monarch."

Germans come bottom of this international ranking of doctors' pay.
DER SPIEGEL

Germans come bottom of this international ranking of doctors' pay.

When Fröhling once alerted his superior to a mistake in how a patient was being treated, he was treated as if he had insulted royalty. He was yelled at. For the following three weeks his name did not appear on any operating timetables, and doctors who don't operate during their training fail to qualify for exams. Embittered, he came to terms with his superior's fantasies of omnipotence and went on to become senior physician at the orthopedic clinic at Frankfurt University.

He worked 60 hours a week, did mammoth shifts around the clock, fulfilled the demands of his superiors. That was reflected in his pay: alongside his standard salary he received additional payments for shift work, fees for medical reports and a share of the money from the treatment of private payments. But then his superior demanded a bigger share of the fees for medical reports and a row over money ensued.

The dispute says a lot about the unfair distribution of the €240 billion spent on the German health service. While most medical staff work like dogs, the profits are pocketed by the few. The medical law in the western state of Hesse, where Fröhlich was working, states that head physicians must distribute about 80 percent of proceeds from private patients to the clinic and to the doctors who treat them. But at Fröhlich's Frankfurt clinic the boss was paying them smaller amounts.

The doctors knew their superior wasn't keeping clean accounts. But they also knew that such bevavior was standard practice in the German health service. No one said anything. Until one day a woman complained that she had paid cash but been treated as if she weren't a private patient. The head physician had taken the money but the computer database claimed she was insured under the public system. Research showed what the Marburger Bund doctor's association has suspected at many university clinics but hasn't been able to prove: head physicians had pocketed around €1 million per year in this way. An auditor found that more than €10 million was missing. The doctors got back only a fraction of that, Fröhlich got around €155,000. He was the only one to leave.

When he got an offer from sweden's Capio group to work at one its 21 clinics in Britain, he jumped at the chance. Now he's steering his Audi through the northern English countryside, headed towards the village of Renacres where he conducts operations once a week. More and more colleagues from Germany are ringing him up to ask him about jobs in Britain because they are sick of mounting bureaucracy and the growing power of hospital managers.

Growing shortage of doctors

Most of the German doctors who emigrate go to the United States, which has taken about 2,700. Britain comes second, according to figures from the National Association of Statutory Health Insurance Physicians. Sweden, which has taken 700, and Norway, with 650, are becoming more popular. Special agencies lure doctors by placing advertisements in professional publications and doctors who want to supplement their income spend weekends working in Britain. After finishing their week's work in German practices they can earn up to €2,000 for a weekend shift in a British hospital.

Doctors' salaries have fallen steadily in the last three years. Many a young clinic doctor gets paid less than a long-serving nurse even if he puts in 70 hours a week. Because ever fewer people are applying for such jobs there's a growing shortage of doctors in parts of the country. Many rural doctors are complaining that they can't find successors to hand their surgeries to.

The situation is disastrous for public health and a debacle for the economy. If the trend of recent years continues -- with only 7,000 of 12,000 medical students completing their training -- over €1 billion of university costs will have been wasted. The deficit will continue to rise the more qualified doctors decide to earn their money abroad.

Fröhling leans back in the chair of his office at Euxton Hall Hospital. His salary here is three times higher than it was in Germany. But his work has disadvantages too. His office is dark and tiny and his medical equipment isn't exactly modern. During operations he doesn't have two assistant doctors on hand to help him. He has to make do with a "leg holder," a semi-skilled helper. Unqualified assistants hand him the tools of his trade -- drills and hammers. Because of these limitations, he has had to change his surgical techniques to make sure he gets hips installed properly.

German doctors who come to Britain must accept that the British health system is by no means exemplary compared with the German system, says Fröhling. The National Health Service provides basic care but passes on orders to the growing number of private clinics. That is making health provision more efficient and patients are benefiting, he thinks.

Medicine men made in Germany remain in demand in Britain because of their solid training. But they aren't universally popular. Many local NHS doctors who treat private patients on the side have suffered big income losses as a result of the German competition.

Some of the guest workers are already encountering the same envy and disapproval they were trying to escape in Germany. "Soon not every colleague will be giving us a friendly welcome," says Fröhling. 

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