Being a family doctor in a small town is exhausting and lacks the charm of working as a specialist in a clinic. The German government is trying to remedy the lack of professionals in the countryside. Doctor Stefan Lichtinghagen had in his father, who was also a doctor, an example of what he didn’t want to be. His father had been a family doctor for 32 years and had a practice in the town of Marienheide, 50 km from Cologne, Germany.
When he was looking for a successor about 20 years ago, the study ended up with his son, who is a gastroenterologist and had very different life plans.
“My father started work early in the morning and went on until late at night. I rarely saw him and thought I would never want such a profession. Today I work almost as much as he does,” smiles Lichtinghagen.
The most diverse cases
In the morning Lichtinghagen had diagnosed appendicitis in a 20-year-old girl, who had been referred to him from the emergency room, with a diagnosis of cystitis.
He also treated the breathing problems of a neighborhood youth he knew from his church youth group days. And he also cared for the laceration suffered by a 91-year-old woman. She fell and hit her head after suffering dizziness while working in the garden.
With its 3,300 patients, Lichtinghagen easily achieves 50 hours of work per day. Even so, he has never regretted the decision he made. Mainly for the gratitude of the patients, whose history of illnesses he knows by heart.
Family doctors are missing
Lichtinghagen took over his father’s firm in 2005, together with a colleague – he wouldn’t have done it alone, he says. But fewer and fewer young doctors choose to become a family doctor in Germany. A study by the Robert Bosch Foundation states that, by 2035, 11,000 vacancies will be vacant.
And this has dramatic consequences for Germany: 40% of municipalities are threatened by a shortage of doctors. And the trend is rising, as every third GP is over 60 and close to retirement.
Already today, Lichtinghagen and his team serve some people who live up to 25 km from the office. The team has no way to deal with new patients. “Every day we have up to five requests. We reject her without thinking twice, we no longer even accept her husband or children”, says the doctor.
Quota to serve regions in need
Germany, known for good medicine, can become a chronic patient, especially in the countryside. The government is trying to buck the trend and is offering incentives to attract doctors to small towns. The Minister of Health, Karl Lauterbach, supports the creation of 5,000 vacancies for medical students, with the aim of adequately serving the baby boom generation.
The German health ministry has allocated 23 million euros, in various projects, to try to tackle the shortage of doctors in the countryside. The governing coalition has agreed to significantly reduce waiting times for care, particularly for children and adolescents, but also in rural areas and areas with underdeveloped infrastructure.
Of the 16 German states, nine have already implemented the so-called quota for country doctors: up to 10% of places to study medicine are granted on condition of working for ten years in an area with poor medical care, and also a bad grade overall at the end of the studies it is not an impediment to getting the job [Na Alemanha, vagas nas universidades dependem de o candidato obter uma nota geral mínima na prova que é feita ao fim do ensino médio, chamada de Abitur].
Lichtinghagen, who initially viewed the fee with suspicion, now sees it as a first step in the right direction. “At first I thought that you couldn’t condemn an 18, 19, 20 year old boy to be a family doctor if he suddenly discovers at university that arthroscopy is his passion,” he explains. “But we have to do something: we can have specialist doctors in other ways, but without family doctors it’s not possible. I’m also surprised that the population’s revolt isn’t greater”.
“The Best Thing I Know”
About two years ago, general practitioner Klaus Korte was perhaps the most important family doctor in Germany. His office is located in Ahrbrück, in the Valle Aurina, a region severely hit by a flood that caused the death of 134 people, as well as leaving a trail of destruction that is still visible today.
Korte’s office was also destroyed by the force of the waters and he kept emergency care on an interim basis, for six weeks, at a school.
“Being a family doctor is the best thing I know. The people here in the region have won me over these past 20 years, but even more in these two years after the flood. These thousands of people affected here in the Ahr tell us they approached it another way.”
So much so that the doctor continues to take care of patients who now live up to 100 km away, in temporary accommodation. And when they go to visit the construction site of the new residence, they take the opportunity to make an appointment with the doctor they trust the most.
And that is why Ahrbrück is one of the German cities that suffers from a shortage of doctors. When Korte started 20 years ago, there were five studios in the small town. Today there are two.
Fundamental, yet discriminated against
Korte knows the prejudices against family doctors: colleagues who spoke contemptuously of second-rate doctors. The university professors who say “that even a country doctor must know”. Or the doctors who exclaim, “My God, what did the GP do this time?”
Korte doesn’t care. For him, the family doctor is like a goalkeeper who must always be attentive. “Here there is no head physician or specialist to ask. We have to make the right decisions ourselves to prevent serious developments, both in cardiovascular diseases and in the diagnosis of tumors. Of course, we do not do invasive medicine or intensive care, but in a study doctor lives can be saved, and they are not few,” he says.
And there is another aspect. Korte says he can treat his patients in a very different way because he knows the history of the family’s illness – for example the father who died of cancer three years ago.
“There is no branch of medicine where you are as close to the patient as the general practitioner. He is the heart of outpatient medicine in Germany. He is the basis, and if the basis is missing, the whole building collapses.”
Source: Terra

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