Concepts against the shortage of rural doctors

Many rural doctors want to retire. But young doctors prefer to settle in the city. A study by the Fulda University of Applied Sciences shows the higher workload of rural doctors, which probably tends to scare off young doctors. The family doctors Dr. Michael Ziegler (61) in Ehrenberg-Wüstensachsen and Dr. Daniel Nolte (40) in Eichenzell-Rothemann have a recipe against this: cooperation!

When Dr. Michael Ziegler set up as a country doctor in the Rhön 30 years ago, he worked as a lone fighter. Mostly 60 hours a week, up to 80 on-call services a year, many house calls. Today, the family doctor practices 40 to 45 hours and does four on-call services per year: "Working conditions have improved a lot," he says. The reasons: He has had a partner for a group practice for 13 years. In addition, on-call duties have been distributed among all doctors in the Fulda region. Since 2008, the medical on-call service has been centralised at the Fulda hospital.
Rural doctors work more than their colleagues in the city

Better work-life balance through mergers

The means to attract younger doctors to the countryside is called cooperation. "Mergers of doctors in joint practices or health centres in rural areas are becoming increasingly important," say Prof. Dr. Stefan Greß and his research assistant Annika Salzmann from Fulda University of Applied Sciences. The researchers from the Department of Nursing and Health have compared the workload of GPs in urban and rural areas. The higher workload of rural doctors is one of the reasons why it is so difficult to find successors, as other studies confirm. The younger generation of doctors attaches more importance to a work-life balance.

Rural doctors work an average of 52 hours a week - seven hours more than their colleagues in the city. They also make more home and nursing home visits - they see about 27 patients per week, six more than their urban colleagues. The differences are particularly stark when it comes to on-call services: city doctors do an average of only 2 services within three months, while rural doctors do 13. The more rural the practice location, the higher the GP workload. The dilemma: "The more rural doctors' practices cannot be refilled, the more work will fall on the others, because they will have to care for the patients as well," Greß and Salzmann explain.

Health centres in rural regions

If practices close, patients have to travel longer distances: "For older people who are no longer so mobile, this can be a huge hurdle," says Salzmann. Especially in rural areas, where buses often only run during school hours, this is a problem. New, cooperative concepts that benefit citizens and doctors will become more important in the future, such as health centres with several doctors and health-related service providers like physiotherapists and nursing services under one roof, along with mobile services like citizen taxis. "A better infrastructure would make it more attractive for young doctors to go to the countryside," Salzmann says.
Mergers have other advantages as well: Dr Daniel Nolte, 40, for example, finds it very relieving that he can exchange information with two other colleagues in the group practice in Rothemann: about diagnoses and treatment or all the bureaucracy that a doctor in private practice has to deal with.

Country doctors and patients: a deep relationship

Five years ago, he took the step of becoming self-employed. What attracted him was the low number of on-call services. "A hospital doctor has significantly more duties than I do," he says. He says it is important for him to combine his profession with his family. "I want to see my son grow up." He usually works around 50 hours a week: "I don't find this stressful because I enjoy the job," he says. In his opinion, the networking of doctors in the Fulda area has many advantages: good communication between GPs, specialists and clinics because people know each other personally. People also live more peacefully here than in conurbations. "I wouldn't want to change places with a doctor in the city," says Dr. Nolte.

One advantage: proximity to patients

Above all, rural doctors Nolte and Ziegler value the proximity to their patients. "I know my patients, their parents and grandparents. I know what it is like in the families, who cares for their relatives and who needs the encouragement or help of the family doctor," says Dr Ziegler. "Thank you for taking such good care of my father," is the appreciation Dr Nolte often hears from relatives. Doctors in Frankfurt or Cologne, on the other hand, are constantly seeing new patients.
Eliminating misconceptions with internships

Both Dr. Nolte and Dr. Ziegler want to make being a country doctor palatable to the next generation of doctors. Medical students from the University of Frankfurt come to Rothemann and Wüstensachsen for practical training, "Landpartie" is the name of the project. "Many young colleagues come with the idea that we treat coughs and colds and only issue sick notes. But they quickly learn how versatile the profession is. We see a wide variety of patients and have to be familiar with many specialties," says Nolte.
"The advantages that GPs have in the countryside simply have to be presented well," Greß and Salzmann also emphasise.

Thedeath of practices threatens to continue
Without new concepts, the death of practices in rural areas will continue: The scenario in five years is anything but rosy: 64 GPs out of 161 doctors will then be in their prime retirement age, according to the regional health report for the Fulda district. If they were to retire at 65, 40 % of all GPs would thus be looking for a successor.

In Gersfeld, for example, two doctors have been looking for successors for years, reports Gabriele Bleul, Managing Director of the Gesundheitsnetz Osthessen. A modern health centre with several doctors under one roof is therefore under discussion in order to attract the next generation of doctors. "This can only go hand in hand with politics," Bleul explains. Because such centres would first have to be built - and young doctors lack the money to do so.

Picture credits: de.fotolia.com/id/65324136