General medicine | General practitioners between austerity constraints and even more tasks

In the future, such routine examinations could be carried out even more by employees in non-medical professions. Photo: dpa/Bernd Weißbrod Family medical care has not improved in recent years: although the number of general practitioners has actually increased slightly, more and more of them prefer to work as employees, for example in a medical care center (MVZ), rather than independently in their own practice. In addition, employed doctors more often work part-time. The demographic clock is also ticking in this area: around 40 percent of the professional group are over 60 years old.

Citizens are definitely noticing the effects of this shortage situation – and are becoming increasingly so. According to a new survey commissioned by the General Practitioners Association, 44 percent of 5,000 respondents said that care in their region had worsened over the last five years. There are regional differences: in Bavaria a deterioration of 40 percent is perceived, in Saxony-Anhalt it is 55 percent.

The planned compulsory medical certificate from the first day of illness creates unnecessary bureaucracy.

Very few people believe that things could get better. Specifically, the questions were asked about the consequences of the GKV Savings Act. Here, 62 percent expect longer waiting times and 60 percent expect the doctors to have less time for them. The bottom line is that 81 percent think that reliable primary care care would definitely have an impact on the quality of life in the regions. Such a high value is rare in opinion surveys, comments Nicola Buhlinger-Göpfarth, co-federal chairwoman of the General Practitioners Association (HÄV).

The effects of inadequate supply also extend into the future: 51 percent of those surveyed say that the issue will influence their decision in the coming elections. That's 14 percentage points more than two years ago, says Buhlinger-Göpfahrt. And from her point of view, it is an issue for increasingly younger people: "Accessibility is an issue for younger and middle-aged people, for families, for working people - and no longer just for seniors." Family doctors are part of public services and the increase at this point is a "warning signal."

A signal also to politicians. And according to the HÄV, it has not yet made it clear where things should actually go between savings targets and new tasks for general practitioners. Accordingly, the association formulated its demands again on the occasion of Family Doctors' Day on Thursday and Friday of this week.

At the forefront is the implementation of the so-called primary care system. Such a system is intended to ensure outpatient supplementation of inpatient care after the hospital reform. Although it is a project in the coalition agreement, the draft bill planned for this summer has not yet been viewed. The first effects are not announced until 2028 at the earliest - which should not reassure either general practitioners or patients. The professional group believes this reform is only feasible if it includes and strengthens family doctor-centered care.

This topic makes it particularly clear that health policy has become entangled in contradictions in recent months and years that are difficult to resolve. On the one hand, as a result of the GKV Savings Act, family doctor care will also be cut: from 2027, the de-budgeting that was only fought for in 2025 will in fact be cut. New patient registrations are also likely to be less financially worthwhile. Instead, there is a risk of reductions in remuneration.

For Buhlinger-Göpfahrt, this is absurd: On the other hand, family doctors should do more - for example, they should take action before contacting specialists. This is apparently due to scaling effects. »But we're not in a radiology practice. More patients mean more space required and more practice staff.«

At the same time, with the reform of emergency care, family doctors are to take on even more tasks, such as working on a new system with more emergency doctor's practices and a greatly expanded visiting service in emergencies - even during the practices' opening hours. In addition, from the point of view of doctors, companies and employees, unnecessary bureaucracy is promoted, namely through the planned compulsory medical certificate from the first day of illness and the elimination of sick leave over the phone.

However, the design of the primary doctor system is still unclear in some respects, including whether only general practitioners are allowed to take on the pilot function or whether other specialist groups can also take on the role. Other demands from general practitioners concern the urgently needed regulation of MVZs that are set up by non-specialist investors, or relief from health insurance companies' recourse claims against practices.

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