Health policy | Country doctor quota: 250,000 euros contractual penalty legally

The first lawsuits against fines for the rural doctor quota are being heard before the Gelsenkirchen administrative court. Photo: Christoph Reichwein/dpa Studying medicine in Germany even without a top high school diploma: This dream of many young people has been possible for several years. This is made possible by the so-called rural doctor quota. In the mid-2010s, politicians recognized that there would be a foreseeable shortage of doctors in rural areas. A quota system was devised as a solution. A certain number of medical study places are not awarded according to the numerus clausus, but to high school graduates who undertake to take up work as a family doctor in rural areas after completing their studies.

The opportunity to study medicine in this way was first introduced nationwide in North Rhine-Westphalia in 2019. There are now similar regulations in all federal states except the three city states and Schleswig-Holstein.

In North Rhine-Westphalia, the first lawsuits from students who have signed a country doctor contract were heard on Tuesday. The students were concerned about two things: on the one hand, the contractual penalty of 250,000 euros, and on the other hand, the desire to work as a pediatrician.

The contract signed by the students states that after completing their studies they must begin further training “immediately” and then start working in the countryside. Otherwise there is a risk of a fine of 250,000 euros. The students' lawyer argued that the punishment was unreasonably high and did not differentiate. In addition, it is not clear enough what it means that students have to work as country doctors “immediately”. The country argued, however, that the punishment was appropriate and that studying medicine costs around 270,000 euros. The amount of the punishment is also correct so that rich students cannot “buy their way out”.

Students who want to work as pediatricians are suing across the country.

The court followed the argument and emphasized that fulfillment of the contracts was also necessary because other students whose grades were sufficient for medical studies would not have been able to get a place at the university due to the rural doctor quota. In North Rhine-Westphalia there are around 12,000 study places annually and 40,000 to 50,000 applicants. The court also declared that the fulfillment of country doctor contracts was “in the public interest of the general welfare” in order to ensure primary care.

However, the plaintiffs can fulfill their wish to work in the field of pediatric and adolescent medicine. This is due to the structure of the country doctor contract that they signed. It talked about family doctor activities in the context of statutory health insurance, which includes not only general and internal medicine but also pediatric and adolescent medicine. Only in contracts from later years did the state make it clear that there must be a shortage in the specific area, which is not the case with pediatricians.

The Gelsenkirchen Administrative Court has decided that the “ambiguities in the contract text of the first generation” are to the detriment of the state. The decisions are not legally binding. However, it is likely that the matter will continue before the Higher Administrative Court.

The decisions in North Rhine-Westphalia are also attracting interest nationwide. In total, around 3,400 people study with the rural doctor quota. Students have filed similar lawsuits in several federal states. In Bavaria, four students have sued because of the high contractual penalties. According to the “Deutsche Ärzteblatt”, 28 students nationwide have filed lawsuits.

Other media have corporations or billionaires behind them. We have the nd.Genossenschaft and readers like you. That makes us independent and that’s exactly how we want to remain. But it also means: without you the calculation won't work. We need 300,000 euros by the end of the year.

You can donate directly here, one-time or regularly, so that nd stays.