The contractual doctor's supply in the amendment law wanted revolutionize. Now, ten years later, the new options are being widely adopted. Example: Westfalen-Lippe
We see the opportunity to counter the impending shortage of doctors and to make service to people more attractive again, especially for the younger generation. ”This is how the board members of the National Association of Statutory Health Insurance Physicians (KBV) praised Dr. med. Andreas Köhler and Ulrich Weigelt, the “Law to amend the law on contract doctors (VÄndG) and other laws”, when it came into force on January 1, 2007. So much optimism from the representatives of the resident doctors and psychotherapists has rarely been seen in the assessment of major reforms in the health care system.
The then Federal Minister of Health, Ulla Schmidt (SPD), initiated comprehensive liberalization of the contract medical profession in autumn 2006 with the VÄndG. Until then, the activities of doctors and psychotherapists within the framework of statutory health insurance were largely tied to personal approval and full-time practice as well as to specific practice location, but now more flexible options for working in outpatient care have been created. This mainly concerned new options for employing doctors and psychotherapists in practices, partial approvals and the combination of activities in outpatient care and in hospitals. The flexible professional community (BAG) replaced the previously only possible, rigid and localized group practice. From now on, the practice seat could be supplemented with branch practice as "subsidiary". Age limits for admission and the termination of contract medical work have been deleted. With the new liberal rules on professional practice, incentives should be created for working in outpatient care.
More competitive doctors
Ultimately, however, it was the doctors, psychotherapists and dentists themselves who did the Set the course for greater flexibility and more competition in outpatient care. The 107th German Medical Association and the German Dental Association 2004 as well as the 7th Psychotherapist Day 2007 had adapted the respective professional law to the requirements of modern care structures. In particular, the competitiveness of resident doctors compared to medical care centers (MVZ) and hospitals should be improved.
The contractual doctor's supply in the amendment law wanted revolutionize. Now, ten years later, the new options are being widely adopted. Example: Westfalen-Lippe
We see the opportunity to counter the impending shortage of doctors and to make service to people more attractive again, especially for the younger generation. ”This is how the board members of the National Association of Statutory Health Insurance Physicians (KBV) praised Dr. med. Andreas Köhler and Ulrich Weigelt, the “Law to amend the law on contract doctors (VÄndG) and other laws”, when it came into force on January 1, 2007. So much optimism from the representatives of the resident doctors and psychotherapists has rarely been seen in the assessment of major reforms in the health care system.
The then Federal Minister of Health, Ulla Schmidt (SPD), initiated comprehensive liberalization of the contract medical profession in autumn 2006 with the VÄndG. Until then, the activities of doctors and psychotherapists within the framework of statutory health insurance were largely tied to personal approval and full-time practice as well as to specific practice location, but now more flexible options for working in outpatient care have been created. This mainly concerned new options for employing doctors and psychotherapists in practices, partial approvals and the combination of activities in outpatient care and in hospitals. The flexible professional community (BAG) replaced the previously only possible, rigid and localized group practice. From now on, the practice seat could be supplemented with branch practice as "subsidiary". Age limits for admission and the termination of contract medical work have been deleted. With the new liberal rules on professional practice, incentives should be created for working in outpatient care.
More competitive doctors
Ultimately, however, it was the doctors, psychotherapists and dentists themselves who did the Set the course for greater flexibility and more competition in outpatient care. The 107th German Medical Association and the German Dental Association 2004 as well as the 7th Psychotherapist Day 2007 had adapted the respective professional law to the requirements of modern care structures. In particular, the competitiveness of resident doctors compared to medical care centers (MVZ) and hospitals should be improved.With the VÄndG, the legislature took over these modernizations in social law.
Ten years after the start of the new world of contract medical work and cooperation, it is time to take stock. What has actually changed positively for the care of the insured? Which options of the VÄndG are used by doctors and psychotherapists? Anyone who worked as resident contract doctor in the early 2000s did so full-time and with their own license. The activity as an employed contract doctor was limited to few special cases. Employment for this special form of care was only made possible with the introduction of MVZ through the GKV Modernization Act 2004. Two years later, when the VÄndG lifted this unequal treatment of MVZs and medical practices and generally allowed employment, goal was thrown open. The number of employed doctors and psychotherapists has grown continuously since then - both in the practices and in the currently 171 MVZ in Westphalia-Lippe. At the end of 2016, 1,163 doctors and psychotherapists had an employment contract with practice and 901 with an MVZ.
Appropriate to the living situation
Admittedly, admission remains the preferred form of participation, especially in the basic care specialist groups at the contract medical care. However, the employment is currently used to get started in outpatient work, because you are not tied to large investments and have not set the course for your entire professional life. Likewise, at the end of their careers, many doctors take advantage of the switch from admission to employment, which opens up options for them to continue working and to flexibly exit work.
Together with the option to work in Part-time employment adapts to the special life situations of doctors and psychotherapists. While part-time work hardly played role before the VÄndG, ten years later in Westphalia-Lippe almost eleven percent of the care contract is being performed by non-full-time doctors. Employment and part-time work also offer practices more options, including staffing branches or rounding off the range of medical services and supplementing specialist skills. Finally, doctors from another specialist area may also be employed (Section 95 (9) SGB V).
Like employment, part-time work is also increasing continuously. While only few doctors make use of an approval with half the care contract, this form of part-time work plays major role, especially for psychotherapists: 41 percent of psychotherapists work with "half" approval.With the VÄndG, the legislature took over these modernizations in social law.
Ten years after the start of the new world of contract medical work and cooperation, it is time to take stock. What has actually changed positively for the care of the insured? Which options of the VÄndG are used by doctors and psychotherapists? Anyone who worked as resident contract doctor in the early 2000s did so full-time and with their own license. The activity as an employed contract doctor was limited to few special cases. Employment for this special form of care was only made possible with the introduction of MVZ through the GKV Modernization Act 2004. Two years later, when the VÄndG lifted this unequal treatment of MVZs and medical practices and generally allowed employment, goal was thrown open. The number of employed doctors and psychotherapists has grown continuously since then - both in the practices and in the currently 171 MVZ in Westphalia-Lippe. At the end of 2016, 1,163 doctors and psychotherapists had an employment contract with practice and 901 with an MVZ.
Appropriate to the living situation
Admittedly, admission remains the preferred form of participation, especially in the basic care specialist groups at the contract medical care. However, the employment is currently used to get started in outpatient work, because you are not tied to large investments and have not set the course for your entire professional life. Likewise, at the end of their careers, many doctors take advantage of the switch from admission to employment, which opens up options for them to continue working and to flexibly exit work.
Together with the option to work in Part-time employment adapts to the special life situations of doctors and psychotherapists. While part-time work hardly played role before the VÄndG, ten years later in Westphalia-Lippe almost eleven percent of the care contract is being performed by non-full-time doctors. Employment and part-time work also offer practices more options, including staffing branches or rounding off the range of medical services and supplementing specialist skills. Finally, doctors from another specialist area may also be employed (Section 95 (9) SGB V).
Like employment, part-time work is also increasing continuously. While only few doctors make use of an approval with half the care contract, this form of part-time work plays major role, especially for psychotherapists: 41 percent of psychotherapists work with "half" approval.On the other hand, employees are more often found in part-time work: 1,371 of 2,175 salaried doctors work to an extent of 25 to 75 percent, with salaried psychotherapists the figure is 152 out of 161. The expectations of both the legislature and the KVen have been fully met .
The term “professional community”, newly introduced by the VÄndG, encompasses the traditional form of cooperation in group practice and expands the possibilities for cooperation. What was new in 2007 was, above all, the joint practice at various contract doctor's offices, the “joint practice”. In addition, the option was created to offer only certain services together in “partial professional community”. The corresponding change in Section 33 of the Admission Ordinance has not, however, led to boom in the new BAG in Westphalia-Lippe. The number of traditional group practices even fell slightly from 1,838 practices at the beginning of 2007 to 1,762 practices in 2016. However, more doctors work in these group practices than ten years ago. This is supported by the decreasing number of individual practices (end of 2007: 7,619, end of 2016: 7,189) with an overall increasing number of members.
There are people who don't want to cooperate
There are advantages in joint professional practice especially ENT doctors. Of the 385 members of this specialist group, 53 percent currently work in BAG. The tendency to cooperate is particularly pronounced in basic medical specialist disciplines. Almost half of the radiologists, ophthalmologists, orthopedists and urologists also contribute to BAG. In Westphalia, on the other hand, psychotherapists who are currently 90 percent preferring individual practices are not cooperative. In the group of general practitioners, the largest group with 4,889 members, 44 percent have joined forces in BAG, 54 percent work in an individual practice and two percent in an MVZ. The possibility of setting up supra-local group practice with different locations is only used to limited extent. Their number has leveled off at around 140 communities in Westphalia-Lippe over the past five years.
Cooperation in an MVZ is also form of joint professional practice. As in the whole of Germany, the number of medical care centers in Westphalia-Lippe has risen continuously since 2004 and reached 171 at the end of 2016. Of these, 51 were run by hospital. The number of doctors working in the MVZ has increased accordingly. At the end of 2016, 103 doctors with their own license and 901 employed doctors shared 682 full-time care contracts.
The main political justification for the introduction of MVZ was the integrated care of patients from single source.On the other hand, employees are more often found in part-time work: 1,371 of 2,175 salaried doctors work to an extent of 25 to 75 percent, with salaried psychotherapists the figure is 152 out of 161. The expectations of both the legislature and the KVen have been fully met .
The term “professional community”, newly introduced by the VÄndG, encompasses the traditional form of cooperation in group practice and expands the possibilities for cooperation. What was new in 2007 was, above all, the joint practice at various contract doctor's offices, the “joint practice”. In addition, the option was created to offer only certain services together in “partial professional community”. The corresponding change in Section 33 of the Admission Ordinance has not, however, led to boom in the new BAG in Westphalia-Lippe. The number of traditional group practices even fell slightly from 1,838 practices at the beginning of 2007 to 1,762 practices in 2016. However, more doctors work in these group practices than ten years ago. This is supported by the decreasing number of individual practices (end of 2007: 7,619, end of 2016: 7,189) with an overall increasing number of members.
There are people who don't want to cooperate
There are advantages in joint professional practice especially ENT doctors. Of the 385 members of this specialist group, 53 percent currently work in BAG. The tendency to cooperate is particularly pronounced in basic medical specialist disciplines. Almost half of the radiologists, ophthalmologists, orthopedists and urologists also contribute to BAG. In Westphalia, on the other hand, psychotherapists who are currently 90 percent preferring individual practices are not cooperative. In the group of general practitioners, the largest group with 4,889 members, 44 percent have joined forces in BAG, 54 percent work in an individual practice and two percent in an MVZ. The possibility of setting up supra-local group practice with different locations is only used to limited extent. Their number has leveled off at around 140 communities in Westphalia-Lippe over the past five years.
Cooperation in an MVZ is also form of joint professional practice. As in the whole of Germany, the number of medical care centers in Westphalia-Lippe has risen continuously since 2004 and reached 171 at the end of 2016. Of these, 51 were run by hospital. The number of doctors working in the MVZ has increased accordingly. At the end of 2016, 103 doctors with their own license and 901 employed doctors shared 682 full-time care contracts.
The main political justification for the introduction of MVZ was the integrated care of patients from single source.In fact, however, form of care has developed alongside the classic practice through which hospitals can also influence outpatient care and which can be operated with the legal form of limited liability company. This type of company and its tax and liability law conditions shape the development of modern MVZ more than the goal of an interdisciplinary range of services. It was therefore logical to abolish the fig leaf "interdisciplinary" and also to allow MVZ with only one specialist group. The partial professional community ultimately remained pure paper tiger of the VÄndG due to unclear and ultimately contradicting regulations.
Since 2007, doctors and psychotherapists have been able to maintain branch practice in addition to their main location. The members of KV Westfalen-Lippe took up this option very quickly. At the beginning of the first quarter of 2007, 41 branch practices had already been applied for and approved. Their number rose by leaps and bounds in the following years, so that by the end of 2010 total of 385 branch practices were in operation. By the end of 2016, their number had fallen slightly to 326.
Currently in Westphalia it is primarily the specialist internists who offer their services at several locations. With 120 doctors - that is 15 percent of all specialist internists - this specialist group uses the option of branch practice clearly before all others. 90 Westphalian general practitioners are currently also operating additional locations - but this only makes up two percent of the total number of this large specialist group. Overall, all medical specialist groups as well as psychotherapists use the opportunity to operate branch practices. More than 300 branch practices in Westphalia-Lippe mean denser medical offer in the area. However, the basic requirement for the approval of spin-off is always the improvement of care for the patients. This makes the branch practice sensible and successful option in outpatient care.
Proven: the supplier branch
One model has particularly proven itself in securing comprehensive care: the “supplier -Filiale ", as it is called in Westphalia-Lippe. The term refers to branch practice that is staffed full-time by an employed doctor - and therefore does not represent supply of care that is only limited in time by the operator of the main location. Such construction is usually used to maintain family or specialist medical care, which would break away without this supply branch. The utility branch has developed into an important instrument for the approval and safeguarding business area of KV Westfalen-Lippe.In fact, however, form of care has developed alongside the classic practice through which hospitals can also influence outpatient care and which can be operated with the legal form of limited liability company. This type of company and its tax and liability law conditions shape the development of modern MVZ more than the goal of an interdisciplinary range of services. It was therefore logical to abolish the fig leaf "interdisciplinary" and also to allow MVZ with only one specialist group. The partial professional community ultimately remained pure paper tiger of the VÄndG due to unclear and ultimately contradicting regulations.
Since 2007, doctors and psychotherapists have been able to maintain branch practice in addition to their main location. The members of KV Westfalen-Lippe took up this option very quickly. At the beginning of the first quarter of 2007, 41 branch practices had already been applied for and approved. Their number rose by leaps and bounds in the following years, so that by the end of 2010 total of 385 branch practices were in operation. By the end of 2016, their number had fallen slightly to 326.
Currently in Westphalia it is primarily the specialist internists who offer their services at several locations. With 120 doctors - that is 15 percent of all specialist internists - this specialist group uses the option of branch practice clearly before all others. 90 Westphalian general practitioners are currently also operating additional locations - but this only makes up two percent of the total number of this large specialist group. Overall, all medical specialist groups as well as psychotherapists use the opportunity to operate branch practices. More than 300 branch practices in Westphalia-Lippe mean denser medical offer in the area. However, the basic requirement for the approval of spin-off is always the improvement of care for the patients. This makes the branch practice sensible and successful option in outpatient care.
Proven: the supplier branch
One model has particularly proven itself in securing comprehensive care: the “supplier -Filiale ", as it is called in Westphalia-Lippe. The term refers to branch practice that is staffed full-time by an employed doctor - and therefore does not represent supply of care that is only limited in time by the operator of the main location. Such construction is usually used to maintain family or specialist medical care, which would break away without this supply branch. The utility branch has developed into an important instrument for the approval and safeguarding business area of KV Westfalen-Lippe.In number of cases, this averted the impending closure of practice requiring care without replacement. Two such constellations were approved under the new law in 2007. At the end of 2016, 168 utility branches were operated nationwide, most of them in small towns and communities in the large districts of Westphalia.
A step in the right direction
The Contract Doctor Law Amendment Act was big step in the right direction. The potential of outpatient care can be tapped more efficiently through the targeted liberalization of professional practice. Doctors and psychotherapists can use their skills better and expand them through cooperation. The competitiveness of outpatient care has been strengthened. The hopes of the legislature, with the VÄndG, to make statutory medical care more attractive again for young doctors and to counteract the shortage of young professionals, have at least partially been fulfilled. To relativize the high hurdle of one's own full-time admission and to supplement it with number of other opportunities to work in care was measure that has certainly opened up additional potential has the option for Westfalen-Lippe to set up branch practices and to work as contract doctor in other locations. The opening of branch practice is not mass phenomenon - the proportion of doctors or psychotherapists with branches per specialist group is usually below five percent. Nevertheless, these 326 locations make specialist medical care more accessible to many people.
Andreas Daniel, KV Westfalen-Lippe
Ansgar von der Osten, KV Westfalen-Lippe
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