122nd German Medical Congress: Health Minister Spahn emphasizes willingness to engage in dialogue

Münster - Federal Health Minister Jens Spahn (CDU) was guest of the. As in the previous year in Erfurt, he had to face critical examination of his numerous health policy initiatives and laws in Münster. A small but noisy group among the 1,000 or so participants at the opening event even acknowledged his appearance with boos and whistles.

"I want constructive debate, don't scream, don't whistle," countered Spahn. His offer to talk is not ritual. He is ready to discuss the proposals from his house with the medical community. There is no law that has not gotten better in the course of the legislative process. "Why are we holding hearings?" Asked the minister. After all, it is about taking up good arguments and possibly incorporating them into the legal text.

Spahn also reacted to the Accusation of lack of transparency in the legislative process for the Appointment Service and Supply Act (TSVG). According to critics, the bill had undergone so many changes that it was hardly understandable. You also have to pause for second or two and consider whether the other might not be right, Spahn appealed to his critics.

The minister also took up the criticism of the number of strokes of his legislative initiatives. “We started lot,” he said. But it's not about quantity, but about quality. If you recognize problem, you cannot postpone it until next year. "That is not my position," said the Minister. “I'm trying to change something.” As examples, he cited his approach to organ donation and vaccination. 10,000 people in Germany are currently waiting for donor organ. In 2017, there were 797 organ donors, the lowest level in 20 years.

Rethink your own position

According to Spahn, more than 80 percent of Germans regularly stated in surveys that they were fundamental ready for organ donation. Obviously, better information and education alone cannot remedy the shortage of organs. “You have to rethink your own position,” said Spahn.

Years ago, he too was critical of contradiction solution. In April he then presented cross-party draft law, which provides in principle that every adult citizen is automatically considered an organ donor if he has not expressly objected. As early as February, with the Organ Donation Act, Spahn had provided better staffing and financial resources for hospitals that remove organs.

The situation with vaccinations is similar, according to the Minister. Education alone could not achieve vaccination goals.That is why you need compulsory vaccination in day care centers, schools and for medical staff. "This is not just about individual freedom," said Spahn. This is also about not unnecessarily endangering other people's health. "The eradication of diseases like measles in the world is now failing in countries like Germany," he criticized. “That doesn't leave me indifferent.”

The minister also left no doubt that he considers the TSVG's criticism of the interference with medical self-administration and practice procedures to be excessive and unfair. The increase in consultation hours from 20 to 25 hours per week was compromise with the coalition partner SPD, said Spahn. The waiting time for doctor's appointment for those with statutory health insurance is hot topic. "We want to make the situation better for these patients," said Spahn. In addition, 90 percent of the doctors assured him that they were working more anyway.

Spahn also defended the decision to take over the majority stake in the company for telematics applications for the health card (gematik). "That also has something to do with the reliability of political decisions," said Spahn. In 2004 the legislature decided to introduce the electronic health card (eGK). It is still not fully functional. "The eGK is developing into the Berlin airport in health policy," criticized Spahn. He wanted to drive the development forward because he didn't want to leave the field to international corporations like Google, Apple and Amazon.

"I want us to be able to implement our ideas on data protection and data sovereignty, among other things," said Spahn. “That is the reason why speed is important to me.” After 15 years, gematik has still not got where it wanted to be.

Now the (BMG) is taking responsibility. "If I have the cake in my face anyway, I want it right on my face," said the minister. He wants to help shape digitalization in the healthcare system and not suffer it. It goes without saying, however, that the medical profession is involved wherever medical expertise is required.

"I am the first health minister in 20 years who has regulated that there is also additional money for additional services" , emphasized Spahn to his critics. In total, that is almost billion euros, which is available, for example, for the treatment of new patients, of patients in open consultation hours or for patients referred by the appointment service point. That is an introduction to the final budget. “You can see that from time to time,” demanded the minister.

Praise from Laumann

Previously, North Rhine-Westphalia's Health Minister Karl-Josef Laumann (CDU) praised his party friend for his “clear will to create” and thus triggered loud protests in the audience. Laumann particularly emphasized the threatened shortage of doctors. Demographic change does not stop at health workers.

Of the 11,500 general practitioners in North Rhine-Westphalia, 6,400 are older than 55 years. In addition, the training system has not responded to the changed demands of the next generation of doctors for better work-life balance. "We train too few doctors," said Laumann.

In North Rhine-Westphalia, people are now reacting to the situation. A chair for medicine is being created at Bielefeld University. In addition, the country is the first to have introduced country doctor quota. Each year, 175 students are to be admitted in addition to medical studies if they commit to working as family doctor in an underserved area for ten years. “There were enough willing people who would otherwise not have been able to study,” said Laumann. There were more than 1,300 applicants for the 175 study places.

Still under the impression of the European elections on May 26th, the President of the German Medical Association (), Frank Ulrich Montgomery, had previously applied the principle of Subsidiarity reminds us that this applies in particular to European health policy. In this area, the member states are usually meticulous in ensuring that Brussels only takes action in cases where it makes no sense to go it alone at national level, for example in the defense against cross-border health threats.

Montgomery drew the link to the current one Health Policy in Germany. Here the federal government is increasingly questioning the division of labor between the state and self-government, criticized the BÄK President. The latest example: the increase in the minimum number of consultation hours for contract doctors from 20 to 25 hours in the TSVG, which undermines an agreement between statutory health insurance physicians and health insurance companies in the federal contract. “Did that really have to be?” Asked the BÄK President. "Does that really serve the supply or is it addressed to pseudo-problems?"

In the same breath, Montgomery criticized the "expropriation-like" encroachment on the company's ownership structure for telematics applications in the health sector (gematik). He doubts that the BMG will advance digitization more successfully than self-administration. The core problem is not the structure of the company at gematik, but that the legal requirements from 2004 required “squaring the circle”. "We have different relationship to self-administration," said the BÄK President to Minister Spahn."Despite some problems, I am deeply convinced of her."

Clear differences of opinion

When it comes to the professionalism of the medical profession, the ideas of the medical profession and the ministry also diverged. Doctors rightly complained about too much work, too few colleagues, constant excessive demands of time, burnout and more - separate item on the agenda at this year's German Medical Congress.

But instead of increasing the number of doctors and getting more medical study places as soon as possible create, the minister create new health professions or expand the range of activities of existing health professions. That undermines the professionalism of the medical profession, criticized Montgomery. "In highly developed health care system, patients have right to well-trained and highly qualified doctors," said the BÄK President.

Unnecessary reform of psychotherapist training

is an example of this deprofessionalization the “completely superfluous” law to install their own basic psychotherapist training, in which the prospective psychotherapists, after completing bachelor's and master's degree, complete further training to become psychotherapist analogous to doctors.

"Apparently it's all about training," said Montgomery. “In truth, however, the entire psychotherapy should be separated from medicine and raised to profession in its own right.” Psychotherapy is medical technique that is still practiced by far more doctors than psychological psychotherapists. The fact that the graduates of the bachelor's and master's degree programs will in future be allowed to call themselves “psychotherapists” and the doctors “medical psychotherapists” is terrific label fraud.

The same applies to the Midwifery Act. “We don't solve the problems that we have in our job today through academization, but only through more practical training, clear liability regulations and clear responsibilities,” explained Montgomery. Women in pregnancy and breastfeeding need practical help, not theoretical instruction.

It is the turn of the federal states

In addition to the federal level, Montgomery also called on the federal states to assume their health responsibility. For 20 years the federal states have not met their investment obligations for hospitals. The result: ailing buildings, outdated equipment and, in many clinics, an electronic infrastructure that does not deserve this name. "The investment gap is put at 3.7 billion euros annually," said Montgomery.It is now really time for the federal states to commit themselves to sustainable investment model.

In addition to all the criticism, Montgomery also highlighted similarities. He praised Spahn's commitment to resolving contradictions in organ donation. The German Medical Association had also expressly spoken out in favor of such solution. Montgomery appealed to the members of the Bundestag not to unsettle people with "petty pseudo-ethical debates". With the Organ Donation Act, which came into force on April 1st and which improves the structural and financial framework for transplantation in hospitals, one has probably already achieved "a huge step forward for the people on the waiting list".

Harsh words from Windhorst

The president of the host, Theodor Windhorst, went hard into court with the politicians. He recalled the doctors' day in 2007, which also took place in Münster, and quoted Jörg-Dietrich Hoppe, then President of the German Medical Association Complaints about services of general interest and the nationalization of supply procedures. “That is exactly what happened,” said Windhorst today in Münster. "We are led into state medicine, we have the health economy with the economization and industrialization of medicine."

Here, freelance work is an indispensable basis and "brand core" of the medical profession. “In patient care, we have to be able to make decisions independently and on our own responsibility, based on technical and medical aspects that primarily focus on the patient's well-being. The patient must be able to trust that, ”said Windhorst.

In the past twelve years alone, 146 laws and ordinances relating to the health care system have been passed - without waiting for the effects of previous laws, without evaluation, without reliable long-term perspective , said the president of the Westfalen-Lippe Medical Association.

This flood of laws had nothing to do with patient care. It is also becoming increasingly difficult in the face of the shortage of doctors and other health professionals. "I therefore urgently demand change of course from you," Windhorst appealed to the Federal Minister of Health: "Instead of state medicine, free, self-administered health system again.“