Emergency helper or cherry picker? : Without borrowed doctors, clinics can’t make money – economics

It started with Marcel von Rauchhaupt two and a half years ago. He felt burnt out as a doctor’s assistant in Oberhausen, sometimes having to work up to 16 night shifts a month – and his salary was not high either. At least that wasn’t enough to repay his student loan. “I felt exploited,” says a psychiatrist and psychotherapy expert. And that he then decided to change something. “I didn’t study medicine so I wouldn’t have family life anymore and I was ruined.”

Since then, the young doctor with the title of nobility has been one of the hospital doctors in the country who can get here and there and not only work more decisively, but also make significantly more money than their permanent colleagues. There aren’t many of them, but the clinics obviously can’t do without them.

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According to the German Hospital Association (DKG), 2,300 honorary physicians worked in 2018 – with 165,000 employed physicians, which is only 1.4 percent. And their number is declining, says DKG spokesman Joachim Odenbach. In 2012, 3,400 temporary doctors had a contract. This is due not only to a somewhat declining shortage of doctors, but also to new legislation. Since the Federal Social Court ruling in June 2019, clinics have now also had to pay social security contributions for taxpayers.

“Honest doctors no longer play a role for us,” confirms Hans-Jörg Freese of the Marburger Bund clinic union. Some hospital operators continue to “occasionally use temporary staff to compensate for bottlenecks in different areas”. The topic was not raised for a good two years with the members of the bargaining commissions and also within the framework of collective bargaining.

Less demand due to the corona pandemic

Of course, due to the corona crisis, demand has already fallen somewhat, as can be heard in this sector. Due to the fact that the operations that can be scheduled have already been terminated due to the epidemic, fewer temporary doctors are currently needed. However, Silke Oltrogge does not want to confirm that demand is generally declining. She is the executive director of doctari GmbH in Berlin, which she claims is the largest online platform in Germany for the placement of temporary doctors and temporary nurses.

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In 2019, doctors engaged in temporary work for 4.1 million hours, he says. 3.6 million of them were performed in hospitals, the rest in rehabilitation facilities and outpatient clinics. For comparison: In the case of nursing, the number of loan hours was 13.7 million, of which 12.7 were in clinics.

Today, there are 25,000 doctors and nurses in the company’s database, which she founded twelve years ago, Oltrogge says – “qualified and ready to act immediately”. The medical quota is around 60 percent. In contrast, there are about 5,000 vacancies in clinics. Anesthesiologists and doctors for internal medicine are currently being sought, as are oncologists at the moment. And specialists for the mentally ill, ie doctors like Marcel von Rauchhaupt.

The 29-year-old actually noticed a bit of uncertainty among colleagues from other disciplines who, like him, had left regular hospital operations due to a lack of contracts. However, he himself cannot complain about the lack of employment. It has already been used in about 15 hospitals: in Berlin, Stuttgart, Fulda in the Ruhr area, where he studied. And eight to ten kept asking. Regular customers, so to speak, who know what they have in it.

Two to three times higher salary

“He no longer has the urge to return to a permanent position,” the young doctor reports. You will learn more when you work in different hospitals and their different groups of patients. And gain a wide range of experiences. The psychiatrist laughs and says, “Anyone who has worked in Duisburg-Marxloh is no longer afraid of Berlin-Neukölln.” As a lending doctor – the second advantage – you don’t have to do night and weekend shifts all the time. And yes, he now earns “two to three times as much” as before.

Doctari CEO Oltrogge believes that more flexibility must be rewarded accordingly. For this reason, honorary physicians have received “at least as many as physicians with comparable qualifications in permanent positions.” If there is a great need and desire for medical intervention in a short time, it can be a little more, depending on the specialization and qualification. And for experienced hired doctors, there is also the possibility to negotiate separately with clinics. Some, with whom the carriers were particularly satisfied, are specifically and repeatedly ordered. The instructions must be followed. The maximum rental period is 18 months. In the meantime, they would have to be at least three months with other employers.

Doctari does not mention abroad due to different national laws. From there to Germany, of course, and here the rate is not so low: 12.5 percent of doctors who pay fees come from the European Union (especially Romania, Poland, Greece), 44 percent from non-EU countries (preferably Syria, Iran, Egypt , Turkey). It is not a problem to travel back and forth between Switzerland and the Federal Republic. After all, the group of companies with its 200 employees has its own branch in Allschwil-Basel.

As a way to come back – or get out of the hamster wheel

The company’s founders came up with the idea for a business concept in Berlin in 2008. While walking. Christoph Siegmann and Stefan Scherf – both now Doctari shareholders – knew the challenges for healthcare professionals from their family backgrounds. Flexible working hours, a good work-life balance, work-life balance: this is difficult in the sector’s rigid shift systems. On the other hand, medical institutions face the need to find good specialists and be able to respond quickly to peak jobs. Why not look for a solution for both parties?

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In 2008, Doctari began in Berlin with the placement of 20 independent doctors. In 2010, a branch was added in Hamburg and later also in Munich. There are now around 5,000 medical facilities on the customer list – and five times as many doctors and nurses who no longer want to be tied to one employer and its specifications.

It’s not just young doctors like Marcel von Rauchhaupt, emphasizes CEO Oltrogge. It’s all “mixed, depending on the life situation.” For example, older people who left work earlier wanted to step out of the “hamster wheel” in the ensemble. Or permanent doctors, who may be located elsewhere – gain new experiences to get some distance, they may sometimes find a better way. Doctors who are otherwise involved in “Doctors Without Borders” and who work in German clinics from time to time are on loan. Or those who would in fact have turned their backs on their work, but now wanted to help intensive care units during a coronary pandemic.

Useful “view of the helicopter”

Hero stories that, of course, cannot be missed in order to legitimize business. But isn’t it still the case that credit doctors and their intermediaries benefit from a shortage of doctors, that they leave poor conditions to permanent employees and choose the icing on the cake for themselves? He does not want to deny it, says Marcel von Rauchhaupt. Many are interested in better conditions and money. There are also fee-based doctors who “feel better”, for example, reject certain employers. He does not do it alone, he also thinks that it is important that the clinic operators and patients are satisfied with it. However, in new employment relationships, he repeatedly encounters reservations from permanent employees. This usually happens when the relationship with oneself becomes more personal.

Finally, an important argument is that credit physicians provide care, allow clinics flexibility, and also relieve permanent employees, says Silke Oltrogge. By filling vacancies, other employees can also find it easier to go on weekends or on holiday. “We’re not poachers.” And being able to work in different conditions and in different places also keeps some hospital doctors at work who would otherwise have given up long ago for health or personal reasons. In addition, doctors sometimes have a kind of “view of the helicopter” from loans thanks to work in various places. The CEO emphasizes that this can be very valuable for the clinician in certain situations. For example, some credit doctors are very targeted at setting up new hospital wards.

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