Foreign Doctors Keep Rural German Hospitals Running

Germany's healthcare system, despite having one of the highest numbers of doctors per capita globally, faces significant challenges, particularly in rural areas. Overcrowded emergency rooms, long waiting times, and staff shortages plague small hospitals. This situation has led to a heavy reliance on foreign doctors, who now constitute one in four medical professionals in Germany.

The Indispensable Role of Foreign Doctors

Many hospitals, especially those outside major cities, would struggle to function without doctors from abroad. Mohamed Cherbagi, a specialist in internal medicine from Syria, commutes daily to Freiberg District Hospital in Central Saxony. He came to Germany eleven years ago and quickly found employment, having completed his medical studies in Syria. He often works six consecutive days, including 24-hour shifts about six times a month.

Similarly, Ina Viaroukina, an intensive care physician from Belarus, works at the hospital in Quedlinburg. She moved to Germany seven years ago with her two daughters, seeking a better life than the €170 monthly salary she earned as a doctor in Belarus. She regularly works six-day weeks and two weekends a month, balancing her demanding job with raising her children as a single mother.

Systemic Issues and Economic Pressures

Professor Christian Karagiannidis, a healthcare system researcher, highlights that while Germany has an abundance of doctors overall, two-thirds of hospitals struggle to fill open positions. He describes a phenomenon of "overprovision, underprovision, and misallocation of care all at the same time." Germany has an exceptionally high number of hospitals (1,700) by international standards, contributing to the most expensive healthcare system in Europe.

Professor Wolfgang Schütte, chairman of the Saxony Anhalt Hospital Association, notes that many hospitals operate at a deficit due to rising personnel and energy costs, and an increasing number of empty beds. The number of hospitals has been declining for years. In Quedlinburg's Harzklinikum, one-third of doctors are now from abroad.

Challenges and Perceptions

The increasing reliance on foreign doctors brings its own set of challenges. Dr. Susanne Hiller, Mohamed Cherbagi's former boss at Freiberg's emergency room, observes a drastic shift: in 2017, only three out of 20 doctors were foreign, a number that has now risen to about twelve out of 20. She attributes this partly to a decline in the prestige of the medical profession, with doctors now seen as overworked, which deters German graduates. Many top-tier German medical graduates opt for research, pharmaceutical companies, or work abroad rather than clinical practice.

Hospitals acknowledge that language skills among foreign colleagues are not always optimal. While some advocate for stricter language requirements, the overall consensus is that these professionals are exceptionally well-trained and essential. In Saxony, nearly one-fifth of all doctors are non-German citizens, and in Freiberg, this figure is close to one-third. Hospitals actively recruit abroad, particularly for nursing staff from countries like the Philippines, Vietnam, and India.

Mohamed Cherbagi, comparing the German system to Syria's, sometimes finds the extensive diagnostic tests and treatments excessive. He notes that Germans live longer and require more medical care, often detecting diseases in early stages. Professor Karagiannidis criticizes the "overtreatment" of very elderly patients, suggesting a need for more focused care to maintain quality of life. Professor Schütte, however, argues against widespread overprovision, emphasizing that medical standards and patient demands drive treatment options.

Life Between Two Worlds

Foreign doctors like Ina and Mohamed navigate a complex life between their home cultures and Germany. Ina, despite her dedication, finds it challenging to balance her demanding job with her family life. She often feels overworked, a sentiment shared by half of all doctors according to a survey by the Marburger Bund doctors' union.

Mohamed's family, including his German wife Manuela and their sons, experiences racism but tries to focus on individual interactions. Manuela, a Muslim woman who wears a headscarf, feels xenophobia more acutely than her husband.

Future Uncertainties and Reform Efforts

The German healthcare system faces additional pressures from slow digitization and increasing bureaucracy. Doctors spend an average of three hours a day on documentation. The German Hospital Association estimates that even one hour less bureaucracy daily could significantly alleviate staffing problems.

The increasing number of part-time doctors (31% by 2022) further exacerbates staff shortages. Regional disparities also play a role, with doctors preferring cities over rural and economically weaker regions. In Saxony Anhalt, only 30% of medical graduates stay in the state.

A commission appointed by the previous federal government proposed a reform to create fewer but larger hospitals, aiming for more efficient staff deployment. However, the distribution of medical professionals remains a challenge, especially in less attractive rural areas.

Some foreign doctors, like Mohamed Cherbagi, consider returning to their home countries. A non-representative survey by the Syrian Society for Doctors and Pharmacists in Germany indicates that 74% of Syrian doctors might return to Syria long-term. Mohamed and his family plan to move to Syria in about a year and a half, once his advanced training is complete. He feels Syria is his true "home" where his legitimacy is not questioned.

The German Hospital Association warns that a mass return of foreign doctors would create significant gaps in the healthcare system. Christian Karagiannidis stresses the urgent need for reform, especially given Germany's rapidly aging population, which will intensify demand for elderly care in the mid-2030s.

As Mohamed Cherbagi leaves Freiberg Hospital for a senior physician position in Chemnitz, his departure highlights the ongoing challenge. Beyond major cities, foreign doctors remain indispensable to German hospitals, and their potential return to their home countries poses a serious threat to the stability of the healthcare system.