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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. [Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST]. Z Rheumatol 2024; 83:257-268. [PMID: 37566120 PMCID: PMC11058970 DOI: 10.1007/s00393-023-01395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | | | - Michael N Berliner
- Rheumatologie und Geriatrie, Helios Klinikum Berlin-Buch, Berlin, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
| | - Gernot Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Andreas Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bernhard Manger
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Deutschland
| | | | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - Matthias Raspe
- Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin Charité - Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Deutschland
| | - Martin Krusche
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST. Z Rheumatol 2024; 83:31-39. [PMID: 37847298 PMCID: PMC10879383 DOI: 10.1007/s00393-023-01433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
| | | | - Michael N Berliner
- Rheumatology and Geriatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Martin Fleck
- Clinic and Polyclinic for Internal Medicine I, University Hospital Regensburg, Regenburg, Germany
- Clinic and Polyclinic for Rheumatology/Clinical Immunology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Gernot Keyßer
- Department of Internal Medicine, Clinic for Internal Medicine II, University Hospital Halle, Halle (Saale), Germany
| | - Andreas Krause
- Clinic for Internal Medicine, Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Bernhard Manger
- Medical Clinic 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian Schuch
- Internal Practice Group Rheumatology-Nephrology, Erlangen, Germany
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Matthias Raspe
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Krusche
- Section for Rheumatology and Inflammatory Systemic Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Schreyer AG, Schneider K, Dendl LM, Jaehn P, Molwitz I, Westphalen K, Holmberg C. Patient Centered Radiology - An Introduction in Form of a Narrative Review. ROFO-FORTSCHR RONTG 2022; 194:873-881. [PMID: 35196713 DOI: 10.1055/a-1735-3552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient centered radiology represents a crucial aspect for modern sustainable radiology. The definition of patient-centered consists of a focus on patients' individual values and wishes with a respectful integration in medical decisions. In this narrative review we try to give a practical introduction into this complex topic with the extension to a person-centered radiology, which additionally encompasses values and wishes of radiological and other medical colleagues. METHODS Medline search between 2010 and 2021 using "patient-centered radiology" with additional subjective selection of articles for this narrative review. RESULTS Regarding patients' experiences the main literature focus were patients' fears of examinations (movement restrictions, uncertainty). Most patients would prefer a direct communication with the radiologist after the examination. Regarding interdisciplinary communication the radiological expertise and quality is highly appreciated; however, there was a general wish for more structured- or itemized reporting. Concerning working conditions radiologists were satisfied despite high psychosocial working pressure. CONCLUSION Most of the literature on this topic consists of surveys evaluating the current state. Studies on interventions such as improved information before examinations or patient-readable reports are still scarce. There is a dilemma between an increasing radiological workload and the simultaneous wish for more patient-centered approaches such as direct radiologist-patient communications in the daily routine. Still on our way to a more value-based radiology we have to focus on patient communications and a patient-centered medicine. KEY POINTS · Patient centered radiology has a focus on the integration of patients' individual values and wishes in their decisions.. · Radiologists are clinicians, who an additional diagnostic and therapeutic surplus for patients and referring physicians.. · The recent literature on this topic consists basically on the evaluation of the current status.. · Most patients prefer a direct communication with the radiologist.. · To gain a "value based" radiology we to focus on an optimized communication with patients and referring physicians.. CITATION FORMAT · Schreyer AG, Schneider K, Dendl LM et al. Patient Centered Radiology - An Introduction in Form of a Narrative Review. Fortschr Röntgenstr 2022; 194: 873 - 881.
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Affiliation(s)
- Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Katharina Schneider
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Lena Marie Dendl
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Westphalen
- Department of Diagnostic and Interventional Radiology, DRK Kliniken Berlin Köpenick, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
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Sieren M, Katoh M, Mahnken AH, Reimer P, Westphalen K, Hoffmann RT, Paprottka P, Rohde S, Wacker FK, Minko P, Molwitz I, Oechtering TH, Afat S, Bucher AM, Gerwing M, Storz C, Ziegler HR, Barkhausen J, Frisch A. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. ROFO-FORTSCHR RONTG 2022; 194:1346-1357. [PMID: 35830856 DOI: 10.1055/a-1853-8549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement. MATERIALS AND METHODS From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists < 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training. RESULTS A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants. CONCLUSION Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curricula & interviews). KEY POINTS Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT · Sieren M, Katoh M, Mahnken AH et al. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1853-8549.
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Affiliation(s)
- Malte Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Marcus Katoh
- Department for Diagnostic and Interventional Radiology, HELIOS Hospital Krefeld, Germany
| | - Andreas H Mahnken
- Diagnostic & Interventional Radiology, Philipps-University Marburg, Germany
| | - Peter Reimer
- Zentralinstitut für bildgebende Diagnostik, Städtisches Klinikum Karlsruhe, Germany
| | - Kerstin Westphalen
- Department of Diagnostic and Interventional Radiology, DRK Hospital Berlin, Germany
| | - Ralf-Thorsten Hoffmann
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl-Gustav-Carus Technical University Dresden, Dresden, Germany
| | - Philipp Paprottka
- Department of Interventional Radiology, University Hospital rechts der Isar, München, Germany
| | - Stefan Rohde
- Department of Radiology and Nuclear Medicine, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Peter Minko
- Institute for Diagnostic and Interventional Radiology, Medical Faculty Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tubingen, Germany
| | - Andreas Michael Bucher
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mirjam Gerwing
- Institute of Clinical Radiology, University Hospital Munster, Germany
| | - Corinna Storz
- Neuroradiology, University Hospital Freiburg, Germany
| | - Henrike-Renate Ziegler
- Department for Diagnostic and Interventional Radiology, HELIOS Hospital Krefeld, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anne Frisch
- Department of Radiology, Charite Medical Faculty Berlin, Germany
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Aksoy C, Reimold P, Borgmann H, Kölker M, Cebulla A, Struck JP, Zehe V, Nestler T, von Landenberg N, Uhlig A, Boehm K, Leitsmann M. [Impact of the COVID-19 pandemic on urology residency training programs in Germany]. Aktuelle Urol 2022; 53:317-324. [PMID: 35580617 DOI: 10.1055/a-1824-4288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several international medical societies reported a negative impact on urology residency training programs due to the COVID-19 pandemic. OBJECTIVES The aim of this study was to investigate the impact of the pandemic on urological residency in Germany. MATERIALS AND METHODS From the 20th of May 2020 until the 20th of June 2020, a Germany-wide online survey on the continuing residency training was distributed via the members of the working group, social media (Facebook, Twitter, Instagram) and the German Society of Residents in Urology (GeSRU e.V.) newsletter. The survey covered 3 topics: 1) basic characteristics of the participants, 2) general and 3) subjective influence of the COVID-19 pandemic on clinics and further residency training. RESULTS A total of 50 residents took part in the survey; 54% were women. The median age was 31 years. Most of the participants were in their 2nd (22%) and 5th (26%) year of training and worked in a university hospital (44%) or in a clinic of maximum care (30%). 38% of the respondents stated that they only served urological emergencies during the COVID-19 pandemic. For 28% this meant a very large delay (80-100%) in the specialisation, while 28% stated only a minor impact. 66% documented training impairments caused by fewer operations, low patient numbers in the outpatient department (50%), congress (50%) and workshop (44%) cancellations. 46% of residents reported direct contact with COVID-19 patients while 10% were deployed on interdisciplinary IMC units. Numerous physical distancing and hygiene measures have been implemented by the clinics. CONCLUSION On average, around 50% of the urology residents indicated significant restrictions in training due to the COVID-19 pandemic in Germany. The delay in training cannot currently be measured in units of time, but it can be assumed that training for residents during the pandemic is likely to be of a lower quality compared to previous generations.
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Affiliation(s)
- Cem Aksoy
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - Philipp Reimold
- Urologische Universitätsklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hendrik Borgmann
- Klinik und Poliklinik für Urologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Mara Kölker
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Cebulla
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Julian Peter Struck
- Klinik für Urologie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
| | - Viktor Zehe
- Klinik für Urologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Tim Nestler
- Klinik für Urologie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | | | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Katharina Boehm
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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Meta-analysis of effort–reward imbalance prevalence among physicians. Int Arch Occup Environ Health 2022; 95:559-571. [DOI: 10.1007/s00420-021-01784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022]
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Arnold H, Fassbach M, Mattigk A, Zehe V, Beck A, Wundrack F, Bellut L, König J, Siech C. [Training and work conditions of residents in urology in Germany : Results of the second German Society of Residents in Urology e. V. (GeSRU) residency survey from 2020]. Urologe A 2021; 60:1025-1034. [PMID: 34259878 PMCID: PMC8278189 DOI: 10.1007/s00120-021-01608-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Residency is the fundation for high-quality medical care and also for career development of young urologists. In 2015 the GeSRU (German Society of Residents in Urology) carried out the first nationwide survey among young physicians in urology and described the status quo of their residency. This revised follow-up examination draws an updated picture of the training and working conditions of residents in urology and assesses the development. METHODS In 2020 the GeSRU conducted an online-based survey of all residents in urology; therefore, the 2015 questionnaire was expanded. The model of the professional gratification crisis was used again. RESULTS A total of 332 questionnaires were analyzed. Major findings have not changed since 2015. The daily working routine is characterized by high pace and workload and economic considerations. Family- and research-friendly working conditions are largely lacking. 35% of the respondents draw professional consequences. The psychosocial strain remains very high and conveys a risk for physicians' health and patients' quality of care. CONCLUSION These results demonstrate that there are still systemically immanent burdens for residents in urology, which require adjustments to the working and training conditions. A structured, transparent curriculum for urological residency, remuneration and time for training and models which enable work-life balance should be established.
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Affiliation(s)
- H Arnold
- Facharztpraxis, Urologie Dr. Hannah Arnold, Gesundheitszentrum Senden, Hauptstraße 11 c, 89250, Senden, Deutschland.
| | - M Fassbach
- Klinik für Urologie, urologische Onkologie und Kinderurologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - A Mattigk
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - V Zehe
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - A Beck
- Klinik für Urologie, Katholisches Marienkrankenhaus Hamburg, Hamburg, Deutschland
| | - F Wundrack
- Klinik für Urologie, Helios Klinikum Berlin-Buch, Berlin-Buch, Deutschland
| | - L Bellut
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J König
- Klinik für Urologie, Asklepios Stadtklinik Bad Tölz, Bad Tölz, Deutschland
| | - C Siech
- Klinik für Urologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
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Pfister D, Bündgen M, Schmautz M, Hartmann FH, Heidenreich A. [Influence of the working model on the education of young urologists : Education through the ages]. Urologe A 2021; 60:1432-1439. [PMID: 34170359 DOI: 10.1007/s00120-021-01572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a trend of increasing discontent of urologic residents with educational programs. One point being mentioned is lack of time during residency for education and self-training. We analyzed the available time for education in our department depending on the used working model through the last 25 years. MATERIALS AND METHODS We calculated the absolute availability of residents during their residency for working models in 1996, 2000, 2007 and 2017. As a basis we used the working model of 1996 as no compensatory time-off for being on call was used. All days on which a delayed start is planned and no schedule in daily routine is possible had been excluded from education time. The numbers implemented in the regulation on further education in the corresponding years had been used to calculate the expenditure of time on the basis of median length of the different intervention. In addition, the patient numbers on the ward and our outpatient clinic had been documented over time. RESULTS With increasing patient numbers in the in- and outpatient clinic there is a continuous decreasing time available for education. The absolute available time in our department is calculated to be 3.1 years compared to 5 years in 1996. With the first day of training a resident has to complete 66.9 min of self-contained diagnostics or interventions per day in addition to clinical routine and administration to meet the requested numbers of the regulation on further education. CONCLUSIONS The limited time being available for the educational program is improved by the current regulation of education. To teach the complex segments of urology there is an urgent need for a well-structured curriculum, which should be used nationwide.
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Affiliation(s)
- D Pfister
- Klinik für Urologie, Uroonkologie, spezielle urologische und roboter-assistierte Chirurgie, Kerpener Str. 62, 50937, Köln, Deutschland.
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9
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[Work within the statutory healthcare system today and tomorrow]. Urologe A 2021; 60:1001-1005. [PMID: 34142168 DOI: 10.1007/s00120-021-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
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Abstract
When a pregnancy is announced, the normal working day is transformed for the urologists concerned. For fear of legal consequences, pregnant employees are still hardly allowed to operate. However, the new provisions of the Maternity Protection Act do not fundamentally exclude pregnant urologists from working and operating. Why do hospitals nevertheless allow such a deplorable state of affairs, which endangers the daily work routine and makes further training of pregnant urologists more difficult?
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Arnold H, Beck A, Mattigk A, Himmler M, Harke NN, von Ostau N, Necknig UH. [Working pregnant in urology! : Assessments by chief physicians and presentation of liability risks]. Urologe A 2021; 60:746-752. [PMID: 33783583 PMCID: PMC8008331 DOI: 10.1007/s00120-021-01504-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES In Germany, approximately 1500 female physicians become pregnant each year. This also applies to urologys. The announcement of a pregnancy is often met with ignorance and unanswered questions by chief physicians and colleagues. The aim of this study is to clarify how urological chief physicians assess the current situation and to present liability risks versus health risks. MATERIALS AND METHODS From July to October 2019, an anonymous online questionnaire was sent to 340 chief physicians by the Working Group Young Urologists of the German Society of Urology (DGU). The questionnaire asked about the risk assessment of the workplace, the timing of a pregnancy announcement, and the employment possibilities of pregnant employees in urology. In addition, a law firm was commissioned to prepare a brief legal opinion on the topic of medical work and surgery during pregnancy with specific reference to the field of urology, including any liability risks. RESULTS In all, 62 chief physicians participated in the survey (18.2%): 93.5% of the respondents considered an anticipatory risk assessment of the workplace for pregnant women to be useful; 82.3% would appreciate an overlapping recruitment by the employer. Respondents (62.9%) were skeptical of pregnant employees operating. Taking into account the regulations of the Maternity Protection Act, the liability risk does not exceed that which the employer generally has to bear. CONCLUSION The amendment of the Maternity Protection Act has not fundamentally changed the reality for female urologists. However, the individual risk assessment provides an opportunity to develop concrete protective measures-also for the operating room-with the employer. The aim must be to provide pregnant women with greater support in asserting their rights in the future.
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Affiliation(s)
- H Arnold
- Urologie Arnold, Urologische Facharztpraxis, Senden, Deutschland
| | - A Beck
- Klinik für Urologie, Katholisches Marienkrankenhaus, Hamburg, Deutschland
| | - A Mattigk
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Himmler
- Klinik für Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - N N Harke
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - N von Ostau
- Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie, Universitätsklinikum Essen, Essen, Deutschland
| | - U H Necknig
- Abteilung für Urologie und Kinderurologie, Klinikum Garmisch-Partenkirchen GmbH, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland.
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Michel MS, Himmler M, Necknig U, Kriegmair M, Speck T, Fichtner J, Steffens J, Borgmann H, Bolenz C, Tuellmann M, Ruppin S, Petersilie F, Rebmann U, König J, Westphal J, Goebell P, Leyh H, Borchers H. [Certified residency curriculum for the specialization training in urology from the German Society of Urology according to the 2018 Training Regulations (version of 20. September 2019)]. Urologe A 2021; 59:135-140. [PMID: 33141266 PMCID: PMC7721681 DOI: 10.1007/s00120-020-01367-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - M Himmler
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - U Necknig
- Abteilung für Urologie und Kinderurologie, Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - M Kriegmair
- Urologische Klinik München Planegg, Germeringer Str. 32, 82152, Planegg, Deutschland
| | - T Speck
- , Treskow Allee 103, 10318, Berlin, Deutschland
| | - J Fichtner
- Klinik für Urologie, Johanniter-Krankenhaus Oberhausen, Steinbrinkstraße 96a, 46245, Oberhausen, Deutschland
| | - J Steffens
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - H Borgmann
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M Tuellmann
- , Dr.-Henkel-Str. 2, 85435, Erding, Deutschland
| | - S Ruppin
- , Friedrichstr. 94, 10117, Berlin, Deutschland
| | - F Petersilie
- Deutsche Gesellschaft für Urologie, Martin-Buber-Str. 10, 14163, Berlin, Deutschland
| | - U Rebmann
- , Große Nikolaistr. 1, 06108, Halle, Deutschland
| | - J König
- Abteilung für Urologie, Asklepios Stadtklinik Bad Tölz, Schützenstraße 15, 83646, Bad Tölz, Deutschland
| | - J Westphal
- Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland
| | - P Goebell
- Urologische und Kinderurologische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, 91054, Erlangen, Deutschland
| | - H Leyh
- Abteilung für Urologie und Kinderurologie, Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - H Borchers
- Deutsche Gesellschaft für Urologie, Martin-Buber-Str. 10, 14163, Berlin, Deutschland
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Bahmer T, Wälscher J, Fisser C, Groth EE, Schreiber T, Koch M, Raspe M. [Young Respiratory Physicians in Germany - Current Situation and Future Perspectives]. Pneumologie 2021; 75:761-775. [PMID: 33853133 DOI: 10.1055/a-1397-6275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Demographic changes in the society and among doctors, as well as changing attitudes towards and norms of how living should be structured are creating challenges regarding the organization of work environment in the hospital. In addition, organization of medical training is increasingly being influenced by economic considerations as well as a high level of medical specialization. We asked young respiratory physicians how they assessed their current situation with respect to quality of medical training and organization of their work environment. METHODS From September to November 2019, we performed an online survey adressing young respiratory physicians in Germany. Participants were recruited via three emails (baseline and reminders after 2 and 6 weeks) sent by the German Respiratory Society (DGP) and the German Union of Pulmonologists (BdP). The questionnaire consisted of a maximum of 62 questions. Apart from own questions that had been aligned with other questionnaires from similar surveys in other medical specialties, we also assessed the effort-reward ratio (ER ratio) based on the short version of the effort-reward imbalance questionnaire (16 questions). RESULTS We recuited n = 224 participants (33.8 ± 4.5 years, 5.4 ± 2.9 years of medical training, 54.4 % female , 86.8 % with German nationality). A little under half of the interviewees (n = 103, 46 %) reported to be very or generally satisfied with their working conditions, while n = 60 (27 %) were unsure. The main reasons for not being satisfied were long working hours and high work-load, as well as a lack of streamlining the work environment in the hospital to the specific needs of doctors. Despite the fact that many participants were satisfied, a large majority (n = 166, 88.2 %) depicted an unfavorable effort-reward ratio imbalance (adjusted mean 1.89 ± 2.18). CONCLUSION Compared to many other European countries and internationally, the German healthcare system offers high-quality patient care and a well-equipped work environment. Increasing demands in the health care sector, however, are leading to a gratification crisis that not only harms the health and work performance of doctors but is also leading to reduced attractiveness of the job that might possibly lead to the search for new fields of activity or migration. Respiratory medicine is a discipline of growing interest and motivating young doctors to secure the promotion of this discipline is increasingly important. Factors harming the growth of this discipline should be immediately addressed. The results of this survey might help leaders in the field to restructure the work environment and medical education according to the actual needs.
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Affiliation(s)
- T Bahmer
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Medizinische Klinik I, Abteilung für Pneumologie, Kiel.,Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL)
| | - J Wälscher
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Zentrum für interstitielle und seltene Erkrankungen, Essen
| | - C Fisser
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - E E Groth
- Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL).,LungenClinic Grosshansdorf, Pneumologie, Großhansdorf
| | - T Schreiber
- Krankenhaus Bethanien gGMBH, Klinik für Pneumologie und Allergologie, Solingen
| | - M Koch
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - M Raspe
- Charité - Universitätsmedizin Berlin, Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin und des Berlin Institute of Health, Medizinische Klinik m. S. Infektiologie und Pneumologie, Berlin
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Arbeitsbelastung und Arbeitszufriedenheit rechtsmedizinisch tätiger Ärztinnen und Ärzte. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund und Ziele
Das Fach Rechtsmedizin unterscheidet sich strukturell und inhaltlich sehr von anderen medizinischen Disziplinen. Da zu Arbeitsbelastung und Berufszufriedenheit der Rechtsmediziner*innen im deutschsprachigen Raum bislang wenig bekannt ist, wurden diese Aspekte über eine Online-Befragung untersucht.
Material und Methoden
Der Fragebogen wurde im September 2019 online an 436 rechtsmedizinisch tätige Ärzt*innen verschickt. Er enthielt je nach Antwortverhalten der Teilnehmer bis zu 53 Fragen zu den Themen Arbeitsbelastung und -zufriedenheit, Weiterbildung, Karriere, Forschung, Beruf vs. Privatleben und Generationenwandel. Die psychosoziale Arbeitsbelastung wurde anhand des Modells der beruflichen Gratifikationskrisen überprüft.
Ergebnisse
Von 199 bearbeiteten Fragebogen waren 181 vollständig ausgefüllt und konnten ausgewertet werden. Der Großteil der Befragten war zufrieden mit der Routinetätigkeit. Die Hälfte der Weiterbildungsassistent*innen (WBA) war zufrieden mit den institutsinternen Weiterbildungsbedingungen. Nur etwas mehr als ein Drittel der Befragten war zufrieden mit der wissenschaftlichen Tätigkeit; die Hälfte der befragten Ärzt*innen forschte aktiv. Die psychosoziale Arbeitsbelastung war bei einem mittleren ER-Quotienten von 1,24 insgesamt eher hoch. Es zeigten sich keine Unterschiede bezüglich Arbeitsbelastung und -zufriedenheit zwischen Assistenz- und Fachärzt*innen. Nur wenige WBA strebten eine zukünftige Leitungsposition an.
Diskussion
Die (hohe) psychosoziale Arbeitsbelastung der Rechtsmediziner*innen ist vergleichbar mit anderen medizinischen Fachrichtungen. Die gleichzeitig hohe Arbeitszufriedenheit könnte für eine Inkaufnahme der (Mehr‑)Belastung aufgrund einer hohen intrinsischen Motivation sprechen. Aus den erhobenen Daten lässt sich Handlungsbedarf zur Etablierung optimierter Bedingungen für Forschung und institutsinterne Weiterbildung ableiten.
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Faßbach M, Arnold H, Tischler M. [Young physicians conception of the work situation at the interface between in- and outpatient care]. Urologe A 2020; 59:905-907. [PMID: 32617621 DOI: 10.1007/s00120-020-01254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Faßbach
- Klinik für Urologie, urologische Onkologie und Kinderurologie, Helios Klinikum Duisburg, Wanheimer Str. 167A, 47051, Duisburg, Deutschland.
| | - H Arnold
- Uropraxis Ulm, Gesundheitszentrum Geschwister Scholl Haus, Ulm, Deutschland
| | - M Tischler
- Hautärzte am Markt, Dortmund, Deutschland
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Pfeil A, Baerwald CGO, Sieburg M, Boche K, Kupka TA, Linde T, Heldmann F, Unger L, Oelzner P, Aringer M, Keyßer G. [Future of rheumatologists: what are the perspectives? : Survey of resident physicians in rheumatology in middle Germany]. Z Rheumatol 2020; 79:168-174. [PMID: 31570975 DOI: 10.1007/s00393-019-00713-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The work environment for rheumatologists has significantly changed over the last years. The healthcare of patients with rheumatic diseases is at risk due to the age structure of specialized rheumatologists in middle Germany and the limited availability of training positions for rheumatologists. In this context, it is important to have detailed information on the resident physicians in rheumatology concerning their own visions regarding their future professional career. MATERIAL AND METHODS A questionnaire was sent to resident physicians in 25 rheumatology training hospitals in the middle of Germany (Saxony, Saxony-Anhalt and Thuringia). The questionnaire was completed and returned by 27 participants (17 women and 10 men). RESULTS Most of the participants (60%) aimed to qualify as a specialist in internal medicine followed by a specialization in rheumatology (altogether training for a minimum of 8 years). After finishing training 44% would prefer to work in an outpatient setting while 30% planned to work in a combined outpatient and clinical setting. Of the participants 48% would prefer to work as part-time rheumatologists and 74% (women 94% and men 40%) were interested in employment in an outpatient medical healthcare center. The compatibility of family and work as well as the work-life balance was considered to be highly relevant for the future professional life. CONCLUSION Less than half of the participants intended to work exclusively in an outpatient setting after completing the training in rheumatology. In addition, the participants preferred a part-time employment with compatibility of professional and private life. Consequently, alternative models of employment should be created in rheumatology to be attractive for future physicians. On the other hand, the study revealed that the independent rheumatological practice has a lower priority for the young rheumatologists taking part in this survey.
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Affiliation(s)
- A Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - C G O Baerwald
- Department für Innere Medizin, Neurologie und Dermatologie, Sektion Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Sieburg
- Rheumatologische Facharztpraxis, Domplatz 11, 39104, Magdeburg, Deutschland
| | - K Boche
- Praxis für Internistische Rheumatologie, Dres. Boche, Hamann, Teich, Käthe-Kollwitz-Straße 9, 04109, Leipzig, Deutschland
| | - T A Kupka
- Rheumazentrum Kupka, Johann-Sebastian-Bach-Str. 2, 04600, Altenburg, Deutschland
| | - T Linde
- Rheumatologische Gemeinschaftspraxis Dr. med. Linde, Dr. med. Wagner, Dr. med. Wilke, Ludwig-Wucherer-Str. 10, 06108, Halle, Deutschland
| | - F Heldmann
- Klinik für Rheumatologie, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstr. 101, 09130, Chemnitz, Deutschland
| | - L Unger
- I. Medizinische Klinik, Städtisches Klinikum Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland
| | - P Oelzner
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - M Aringer
- Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Medizinische Klinik und Poliklinik III, Rheumatologie, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
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Analyse von europäischen Weiterbildungskonzepten zum Facharzt für Urologie unter besonderer Berücksichtigung der intersektoralen Weiterbildung. Urologe A 2020; 59:931-940. [DOI: 10.1007/s00120-020-01273-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund
Ziele der Arbeit sind der Vergleich der deutschen Weiterbildung zum Facharzt für Urologie mit anderen europäischen Konzepten, die Analyse lokoregionaler Unterschiede, sowie der personellen Entwicklung der deutschen Urologie in den letzten 5 Jahren. Zudem sollen finanzielle Fördermöglichkeiten für Weiterbildungsassistenten im ambulanten Sektor evaluiert werden.
Material und Methoden
Nach Analyse der neuen Musterweiterbildungsordnung (MWBO) erfolgte die Untersuchung der aktuellen Weiterbildungssituation in Deutschland im europäischen Vergleich. Es wurde eine Trendanalyse der Entwicklung von Personalstrukturen in der Urologie in den letzten Jahren durchgeführt. Zudem wurde ein intersektorales Rotationskonzept entwickelt. Zuletzt wurden finanzielle Fördermöglichkeiten für urologische Weiterbildungsassistenten durch eine standardisierte Telefonbefragung evaluiert.
Ergebnisse
Im Vergleich zu anderen europäischen Weiterbildungsinhalten zeigt sich die positive Sonderstellung der deutschen Urologie mit ihrem enormen Spektrum. In einigen Bundesländern bestehen bereits finanzielle Fördermöglichkeiten für Weiterbildungsassistenten durch die regionalen Kassenärztlichen Vereinigungen.
Diskussion
Während in anderen europäischen Ländern eine einheitliche Weiterbildung auf Staatsebene üblich ist, herrscht in Deutschland durch die Länderhoheit Heterogenität. Durch die Verlagerung vieler Weiterbildungsinhalte in den ambulanten Sektor werden zukünftig Allianzen zwischen Kliniken und Praxen im Sinne der intersektoralen Weiterbildung immer wichtiger werden. Dafür ist die Nutzung bestehender Fördermittel und als Fernziel der flächendeckende Zugang zu solchen Fördermitteln wünschenswert.
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Lermann J, Knabl J, Neimann J, Schulte K, Proske K, Schott S, Raspe M. The work and training situation for young physicians undergoing specialty training in gynecology and obstetrics in Germany: an assessment of the status quo. Arch Gynecol Obstet 2020; 302:635-647. [PMID: 32458131 PMCID: PMC8328906 DOI: 10.1007/s00404-020-05616-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
Abstract
Purpose General conditions in the health-care system in Germany have changed dramatically in recent years. Factors affecting this include above all demographic change, rapid developments in diagnostic and therapeutic options, and the application of economic criteria to the health-care sector. This study aimed to establish the current status quo regarding conditions of work and training for young doctors in gynecology and obstetrics, analyze stress factors, and suggest potential improvements. Methods Between October 2015 and March 2016, a web-based survey was carried out among residents and members of the German Society for Gynecology and Obstetrics. The electronic questionnaire comprised 65 items on seven topics. Part of the survey included the short version of a validated model of professional gratification crises for analyzing psychosocial work-related stress. Results The analysis included a total of 391 complete datasets. Considerable negative findings in relation to psychosocial work pressure, time and organizational factors, quality of specialty training, and compatibility between work and family life and work and academic tasks were detected. A high level of psychosocial work pressure is associated with more frequent job changes, reduced working hours, poorer health among physicians, and a lower subjectively assessed quality of care. Conclusions Greater efforts are needed from all the participants involved in patient care to achieve high-quality training and working conditions that allow physicians to work in a healthy and effective way. These aspects are all prerequisites for sustainably maximizing the resource “physician” and for ensuring high-quality patient care.
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Affiliation(s)
- Johannes Lermann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen,, Germany.
| | - Julia Knabl
- Department of Obstetrics and Perinatal Medicine, Hallerwiese Clinic, Nuremberg, Germany
| | | | - Kevin Schulte
- Department of Internal Medicine IV/Renal and Hypertensive Diseases, Schleswig-Holstein University Hospital, Kiel Campus, Kiel, Germany
| | - Kim Proske
- Department of Obstetrics and Perinatal Medicine, Hallerwiese Clinic, Nuremberg, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Raspe
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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[Taskforce work-life balance-concepts instead of slogans]. Urologe A 2020; 59:484-486. [PMID: 32128631 DOI: 10.1007/s00120-020-01161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
After the Young Urologists' Working Group was founded in April 2018, the taskforce "Work-Life-Balance" was set up. The Working Group deals with the following topics.Most recently, a discussion guideline was developed for requests for part-time or parental leave. The guideline recommends to conduct the interview as soon as possible and in a structured manner. The maximum and minimum goal of working hours should be clearly and transparently defined.The inconsistent regulations on the crediting of absences during continuing medical education in the various federal states are also discussed as a further problem.Currently, the task force "Work-Life-Balance" is conducting and evaluating a survey on the topic of surgery during pregnancy and risk assessment of the workplace for pregnant women.The survey's results are expected to yield recommendations for the clinical practice.
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GeSRU. Urologe A 2020; 59:385-387. [DOI: 10.1007/s00120-020-01138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Necknig U, Wolff I, Bründl J, Kriegmair MC, Marghawal D, Wülfing C, Burger M, May M. Gender-Specific Variations in Professional and Personal Aspects among Senior Urology Physicians at German Centers: Results of a Web-Based Survey. Urol Int 2019; 104:309-322. [PMID: 31715601 DOI: 10.1159/000503869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Senior urology physicians represent a heterogeneous group covering various clinical priorities and career objectives. No reliable data on gender-specific variations among senior urology physicians are available concerning professional and personal aspects. METHODS The objective of this study was to analyze professional perspectives, professional and personal settings, and individual career goals. A Web-based survey containing 55 items was designed which was available for senior physicians at German urologic centers between February and April 2019. Gender-specific differences were evaluated using bootstrap-adjusted multivariate logistic regression models. RESULTS One hundred and ninety-two surveys were evaluable including 29 female senior physicians (15.1%). Ninety-five percent would choose urology again as their field of specialization - with no significant gender-specific difference. 81.2% of participants rate the position of senior physician as a desirable career goal (comparing sexes: p = 0.220). Based on multivariate models, male participants self-assessed themselves significantly more frequently autonomously safe performing laparoscopic, open, and endourologic surgery. Male senior physicians declared 7 times more often to run for the position of head of department/full professor. CONCLUSION This first study on professional and personal aspects among senior urology physicians demonstrates gender-specific variations concerning self-assessment of surgical expertise and future career goals. The creation of well-orchestrated human resources development strategies especially adapted to the needs of female urologists seems advisable.
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Affiliation(s)
- Ulrike Necknig
- Department of Urology and Pediatric Urology, Hospital Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany,
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Bründl
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | | | - David Marghawal
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany
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Arbeitsbedingungen und Gesundheitszustand junger Ärzte und professionell Pflegender in deutschen Krankenhäusern. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 63:113-121. [DOI: 10.1007/s00103-019-03057-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Zusammenfassung
Hintergrund
Tief greifende Veränderungen im Gesundheitswesen haben für junge Angestellte in der stationären Patientenversorgung zu einem stark verdichteten Arbeitsalltag geführt. Vorarbeiten legen eine Gesundheitsgefährdung durch diese Arbeitsbedingungen nahe.
Ziel der Arbeit
Diese Studie hatte zum Ziel, mit einer interprofessionellen Erhebung aktuelle Belastungsfaktoren, deren Konsequenzen und subjektive Verbesserungsbedarfe zu untersuchen.
Methoden
Im September 2017 wurde eine anonymisierte Querschnittserhebung unter Ärzten und professionell Pflegenden bis ≤35 Jahre und mit maximal 6 Jahren Berufserfahrung in der stationären Patientenversorgung durchgeführt. Der Feldzugang erfolgte über sieben teilnehmende Fachgesellschaften und Berufsverbände. Der elektronische Fragebogen enthielt überwiegend validierte Erhebungsinstrumente. Durch Regressionsmodelle wurden mögliche Störfaktoren in die Datenanalyse einbezogen.
Ergebnisse
In die endgültige Analyse gingen 1060 komplette Fälle ein. Die Teilnahmequote lag bei 13 %. Es wurden u. a. zeitliche und psychosoziale Belastungsfaktoren mit überwiegend erheblicher Ausprägung festgestellt. Diese Belastungsfaktoren sind mit einem reduzierten Gesundheitszustand und erhöhtem Burn-out-Risiko sowie einer subjektiv schlechteren Versorgungsqualität assoziiert. Junge Ärzte wünschen sich weniger Dokumentation und eine Reduktion der Arbeitsverdichtung; junge Pflegende erwarten eine leistungsgerechte Bezahlung und festgelegte Personalschlüssel.
Diskussion
Aktuelle Arbeitsbedingungen stellen eine Gesundheitsgefährdung junger Angestellter in der stationären Patientenversorgung dar. Es müssen Rahmenbedingungen geschaffen werden, die den Leistungserbringern nachhaltig ein gesundes und effektives Arbeiten ermöglichen.
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Abstract
Educational research (ER) should be defined as the motivated guidance of residents to be involved and to conduct structured research. ER does not only pursue the goal to promote residents for an academic career but it also concentrates on the improvement of residency in general. Based on the data of national and international studies lack of time, enthusiastic mentors and financial resources represent the most significant obstacles to realize concepts of dedicated ER. The current article highlights options to improving ER with a structured curriculum starting in medical school and extending to board examination and fellowship training. Three staged concepts should be continuously integrated into residency programs: (1) ER to improve individual competence in urology, (2) clinical and patient-oriented ER, (3) ER to realize academic career. Concept 1 includes scholarly aligned M&M conferences, journal clubs, OR workshops, tumor boards, visiting professors. Concept 2 includes the scientific analysis of well circumscribed questions concerning site-specific medical strategies in the context of the current literature. Concept 3 requires continuous and reliable communication between the residents and their mentors. It also requires a well-structured and harmonized strategy to combining the clinical and research education which comprises 5 phases. Eventually, ER curriculum must be integrated into residency programs which can only be realized if the structure of German academic urology is changed from a more or less vertical hierachy to a horizontal hierarchy with clinically and scientifically aligned department structures.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Cebulla A, Bolenz C, Carrion DM, Bellut L. [Urology training in Germany: international comparison of educational concepts and satisfaction]. Urologe A 2019; 58:132-138. [PMID: 30683972 DOI: 10.1007/s00120-019-0854-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The training of residents in urology is challenged by global trends in surgical education, increasing technological developments, subspecialization of the field and working hour regulations for physicians. Currently, there is no standardized curriculum in Europe and significant international differences exist in the education of residents. OBJECTIVES We aimed to comprehensively map the state of urological training in an international comparison. MATERIALS AND METHODS A selective literature review was conducted using the following keywords: "urology, training, residents". RESULTS Recent surveys have shown that urology training in Germany is subject to relatively few regulations on content, time and space when compared to other countries. A lack of a structured curriculum is considered as the main factor leading to dissatisfaction of the residents. Increasing work load, lack of surgical training and limited flexibility in family or research planning have been mentioned as barriers for successful training. CONCLUSION Structured and validated competence assessments and not "minimum numbers of operations" may help improve surgical training. An objective nationwide examination at the end of residency may be useful for international benchmarking.
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Affiliation(s)
- A Cebulla
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - D M Carrion
- Klinik für Urologie, Universitätsklinikum La Paz, Madrid, Spanien
| | - L Bellut
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Heidenreich A, Salem J, Paffenholz P, Pfister D. [Interdisciplinary education in urology: innovations for better training]. Urologe A 2019; 58:870-876. [PMID: 31168674 DOI: 10.1007/s00120-019-0958-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current version of the urology training program will concentrate on the mediation of competences and skills in various fields of action for outpatient urology instead of persisting on the minimum and reference numbers of surgical and diagnostic procedures. However, the following fields of action must be fulfilled: microbiology, andrology and systemic cancer therapy. There is justifiable concern that various institutions will lose their permission for a complete 5‑year residency program based on the above-mentioned demands since not all institutions have all subspecialties in urology. Those institutions need to define new ways of residency training such as interdisciplinary programs within their own institution between disciplines like pediatric surgery, gynecology and medical oncology. Other options are combined training programs between regional urology departments with different main focuses or training programs between institutions and urologists in private practice. There is an unmet need to improve residency training as well as board examinations by new structures and a reliable curriculum. Based on the changed main focuses of the new version of urology training, we need to discuss the future of residency programs. It might be helpful to discuss two different types of urology training with a common trunk for the first three years followed by a more outpatient-based residency training for the general urologist and a more specialized training for the inpatient urologist to be educated in complex treatment modalities. An open mind to broadening our own horizon, respectful discussion with other departments and the development of common, reliable and interdisciplinary contents represent indispensable prerequisites to realize such an innovative future training program.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - J Salem
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Paffenholz
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Pfister
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Necknig U, Borowitz R, Wöhr M, Leyh H, Weckermann D. [How do residents in urology evaluate their daily routine at work-a survey analysis]. Urologe A 2019; 57:1481-1487. [PMID: 29808367 DOI: 10.1007/s00120-018-0674-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The changing conditions in German hospitals is causing a shortage of young people. In order to identify starting point for improvements, the Bavarian association of urologists in collaboration with the German Society of Residents in Urology (GeSRU) conducted an online survey among residents in urology in summer of 2017. MATERIALS AND METHODS A standardised survey composed of 38 questions was distributed to participants through a mailing list of the GeSRU. Most questions were closed-ended; however, some did allow participants to respond by means of an open-ended answer. RESULTS A total of 218 participants provided a total of 11,764 responses: 58% were female and 42% were male. Over 70% were aged between 31 and 35 years. In all, 29% of participants responded negatively to the question asking whether they feel like their medical studies at university prepared them well for the daily routine in their workplace. Participants particularly demanded a higher degree of practical experience during their studies, as well as more teaching of soft skills. In relation to choosing their specialisation, participants considered the intern year and their clinical traineeships as crucial factors. Participants did express appreciation of their field of specialization in relation to the broad range of available treatments, the opportunity of further specialising, the clientele of patients, the opportunity of working in a small team, innovations, and the high possibilities of opening their own medical practice. On a personal level, participants specifically wished for a more structured plan relating to their further internship, involving regular meetings. They also expressed the wish for more personalised career plans, more flexible work hours, and improved advanced training, both internally and externally. CONCLUSIONS With the aim of making urology even more attractive, participants' wishes and suggestions should be taken into consideration. These, in general, involve a more structured training plan, better working conditions with part-time programmes, and improved surrounding conditions at the workplace, in particular for families.
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Affiliation(s)
- U Necknig
- Urologische Klinik, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - R Borowitz
- Urologische Klinik, Klinikum Memmingen, Memmingen, Deutschland
| | - M Wöhr
- Urologische Klinik, Klinikum Rosenheim, Rosenheim, Deutschland
| | - H Leyh
- Urologische Klinik, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - D Weckermann
- Urologische Klinik, Klinikum Augsburg, Stenglinstraße 1, 86156, Augsburg, Deutschland.
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[Attending physicians in urology working at university centers or non-university centers-what are the differences? : Results of a web-based cross-sectional study at German hospitals]. Urologe A 2019; 58:1469-1480. [PMID: 31451840 DOI: 10.1007/s00120-019-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Attending physicians (AP) in urology represent a very heterogeneous group covering various clinical priorities and career objectives. To date, there are no reliable data on professional, personal and position-linked aspects of AP in urology working in university centers (univ-AP) opposed to those working in non-university centers (n-univ-AP). MATERIALS AND METHODS The objective of this study was to analyze individual professional perspectives, professional and personal settings, specific job-related activities and individual professional goals of univ-AP opposed to n‑univ-AP. Thus, a web-based survey containing 55 items was designed to perform a cross-sectional study that was then forwarded using a link which was sent via a mailing list of the German Society of Urology. The survey was available for completion by AP at German urological centers from February to April 2019. Group-specific differences were evaluated using bootstrap-adjusted multivariate logistic regression models. RESULTS Of the 192 evaluable surveys, 61 (31.8%) and 131 (68.2%) were part of the univ-AP and n‑univ-AP study group, respectively. Participating n‑univ-AP compared to univ-AP held the position of AP (p = 0.022) significantly longer and were on call significantly more frequently (p < 0.001). AP in urology (self)-assessed themselves as autonomously confident in performing robotic, laparoscopic, open, endo-urologic, and plastic-reconstructive surgery in 12.4%, 25%, 59.6%, 92.1%, and 25.7%, respectively, with no significant differences between the two groups among all above mentioned surgical subdomains based on multivariate analysis. AP in urology were (very) content in 92% concerning the choice of their discipline, in 73.9% concerning their actual working circumstances, and in 60.2% concerning their level of surgical expertise. Only 27.1% and 19.9% were (very) content with the amount of available time for their personal professional development and for private affairs, respectively. As opposed to n‑univ-AP, univ-AP would choose a career in clinical centers once again significantly more frequently (OR 2.87; p(BS) = 0.041), but assess the position of AP as their definitive career goal significantly less frequently (OR 0.42; p(BS) = 0.40). Univ-AP state significantly more frequently that they were running for the position of head of department or full professor (OR 5.64; p(BS) = 0.001). CONCLUSION In this first survey study world-wide on AP in urology divided according to their academic background, similarities and variances were analyzed, baring the potential to further improve identification of AP for a career in clinical centers.
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[Nationwide survey of postgraduate medical training in clinical neurology]. DER NERVENARZT 2019; 89:1378-1387. [PMID: 29872878 DOI: 10.1007/s00115-018-0547-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Currently, no data are available, which reflect the situation of medical doctors specializing in neurology in German hospitals. In order to secure the high standard of neurological patient care it is essential to evaluate the working conditions and the specialty training in neurology. OBJECTIVE This nationwide survey was conducted throughout Germany with the aim to address problems and to give suggestions for improvements in neurological training curricula. MATERIAL AND METHODS The survey was online from February to May 2017 and 953 neurologists undergoing further training participated. RESULTS More than half of the young neurologists were satisfied with their medical training. One of the main problems that complicates clinical training is the workload. In addition, organizational obstacles within the clinic, such as poor structure of education or a lack of mentors, lead to dissatisfaction among participants. The size or type of the department, as well as the prevailing service system, exert only a minor influence on the quality of specialist training, although there were differences especially in the self-assessment of the participants in connection with the type of department (university hospital versus public or private hospital). CONCLUSION Specialist training in neurology can be improved by simple arrangements, e. g., the introduction of a binding rotation scheme, internal mentoring and structured feedback. In addition, it will be necessary to relieve medical staff of administrative duties in order to create time for training and the learning of competencies.
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König J, Aeishen S, Cebulla A, Bellut L, Fassbach M, Westphal J, Struck JP. Qualität statt Quantität verbessert die Weiterbildung. Urologe A 2019; 58:877-880. [DOI: 10.1007/s00120-019-0987-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Die Arbeitszeitbelastung von Fach- und Oberärzten in der deutschen Urologie – eine Bestandsaufnahme. Urologe A 2019; 58:918-923. [DOI: 10.1007/s00120-019-0997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arbeitsbelastung, Arbeitszufriedenheit, Arbeitszeitgesetz – was macht die Urologie? Urologe A 2019; 58:881-884. [DOI: 10.1007/s00120-019-0981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[Urology onLINE-webinar for assistants : Implementation and evaluation of a voluntary, web-based e‑learning training series for urology assistants in continuing education (Urology onLINE)]. Urologe A 2019; 58:658-665. [PMID: 30623215 DOI: 10.1007/s00120-018-0845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The rapid development of new knowledge resources is essential for continuous training and continuing education. Since the training period often coincides with the starting of a family, time resources are often scarce. For this reason, a new, voluntary, web-based e‑learning training series was designed for urological assistants (urology onLINE). We investigated to what extent the offer of a web-based training series is used by urological training assistants and how it is evaluated by participants and speakers. MATERIALS AND METHODS The training series includes a one-month training on a topic from the urological continuing education, which is presented online and whose contents are checked by means of interspersed CME questions. During the investigation period November 2016 to October 2017, participants in the Urology onLINE training series were evaluated. In addition, an evaluation of individual events and an evaluation of the work load of the speakers took place. RESULTS On average, 60 participants participated in the individual events. These were rated very well with an average grade of 1.43 ± 0.21. Two thirds of the participants experienced an active and inquisitive experience during the event. The workload for the speakers was less than that of a comparable classroom event. CONCLUSIONS Overall, the new Urology onLINE training series aims to contribute to the increase in spatial and temporal flexibility, and complements existing training formats, especially in times of scarce time resources.
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Struck JP, Cebulla A, Ralla B, Koenig J. [Structured training curriculum for urological residents: chances and limits]. Urologe A 2019; 58:109-113. [PMID: 30623217 DOI: 10.1007/s00120-018-0847-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Current surveys show that 45% of German urologic residents do not feel sufficiently prepared for their later urologic work, and 85% lack a structured training curriculum in their home institutions. Furthermore, they report a lack of transparency and evaluations as well as economic constraints. This gives reason to revise and adapt the current urologic training curriculum. In the following article we compare the current urologic curriculum with other disciplines and discuss chances and limits of possible future models. These include better definitions of basic training skills, specialization, a structured evaluation system, standardization of exams and room for research.
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Affiliation(s)
- J P Struck
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
| | - A Cebulla
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - B Ralla
- Klinik und Poliklinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Koenig
- Klinik für Urologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
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Wehkamp KH, Naegler H. The Commercialization of Patient-Related Decision Making in Hospitals. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:797-804. [PMID: 29229044 PMCID: PMC5736863 DOI: 10.3238/arztebl.2017.0797] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/18/2017] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospitals must make a profit to ensure their continued existence. The observed rises in case numbers and case-mix indices lead us to suspect that the admission, treatment, and discharge of patients are now being influenced not just by purely medical factors, but also by economic considerations with a view toward making a profit-i.e., that decision-making has become partially commercialized. In this study, we investigated whether doctors and hospital chief executive officers (CEOs) share this perception of their professional environment. METHODS In a qualitative study, doctors and hospital CEOs were interviewed. The survey was carried out in two waves over the period 2013-2016. 22 pilot interviews, 41 guided interviews, 3 focus groups, 1 written expert questionnaire and 1 workshop discussion were conducted. Responses were evaluated according to the "grounded theory" of the social sciences. RESULTS Some of the doctors' and CEOs' perceptions of the patient-care situation differed markedly from each other. The CEOs mentioned the need for a profit orientation and stressed that they obeyed the legal requirement not to have any direct influence on medical decision-making, while acknowledging that physicians' actions might be influenced indirectly. The doctors, on the other hand, reported feeling increasing pressure to consider the economic interests of the hospital when making decisions about patient care, leading not only to overtreatment, undertreatment, and incorrect treatment, but also to ethical conflicts, stressful situations, and personal frustration. CONCLUSION The doctors' responses indicate that the current economic framework conditions and the managers of hospitals are currently influencing medical care to the detriment of the patients, physicians, and nurses. It is important to acknowledge that economic pressure on hospitals can undermine the independence of medical decision-making. The dilemmas facing doctors and hospital CEOs should be openly discussed. The economic framework conditions and steering concepts should be changed as suggested by these findings.
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Affiliation(s)
- Karl-Heinz Wehkamp
- SOCIUM – Research Center on Inequality and Social Policy, University of Bremen
| | - Heinz Naegler
- Berlin School of Economics and Law (HWR Berlin), Berlin
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