Bestandsaufnahme und Perspektiven der ambulanten rheumatologischen Versorgung in Deutschland

[Rheumatology in private practice: yesterday-today-tomorrow]

Rheumatologic practices were still rare in the early 1990s and rheumatologic treatment took place mainly in the rheumatology clinics and university rheumatology clinics. In the following decades, the number of the rheumatologists in private practices increased and in the year 2004 about two thirds of the outpatient care were already carried out in private practices. In 2020 a total of 597 rheumatologists out of 1106 nationwide worked in private practices, including 203 who were employed. Since 2008, the number of rheumatologists in medical care centers increased more than the number of rheumatologists in private practice. In 2020 only 75% of panel rheumatologists in private practice were in full-time employment. This development to an altered work mentality of the incoming generation and an age structure in which approximately 30% of panel rheumatologists are older than 60 years, threatens a further deterioration of the anyway insufficient outpatient care. In contrast, there are developments that strengthen the outpatient care especially in practices, such as the outpatient specialist medical care and quality-oriented selective contracts as well as rheumatological and immunological laboratory diagnostics. These cornerstones give rheumatology a special position in the panel medical care within the group of specialties in internal medicine and an attractive economic basis. In addition to the medically and scientifically interesting discipline, this could be a further incentive for young trainees to choose rheumatology as a specialty and working in a private practice.

[Outpatient rheumatologic treatment in Germany]

Outpatient rheumatologic treatment in Germany is managed by rheumatologists in private practice (n = 557), by authorized rheumatism outpatient centers (n = 116), by rheumatism centers according to §116b (n = 43) and by university outpatient departments. A total number of 975 rheumatologists were registered by the end of 2012 of whom approximately 830 were active in outpatient care. With this number of rheumatologists Germany is in the middle range in comparison to eight industrial nations including the USA. This number is not sufficient to provide adequate medical care and the consequences are too long waiting times for an appointment with a rheumatologist. Statistical data of the Kassenärztliche Bundesvereinigung (KBV, National Association of Statutory Health Insurance Physicians) showed 688,000 general insurance patients with rheumatoid arthritis (RA). As some 68.9 % of the population are in this insurance scheme there are some 770,000 RA patients in Germany (almost 1 % of the population). One way to improve rheumatology care in spite of the lack of rheumatologists could be special agreements with the general health insurance providers to improve cooperation and division of responsibilities between rheumatologists and general practitioners, to implement patient education, tighter control and treat to target in rheumatology care. Another way could be a new treatment level called "ambulant specialist care", with no budget for medical care and no budget for the number of patients treated and therefore the chance for rheumatologists to treat more patients and have a better income. To achieve that more young doctors receive approval as a specialist in rheumatology, more chairs of rheumatology at universities and a nationwide stipendium for training assistants are needed.

[Updated results of a survey on outpatient healthcare structures in rheumatology]

AIM

the aim of this study was to give an update on outpatient healthcare structures in rheumatology in Germany.

METHODS

a survey among the members of the German Association of Rheumatologists was carried out via a self-developed questionnaire, followed by a detailed descriptive and explorative statistical analysis. Contents of the questionnaire focussed on data concerning the practice, structure of the patients with regard to different indications and therapies, structure and quality of healthcare services provided, quality assurance and the economic situation of the practice as well as a subjective assessment of the outpatient healthcare environment. This approach is similar to the first survey conducted in 2005.

RESULTS

compared to the findings from the first survey in 2005 no significant changes could be found in many areas. As this may intuitively sound disappointing it must be stated that high positive levels maintained in some areas, which cannot be taken for granted, can also be counted as success. With respect to the structure of services provided and medical therapies, a further upward trend could be observed. Topics which were assessed for the first time dealt with communication with healthcare insurers and teaching of rheumatology as a discipline in hospitals.

CONCLUSIONS

rheumatologists in Germany offer a broad spectrum of different services and actively make use of quality assurance measures in the daily practice. The communication with general practitioners and the training of new rheumatologists in the future remain an area of concern and need to be addressed.