Striking German Doctors Shed Light on System Ills

On Wednesday afternoon, several dozen physicians stood outside the University Hospital of Cologne, cleaning the windows of stopped cars. The action was meant to show that they are treated more like menial labor than highly trained professionals.

Doctors across Germany went on strike after the state tariff association, which represents university hospital employers, sought to increase the official working week to 42 hours from 38.5. But the physicians' union, the Marburger Bund, argued this would mean a pay decrease in real terms. They demanded a 30 percent wage increase in turn.

Negotiations reached an impasse last week, leading to preliminary strikes that have since grown. Altogether, more than 20,000 M.D.s have stopped work across the country in staggered protest strikes (only non-urgent medical services have been affected so far.) On Wednesday, more than 5,000 white-coated doctors turned up for a massive protest march in Hanover.

Offer 'too bad to take'

According to Rudolf Henke, vice chairman of the Marbuger Bund, accepting the 42 hour-week would mean a real loss to physicians of up to 15 percent of their earnings.

"We know in the end we have to negotiate (over the 30 percent wage increase demand,) but I have to say, the employers’ offer to date is just too bad to accept," Henke said.

Exploratory talks Thursday had failed to bring about a deal, but both sides agreed to further negotiations next week.

The M.D.s also argue that most hospital physicians work way more than 42 hours each week already -- hours they aren’t compensated for. And they complain they are underpaid for on-call shifts, and have steadily lost holiday pay.

"The general public people think doctors earn really well. But when it comes to hospital doctors, that’s not the case," said Roland Teufer, head of anaesthesiology at the Community Hospital of Traunstein in southern Germany. "Clinic doctors generally work a lot of overtime hours, well more than 38.5 hours, and they aren’t paid for it."

Germany: lowest wages

Indeed, a 2004 study by UK economic research group NERA showed German hospital physicians at the rock bottom of a list of 11 western countries in terms of compensation, earning between 35,000 and 65,000 euros ($41,000 to $77,000) per year. A similar OECD study showed German physicians earning 15 percent less than their counterparts in the UK, and 40 percent less than US doctors.

Ulrich Rieger, president of the state tariff association, TdL, says the situation isn’t as bad as it looks. He claims the income earned through billing privately insured patients actually boosts the pay of many hospital doctors. (Doctors reply that this used to be true, but is no longer the case due to changes in insurance and billing.)

Service-based pay?

Meanwhile, Rieger and TdL are proposing a pay system that would reward doctors with better results. "In this system, a doctor who consistently performs a successful operation in two hours would earn more than one who did the same operation in five hours," said Rieger.

Marburger Bund’s Henke said he is not opposed to rewarding certain excellent doctors, but pointed out that such a plan does not address the overall pay disparity issue.

Besides, he asks: "How do you determine what constitutes a good service? Is a good service sitting for a half hour by the bedside of someone who just got a bad cancer diagnosis, or is it doing three ultrasound scans in the same time?"

The physicians' strikes are taking place against a backdrop of widespread labor unrest in Germany: Trash collectors , nurses, maintenance workers and other public servants have been on strike for seven weeks.

So is it hard for the public to feel sympathy with physicians, who are generally seen as a cadre of economic elites?

Perhaps, Henke said. But he added: "We don’t want social pity. It's just that physicians have jobs that are very responsible, difficult, and sometimes dangerous. They require constant advanced training and further eductation, a very very long education period, and that all needs to be fairly compensated."

Long-time problem

The problem with physicians' pay is not recent. "It has been a political problem for the past 20 years, but it's been ignored," Henke said.

Up to the end of the 1990s, a glut of doctors meant the oversupply of labor made it possible for employers to get sweet deals. Today, however, there is a physician shortage. Now, the relatively poor pay and difficult conditions have led to a mini-exodus of doctors fleeing Germany for the UK, Scandinavia and elsewhere.

"In my opinion, Germany's low-qualification jobs are overpaid, so those jobs are going overseas," said Henke. "At the same time, our qualified people earn far too little. That leads to a brain drain of all professionals ... But for physicians it is particularly extreme, because of the capped budgets at state hospitals."

The budgets are the problem, of course: While hospital physicians may well deserve more money, there are those who point out that in its current ecnomic doldrums, Germany has no extra money to throw around.

Demand called 'unrealistic'

The doctors' cause was recently dealt a PR blow when German Health Minister Ulla Schmidt publicly called their 30 percent pay hike demand "unrealistic" and said the parties should sit down and find a solution, fast.

Traunstein Clinic's Teufer pointed out that in places where doctors earn more, the care is either much more expensive, or less extensive, than in Germany.

"The countries that pay their doctors more often have more restrictions on benefits. Patients have to wait longer for treatment -- in Holland you can wait six months for a hip replacement, and here you get it in four to six weeks," he said.

"Germany still tries to provide a lot of its medicine via the state -- and makes it immediately available. That costs a lot, and we don’t have a lot of money available. It is done at the expense of the doctors."