Medical care centers (MVZs) are emerging in Germany to address the shortage of family doctors, as many practitioners retire without successors. While these centers offer a collaborative environment for specialists and alleviate administrative burdens for physicians, concerns arise over potential profit motives overshadowing patient care. Critics highlight the risk of investor-driven practices prioritizing profitability. Government efforts are underway to regulate MVZs and ensure transparency regarding ownership, as the healthcare system grapples with maintaining quality care amidst these changes.
The Emergence of Medical Care Centers: A Response to Doctor Shortages
As many medical practices face the challenge of finding successors, investors are stepping in to create medical care centers. These centers take over the administrative responsibilities while physicians remain employed. What implications does this trend hold?
Family doctor Luca Lehnig from Cottbus is set to retire at the year’s end, joining numerous other family doctors in the city of 100,000. Due to a shortage of successors, many residents in Cottbus currently lack access to a family physician.
“My son is taking over my practice, but that’s not the case for many of my colleagues,” shares Lehnig, who fields about 20 inquiries daily from patients seeking new family doctors. “We are in a precarious situation,” he notes, describing the overwhelming demand.
What’s occurring in Cottbus mirrors a nationwide issue in Germany. Many baby boomers, including numerous family physicians, are retiring. The Robert Bosch Foundation projects that by 2035, Germany will face a deficit of around 11,000 family doctors.
In response to this crisis, the introduction of a new medical care center (MVZ) in Cottbus is being prioritized. The city is actively supporting the necessary construction applications.
However, the Brandenburg Medical Association has raised alarms over the proliferation of MVZs, expressing concerns that profit motives may overshadow patient care.
Understanding Medical Care Centers
A medical care center (MVZ) is an outpatient facility where a variety of medical specialists collaborate under one roof. Established in 2004, these centers were designed to enhance the flexibility and efficiency of outpatient care.
Interestingly, the ownership of an MVZ doesn’t have to rest solely with medical professionals. Hospitals, municipalities, and non-profit organizations can also hold ownership. The National Association of Statutory Health Insurance Physicians reports a notable rise in MVZs over recent years, particularly in regions like Bavaria and North Rhine-Westphalia.
Currently, Germany boasts over 4,800 MVZs with more than 30,000 practicing doctors, predominantly structured as limited liability companies (GmbH).
The situation on the North Sea island of Amrum highlights a critical need for improved medical services.
Benefits and Drawbacks for Patients
Patients ideally enjoy the convenience of ‘one-stop’ care, eliminating the need for extensive travel to see different specialists and reducing referral hassles. In regions with fewer resources, MVZs can ensure that patient care is maintained, particularly in rural areas where specialist availability is often limited.
However, a potential drawback is that the doctor-patient relationship in an MVZ may lack the personal touch found in traditional practices where a single doctor has established long-term relationships with patients.
The Appeal of MVZs for Doctors
An increasing number of medical students are choosing not to open their own practices or work in hospitals, including those with demanding shift work and overtime. Many prefer the structure of an MVZ, which offers a healthier work-life balance.
Additionally, employed physicians are shielded from financial risks associated with starting a practice, which can be costly and fraught with entrepreneurial uncertainties. However, this employment comes with certain limitations, as doctors must adhere to the MVZ’s operational guidelines.
In Germany, physicians also find they have less time for patient consultations compared to their counterparts in many other European nations.
Criticism of MVZs
MVZs have faced criticism for being increasingly acquired or established by private investors, raising concerns over the prioritization of profit over patient care.
For instance, the Brandenburg State Medical Association has expressed concerns that private equity firms are purchasing small practices and transforming them into larger, profit-driven units. This shift raises fears that patients may not receive optimal care but rather the most profitable or unnecessary treatments. “This trend adversely affects the already strained outpatient care in rural regions,” warns President Frank-Ullrich Schulz.
The National Association of Statutory Health Insurance Physicians in Bavaria sought to investigate further and conducted a billing analysis. The findings indicated that investor-owned MVZs bill for significantly more services. For instance, in family medical care, MVZs in Bavaria reported nearly 20% more co-care services billed compared to individual practices.
As the government tackles hospital reforms, the traffic light coalition has been engaged in this crucial discussion, with legislation recently passed by the Bundestag.
Government Actions and Future Directions
In 2022, Health Minister Karl Lauterbach announced plans to draft legislation aimed at curbing the encroachment of profit-driven entities into medical practices. The Greens have also pushed for stricter regulations but faced opposition from the FDP.
State governments have long advocated for tighter controls on investor-operated MVZs, yet a proposed Federal Council initiative for regulation did not succeed. States like Bavaria, Rhineland-Palatinate, and Schleswig-Holstein suggested creating an MVZ register and implementing a requirement for transparency regarding ownership.
This proposed signage would clarify the operator and owner of each care center, addressing the often opaque ownership structures. Additionally, discussions included measures to prevent monopolistic tendencies, restricting hospitals from establishing MVZs within a 50-kilometer radius of their facilities.
Lauterbach’s legislative proposal has now been submitted to the Bundestag for further consideration, with experts raising concerns about the potential risks to patient care posed by non-medical investors.
This important topic will be covered by MDR Thüringen – The Radio on December 8, 2024, at 6:00 PM.