[Competition among office-based physicians and hospitals: implications for the office-based physician].

Our healthcare service system which used to have a strictly sectoral structure experiences a radical change. Office-based specialists cannot any longer rely on the fact that they have exclusive responsibility for the ambulatory treatment of patients. In the past years the legislator has melted the strict separation between hospital treatment and ambulatory care. Finally the establishment of medical service centres (MVZ) and the opening of hospitals for highly specialized services and the treatment of special diseases relating to the Fifth Book of Social Code, Para. 116 b, (SGB V) have dramatically changed the position of office-based specialists. The legislative measures aim at eliminating the so-called "double specialist track2 (doppelte Facharztschiene)". So far no satisfying solution to this new conflict has been found.