Gigou Sophie, Corazza Laura, Fett Sandra, Tauscher Martin, Gerlach Roman, Donnachie Ewan, Schneider Antonius
Institut für Allgemeinmedizin und Versorgungsforschung, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
KVB, Kassenärztliche Vereinigung Bayerns, München, Germany.
Gesundheitswesen. 2024 Dec;86(12):803-813. doi: 10.1055/a-2328-4088. Epub 2024 Jul 16.
Although the number of places at medical schools and physicians in Germany has increased continuously over the past 25 years, there is a threat of a shortage of physicians. Based on data from the Bavarian Medical Association (BLÄK) and the Association of Statutory Health Insurance Physicians of Bavaria (KVB), an analysis of the number of physicians in Bavaria over a longer period of time was carried out in order to understand current developments and possible starting points for the future organization of medical care. The figures were analyzed with regard to the distribution of physicians by outpatient and inpatient sector as well as with regard to the development of the number of employees, the scope of employment and the gender distribution in the outpatient sector.
Data were taken from the annually published and systematically compiled numbers of physicians from the BLÄK (2000 to 2022) as well as the outpatient billing data of practicing and employed physicians in Bavaria (2010 to 2022), processed by the KVB. Descriptive analyses were performed.
Since 2000, the number of physicians in Bavaria has risen by 83% in the inpatient setting and by 35% in the outpatient setting. As a result, more physicians have been working in hospitals than in outpatient care since 2010. In the outpatient setting the trend is moving away from establishing one's own practice and full-time work towards salaried and part-time employment. Employed physicians have lower average working hours than self-employed physicians. The proportion of women among physicians has steadily increased, with female physicians more likely to be employed and working part-time compared with male physicians. Nevertheless, part-time employment is also prominent among male physicians in some specialties today.
The trend towards practicing in salaried and part-time positions continues unabated and is represented across all specialties, suggesting that more physicians are needed to maintain the number of working hours over time. In addition to incentives and subsidies, this reality must be taken into account when planning care. At the same time, it is questionable whether increasing medical school places without managing them according to need is the right way to address the shortage of physicians in outpatient care when an ever-increasing proportion of physicians is working in inpatient care.
尽管在过去25年里，德国医学院的招生名额和医生数量持续增加，但仍存在医生短缺的威胁。基于巴伐利亚州医学协会（BLÄK）和巴伐利亚州法定医疗保险医生协会（KVB）的数据，对巴伐利亚州较长一段时间内的医生数量进行了分析，以便了解当前的发展情况以及未来医疗服务组织的可能切入点。对医生在门诊和住院部门的分布数据，以及门诊部门的员工数量发展、就业范围和性别分布数据进行了分析。
数据取自BLÄK每年公布并系统汇编的医生数量（2000年至2022年）以及KVB处理的巴伐利亚州执业和受雇医生的门诊计费数据（2010年至2022年）。进行了描述性分析。
自2000年以来，巴伐利亚州住院环境中的医生数量增长了83%，门诊环境中的医生数量增长了35%。因此，自2010年以来，在医院工作的医生比从事门诊护理的医生更多。在门诊环境中，趋势正从建立自己的诊所和全职工作转向受薪和兼职工作。受雇医生的平均工作时间比自营职业医生短。医生中女性的比例稳步上升，与男性医生相比，女性医生更有可能受雇且从事兼职工作。然而，如今在某些专科中，男性医生的兼职工作也很突出。
受薪和兼职执业的趋势持续不减，且在所有专科中都有体现，这表明需要更多医生才能随着时间推移维持工作时长数量。除了激励措施和补贴外，在规划医疗服务时必须考虑到这一现实情况。与此同时，当越来越多的医生从事住院护理工作时，在不根据需求进行管理的情况下增加医学院招生名额是否是解决门诊护理医生短缺问题的正确方法，这值得怀疑。
