Barth J
J Dermatol. 1998 Dec;25(12):819-20. doi: 10.1111/j.1346-8138.1998.tb02512.x.
In Germany, dermatology has a long tradition as a medical specialization. The first dermatological university departments were established about 120 years ago. From the beginning, venerology was integrated in this field. Today it also covers andrology, allergy, medical cosmetology, mycology, dermatosurgery, phlebology and photodermatology. This broad spectrum more and more gives rise to competition with other medical fields. About 77% (n = 3281) of all German dermatologists (n = 4240 in 1997) work in private practices. The others are employed in clinical departments. The official number of working physicians in Germany in 1997 was 343,556; about 1.5% of them were dermatologists. This means that one dermatologist takes care of 20,000 people. The overwhelming majority of dermatological patients directly contacts the specialist and are not referred by general practitioners (GPs) who comprise about 40% of all German physicians. This is a great advantage over those countries in which patients primarily have to consult the GP. At present, there is a discussion initiated by GPs to change this system in Germany and to reestablish the GP's role as "gatekeeper". Dermatologists together with other specialists are trying to prevent this an to maintain the traditional broad spectrum of German dermatology.
在德国，皮肤病学作为一门医学专科有着悠久的传统。首批皮肤病学大学系大约在120年前设立。从一开始，性病学就被纳入这个领域。如今，它还涵盖了男科学、过敏学、医学美容学、真菌学、皮肤外科、静脉病学和光皮肤病学。这种广泛的领域越来越引发与其他医学领域的竞争。在所有德国皮肤科医生（1997年为4240人）中，约77%（n = 3281）从事私人执业。其余的受雇于临床科室。1997年德国在职医生的官方人数为343,556人；其中约1.5%是皮肤科医生。这意味着一名皮肤科医生要照顾2万人。绝大多数皮肤病患者直接联系专科医生，而非由全科医生转诊，全科医生约占德国所有医生的40%。与那些患者主要必须咨询全科医生的国家相比，这是一个很大的优势。目前，全科医生发起了一场讨论，试图改变德国的这一体系，并重新确立全科医生作为“看门人”的角色。皮肤科医生与其他专科医生正努力防止这种情况发生，并维持德国皮肤病学传统的广泛领域。
