Do you know what a “Verah” is? No? You should know. Verah means “care assistant,” and whether or not your GP practice has one on staff could have a significant impact on your health. So, if you are old and sick.
Verahs are one of several particularly good solutions to address the much-talked about shortage of doctors. These are medical assistants (MFA, formerly: “medical assistants”) who have received extensive further qualifications. They take on routine tasks that the family doctor has previously carried out. This is not a future scenario, they are among us, there are now 15,000 of them.
Verahs periodically call chronically ill patients to inquire about their condition. They make home and nursing home visits, treat the wounds of diabetes patients, carry out blood tests, blood pressure checks, vaccinations – everything that MFAs do in practices. The only difference is that the family doctor is usually solely responsible for home visits – even though he has enough to do. That’s why my own family doctor hasn’t provided nursing care for years. This is not a forward-looking path.
Many Verahs specialize – for example in wound care, home care for the dying, dementia or burnout. Some complete postgraduate courses and then take on even more responsibility – of course for significantly higher earnings. Four such specialists work in the large practice of family doctor Susanne Bublitz from Pfedelbach near Stuttgart. She believes: “With career opportunities like these, we can also attract female graduates with good secondary school qualifications to this profession.” Anyone who comes to Pfedelbach with routine problems such as coughing, runny nose, hoarseness or gastrointestinal problems is first directed to one of her assistants, who then decides together with the patient how to proceed. This means Bublitz has more time for the really complex cases, she says. An employee who is studying to be a doctor’s assistant in Cologne carries out ultrasound examinations on her own, and Bublitz then just stops by for a quick check.
It’s not possible, you say, can only the doctor do it? If you think like that, you will be speaking from the hearts of many MPs at the 2024 Medical Day. Because there is little that the medical profession is more afraid of than losing supposedly core medical tasks. No matter how great the shortage of doctors is. Two words scare them: the “delegation” of medical tasks, which could all too easily become a “substitution.” In other words: MFA and nursing staff with academic degrees could replace them to some extent, especially now that many of them see the possibilities of AI less as an opportunity than as a threat.
The family doctor Bublitz, together with other general practitioners, submitted several applications for voting at the Doctors’ Day, which, among other things, concern the delegation of medical tasks to MFA. One came through: an application to expand “family doctor-centered care” (HzV). The concept stipulates that patients voluntarily agree to consult their family doctor first for almost all health questions – before they go to a specialist.
Such a concept, which is essentially based on the delegation of medical tasks, could work, as the example of Baden-Württemberg shows. The “HzV” was widely established there 15 years ago in selective contracts between health insurance companies and doctors. An interim report from the university hospitals in Frankfurt and Heidelberg showed how much the participating diabetics benefited: They experienced 11,000 fewer serious complications such as strokes, blindness, kidney damage or amputations than comparable patients in standard care. For every 1.78 million insured people, there were 27,000 hospital admissions and 125,000 fewer hospital days.
Although the statutory health insurance companies also recognize these successes, it is doubtful that Baden-Württemberg could become a blueprint for Germany. “The contracts there were concluded voluntarily, and they are supplemented by other specialist programs,” says a spokesman for the AOK federal association.
In addition to “family doctor-centered care,” there are even more revolutionary concepts to combat the shortage of doctors that would take more of the burden off doctors’ shoulders. We are talking about “primary care centers”, as the federal government was planning until recently. There are award-winning, internationally known flagship projects such as the Veddel Polyclinic, which was founded in a district of Hamburg after there were no longer any statutory health insurance doctors. It is a grassroots, democratically organized collective in which all health professionals work on an equal footing, including doctors, physiotherapists, psychologists, nurses, social workers, midwives and volunteers. A vision that the SPD, Greens and FDP formulated in the coalition agreement went beyond this concept – there was talk of “integrated health centers” in which patients with diabetes or high blood pressure could also be hospitalized for a few days without the expensive logistics of a large hospital would be necessary.
Many experts are convinced that primary care centers are a solution to the big question of how health remains affordable. Germany already has one of the most expensive healthcare systems in the world. Almost 500 billion euros recently flowed, 12.9 percent of gross domestic product. Only the USA and Switzerland spend more.
Primary care centers were one of the heart projects of Health Minister Karl Lauterbach and were part of the draft bill for the “Health Care Strengthening Act” until March 2024. In the April version now being voted on, they mysteriously disappeared.
It can be assumed that the lobbying of the medical profession was effective here. In any case, German Medical Association President Klaus Reinhardt welcomed the deletion of the primary care centers. When asked by Stern, he admits that such concepts are promising, but too complex given the legislative period that is coming to an end. There are 15 unrealized legislative projects on Lauterbach’s table. “I’m afraid that nothing will come of it.”
So it is not surprising that the proposal for the greatly scaled-down concept of “family medical primary care centers,” which Bublitz also launched, also failed in the vote at the Doctors’ Day. The very word seems to scare doctors.
So we continue to wait for the big breakthrough: for the real “turning point” in the healthcare system, which the highly ambitious, but so far unsuccessful Lauterbach once again invoked at the Doctors’ Day.
