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"The resentment in the practices is huge"

Although the final manual work is still being done in the hallway in front of her door, Irini Panteli, a doctor specializing in plastic and aesthetic surgery and hand surgery, is already welcoming the first patients for consultation.

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"The resentment in the practices is huge"

Although the final manual work is still being done in the hallway in front of her door, Irini Panteli, a doctor specializing in plastic and aesthetic surgery and hand surgery, is already welcoming the first patients for consultation. She brought the laptop on the desk in front of her – treatment chair, syringes for minimally invasive procedures, hygiene products and everything else was already there.

After 15 years with her own practice, she was looking for smaller premises and came across the newly opened coworking floor of Eterno Health GmbH in the city center. The model is aimed at freelance doctors and health professionals who rent space there based on their hourly needs. Hamburg is the first location, Frankfurt and Berlin are to follow. A concept is also being worked on for Harburg, because the need is particularly high in the outskirts because there is a shortage of doctors.

One reason: The hurdles to becoming self-employed as a doctor and setting up your own practice are high. Philip Catalá-Lehnen, part of the founding team of Eterno Health, calculates that orthopedists and trauma surgeons like him would have to invest a good 700,000 euros in premises and equipment alone. "And without knowing whether there are enough patients."

Many colleagues in private practice also get annoyed with "paperwork" after work and on the weekends, and they also have difficulties finding qualified practice staff. The Hamburg Medical Association is also aware of the problems. According to President Pedram Emami, in addition to the financial burden and "excessive bureaucracy", "the question of the compatibility of family and work" is often an argument against having your own practice.

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On Wednesday, around 1,300 of them protested in the rooms of the Hamburg Association of Statutory Health Insurance Physicians (KVH) in Barmbek-Süd. The trigger was the plans of the Federal Health Minister Karl Lauterbach (SPD) to delete the so-called new patient regulation. Thanks to her, contract doctors have had to extend their consultation hours since 2019, take on new patients and in return have received extra remuneration, which is now in the balance.

According to the KVH in Hamburg, four percent more cases could be treated with their help by the end of 2021. Especially in the socio-economically weaker parts of the city, the regulation has ensured more treatment capacities. "The current political plans are jeopardizing what has already been achieved," said KVH CEO John Afful. The state association chairwoman for paediatricians, Claudia Haupt, fears "that many patients - especially in structurally weaker parts of the city - will no longer be able to find a practice".

And the chairman of the meeting of representatives, Dirk Heinrich, who has been an important voice in Hamburg's medical profession since he became head of the vaccination center, described the resentment in the practices as "huge": "Super inflation, super energy prices, super budget - the doctors have to take responsibility for everything.”

Health Senator Melanie Leonhard (SPD) had recently emphasized that Hamburg still had good care compared to other regions. The new patient regulation was “very well controlled” here. “There seem to have been other tendencies nationwide. It is therefore not entirely unjustified that the federal government is putting this regulation to the test," Leonhard continued. But it is still important for metropolitan areas. "That's why Hamburg has also campaigned in the Bundesrat for it to be preserved."

The number of outpatient doctors in Hamburg has increased in recent years - at the end of 2021 there were around 5400, of which 3332 were in private practice. This means that after Bremen, Hamburg has the most employed outpatient physicians in relation to the number of inhabitants and, by definition, there is an oversupply in almost all specialist disciplines. Nevertheless, there are too few practices in some parts of the city.

According to Emami, President of the Medical Association, in order to make the less affluent areas more attractive for resident doctors, “above all they need the certainty that they can operate the practice there economically, and they need space and time for what should be the priority , namely patient care. Daily disputes with the digital infrastructure or remuneration issues tend to be a hindrance.”

For this reason, too, he welcomes the initiative of the citizenship, according to which the Senate should examine whether and how the KVH can operate practices itself for a transitional period. "This offer could make it easier for many colleagues to take the step into self-employment, because they can then better assess the entrepreneurial risk of self-employment in underserved or supposedly less attractive parts of the city," Emami is convinced.

In an application by the Greens and SPD to “secure practice locations and improve outpatient care in underserved districts together with the Hamburg Association of Statutory Health Insurance Physicians” it says: “The KVH’s own facilities can be an important step towards the commercialization of the outpatient healthcare system by taking over practice seats counteract this through profit-oriented private equity companies in Hamburg.”

For private patients and self-payers, there are often better ways to get appointments with specialists quickly with private and weekend consultation hours set up especially for them. However, around 87 percent of Hamburg's residents have statutory health insurance. Eterno Health founder and CEO Maximilian Waldmann wants to reach exactly them with his new coworking concept: "We want to show that health insurance can also be 'high level' if you share the costs."

On 2000 square meters, furnished with lots of wood and light colors, various disciplines are under one roof, there is a coffee bar in the waiting area, areas for physiotherapy and yoga, an operating room for minor procedures and a private laboratory. A maximum of 30 percent private consultation hours should be offered. Doctors do not have to take care of receiving, booking, billing and marketing themselves. Around 5,000 euros per month are due for full-time use.

Whether such coworking models, video consultation hours or other digital offers can help solve the misery in the healthcare sector? In any case, Eterno Health says it has no problems finding qualified professionals or patients. According to Emami, however, it is necessary to take a very close look to see whether such models do not reinforce "malfunctions in the healthcare system". For example, because they are only available in economically attractive parts of the city - or doctors "only offer financially lucrative treatments".

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