Interview with Dr Hendrik Balonier, Director PPV AG
The shortage of specialists in Germany’s healthcare sector has been the object of constant concern for a number of years. Georg Baum, General Manager of the Deutsche Krankenhausgesellschaft, records a lack of 5000 hospital doctors and almost 4000 general practitioners, calling the situation “a grave problem”. How do you see the extent of this lack of healthcare specialists in Germany?
Dr Hendrik Balonier: The shortage of specialists has been dramatic for some time already, and the situation is still deteriorating. In more rural regions in particular, real coverage seems virtually impossible. We are, for instance, looking for specialists for hospitals in the former East, and staffing those vacancies has proven to be an uphill challenge. One cause for concern is that there are not enough qualified specialists in the operating disciplines, since many doctor’s train for other areas of specialization. The natural result is that we are lacking surgeons. Another issue reinforces this: hospitals are coming under increasing pressure as the competition for medical staff heats up. Many doctor’s have already gone abroad or are moving immediately from their studies to other areas of work far away from hospital life, such as the pharmaceutical industry or public administration.
Which differences can you see between the various service providers, healthcare trusts, or regions? Which specialists are currently in particular demand?
Dr Hendrik Balonier: It is hard for us to reach a definitive judgment. Surgeons and care specialists are indeed in short supply, although this can vary considerably from region to region. The differences between the service providers are not as noticeable. Even public sector institutions try to offer attractive and competitive salaries to the extent that the collective agreements in their sector allow. They have to hold their own in the competition with private hospitals. In this respect, I would like to mention the new conditions in place at university hospitals: with their excellent reputation, they have again become very appealing options. Generally speaking, the entire sector has been regaining its usual attractiveness.
When people discuss the reasons for the current shortages, they often mention the highly complex, broad-ranging, and long training for general or specialist practitioners. The rigid hierarchies and organizational structures at individual service providers is another regular complaint. Does the entire professional culture in the medical profession have to change to attract young people?
Dr Hendrik Balonier: Hospital hierarchies have their roots in the military world and they were modelled to resemble military hierarchy. Assistant or senior physician posts are often not very attractive posts. We also belief that the unusually high barriers that are put in the way of young people who want to study medicine are a problem. They have a deterrent effect and will make school-leavers think twice about this field of study. Another aspect in this respect is the quite rigid curriculum which does not seem to keep pace with the changing and rather diverse nature of modern medical work. Patients now prefer to go to established specialists in the specific discipline they need. For instance, they want their doctors to be particularly skilled with a specific operating method, with a proven track record to give the patient a greater sense of security. This new development means that practical training needs to become a much earlier element of medical degrees to prepare students at a far earlier point for active work as specialist physicians.
What could individual hospitals, teaching hospitals or other healthcare institutions do in practical terms to respond to the shortages? Could the problem be alleviated by introducing more efficient clinical and non-clinical processes?
Dr Hendrik Balonier: We believe that all service providers need to adjust for an internal labour market. Since many doctors are attracted by international opportunities, we also need to go to other markets and respond quickly and flexibly. Just like any modern employer, hospitals should offer relocation services for foreign specialists. Language courses are an option or support for integrating the families of their new recruits. Specifically, this means: go to the market, proactively and in a structured manner, instead of expecting the market to come to you. More flexibility in the remuneration system is one part of this, as are concepts for HR development and training as a way of countering the high rate of fluctuation. If physicians are happy where they are, not least in their private lives, and if they are given internal prospects at the hospital, they can be persuaded to stay at that hospital or that institution. Larger providers have the option of offering their medical staff many interesting positions at different locations. Again, we can take a model from industry: systematic job rotation.
People usually take the shortage of specialists to refer to medical staff alone. But should we not also be speaking about the shortage of executive personnel, if we remember that hospital managers typically earn far less than their peers in the pharmaceutical industry?
Dr Hendrik Balonier: This is not simply a matter of lower salaries: managers used to the private sector will have a hard time adjusting to the highly regulated healthcare sector. Most hospitals, even privatized ones, are still being managed in a very decentralized manner, which makes effective management hard. We anticipate rising salaries in hospital management and we have begun to see some specific qualification and training opportunities for hospital management.
We do not believe that the benchmark should be the remuneration packages of the pharmaceutical industry for the time being, since it also exceeds the average pay of the healthcare sector in general. For example, we see lower salaries offered by health insurances, even though their managers’ responsibilities are as complex as those of managers at pharmaceutical companies.
One final question: which innovative and established HR development concepts are there and when should they be used?
Dr Hendrik Balonier: In the economy at large, succession management has become a major theme (even if not always fully successfully so). The situation is completely different in hospitals: even major institutions tend to appoint their medical directors on an ad-hoc basis, while simultaneously having to follow complex public advertising requirements. Junior physicians should already be given specific prospects, e.g. with job rotation, to help them gain more specialists or leadership skills. At the same time, these skills need to be put to the test, which the high-pressure life at most hospitals does not allow. Other companies are using a whole host of measures, such as training and qualification, executive development, social skills training. At the same time, regular auditing of these skills has become a normal experience, especially for top managers. Soft skills, such as management competence, leadership styles, or social skills, are becoming more and more relevant and play a major role. Hospitals are still, unfortunately, failing to take this into consideration: if their stressful work allows any, most physicians still concentrate their training and development on purely technical aspects of their disciplines.
(Interview in the KPMG Gesundheitsbarometer 2010)