Country’s robust economy has made it a magnet for doctors from crisis-stricken parts of Europe Dr. Tamara Lowe, who is originally from Bahamas, speaks with one of her patients, Harry Schmidt, at the Pleissental Hospital in Werdau, Germany. Dr. Rainer Kobes has traveled hundreds of miles in search of a cure—not for one of his patients, but for the chronic shortage of doctors in this eastern German town. Down seven residents at the 240-bed hospital here, he began heading abroad six years ago—to job fairs in Austria, the Czech Republic, and as far as Bulgaria—to recruit desperately needed staff. Now, 30% of the hospital’s doctors are foreigners, compared with none when he started, though that still isn’t enough. “I said to myself: If I don’t do something now, then I’ll end up here completely alone,” said Dr. Kobes, the hospital’s chief of internal medicine. Even today, he added, chief residents have to take extra supervision duties and some nurses are delegated tasks traditionally done by doctors here, such as administering transfusions. His hospital’s predicament isn’t an isolated case. Like a number of European countries—such as Finland, Denmark, the Netherlands and Sweden—Germany doesn’t have enough of its own doctors. Many leave for better pay in countries such as the U.S., the U.K. and Switzerland, where doctors say less-rigid hospital hierarchies often give them more responsibilities at a younger age. The problem is particularly acute in Germany. Its health care needs are rapidly growing—thanks in part to a population in which 20.8% are 65 and older, more than any European country besides Italy. At the same time, an average 3,000 German doctors have headed abroad for jobs a year since 2010, according to German Medical Association data. The shortage is worse in smaller towns in the former communist east, such as Werdau, where the municipalities that typically finance hospital staff salaries have less cash than those in western Germany. Germany faces shortages in other kinds of highly trained workers—such as engineers and information technology specialists—and has helped fill the gaps with workers from elsewhere in the Europe, especially those from countries with stubbornly high unemployment. Yet few industries grappling with skilled-labor shortfalls have resorted to foreign hiring on as big of a scale as medicine—making medical recruiters the vanguard of German cross-border hiring. The number of foreign doctors in Germany rose 57% in the five years to 2014, according to German Medical Association data, and now make up 10% of all doctors in Germany and 15% of those working in hospitals. Eastern Europeans are at the top of the list of newcomers. So are Greeks, whose six-year debt crisis has driven many of its doctors to search for better opportunities abroad. Germany’s share of foreign doctors is still small compared with countries with higher medical salaries and a longer tradition of luring doctors from abroad: In the U.S. and U.K., for example, roughly a quarter of doctors are foreign nationals or have been trained abroad, and in France, 19% of doctors are foreign-born, according to national medical associations. Few, though, have seen as sharp of an increase in foreign recruits in recent years as Germany, whose relatively robust economy has made it a magnet for doctors from crisis-stricken parts of Europe. “We’ve had markedly good experience with them,” Dr. Kobes said of his hospital’s foreign hires. “Of course, it’s not unproblematic with the language.” After his 2008 appointment as head of internal medicine at the Pleissental Hospital, Dr. Kobes embarked on his first recruiting mission. Armed with a stand, posters, and a PowerPoint presentation, the gastroenterologist toured job fairs and placed adverts in German medical journals, trying to entice doctors to move to Werdau. But the town of 21,700 located in a rural, economically weak region proved a tougher sell than he had envisioned and even after several recruiting trips, he failed to fill his staffing holes. “It’s impossible to get an unemployed doctor to even move from [the German capital] Berlin to the provinces,” Dr. Kobes said. Only after extending the radius of his search, first to neighboring countries, and then beyond EU borders, did he began to score hits. Today, eight of the 13 doctors his department are foreigners, most of them from Balkan nations. Germany’s appetite for foreign health workers is expected to increase as its senior citizens live longer, boosting demand for labor-intensive care for the elderly. Germany’s working-age population is predicted to shrink by up to 30% over the next four decades, according to the federal statistics office Destatis, while the number of those aged 65 and over rises to a third of the population. The EU introduced stricter directives on doctors’ working hours in 2009, exacerbating the crunch in countries with tight staffing like Germany. Meanwhile, temporary rules restricting people from newer, eastern EU countries from seeking work elsewhere in the bloc in the first years of membership have expired over the past decade. That has given German hospital administrators a broader pool of recruits to tap. Yet hiring abroad isn’t cheap: the Pleissental clinic says the fees it pays recruitment agencies to find qualified staff are equivalent to three months of the doctor’s pay. The hospital, which is owned by the local district of Zwickau, also pays for candidates to fly to Germany for interviews and a trial period, and funds a language course for new hires. Bureaucracy such as work visas and verifying foreign medical qualifications is also labor-intensive. Though recruits from other EU countries don’t have to do any repeat training in Germany, they still need to secure a language certificate and, in some cases, have to take an oral exam. Birgit Neubert, head of the hospital’s personnel department, estimates the extra costs to be about €20,000 ($22,300) per hire. Even after they have been taken on, the new doctors “are far from being fully operational,” she said. “It takes a relatively long time for them to learn the ropes, about a year.” As foreign doctors become the norm in Germany, both doctors and patients face something of a culture shock, and a learning curve.Irmgard Reh, an 89-year-old undergoing treatment at the Pleissental clinic, said her experiences with foreign doctors “have been a bit problematic, maybe because I can’t hear so well and the accent is very strong.” Dr. Rainer Kobes—here with patient Irmgard Reh at the Pleissental Hospital in Werdau—has traveled across Eastern Europe to recruit doctors to the staff. One of the main hurdles for foreign doctors is communication. Although they have to pass a German language test to work here, the doctors and patients say language is an obstacle, particularly in rural areas where many patients speak local dialects. Doctors from different countries also have to get used to new diagnostic and treatment methods in the German system. Diyana Halilovic, a doctor from Bosnia who works at the hospital, said while medical training in her homeland of Bosnia is similar, diagnosis is far more advanced in Germany since health insurers fund a broad range of tests and procedures. In Bosnia, by contrast, she said corruption is rife and “treatment depends on how much money you have.” Dr. Halilovic moved to Germany four years ago with her sister, also a doctor, who works at a hospital in nearby Reichenbach. They are happy working in Saxony, the 29-year-old said, but it was difficult to meet people at first. “As a community it’s not open,” Dr. Halilovic said. Another doctor in Werdau, Tamara Lowe, hails from the Bahamas and said she studied medicine in the eastern German city of Leipzig because it was less expensive than medical school in the U.S. After a brief stint back in the Bahamas, she decided to make Germany her home. “Unfortunately in the beginning I had patients who didn’t want to be treated by a foreigner,” said Dr. Lowe, a 35-year old internist. But she likes the 7 a.m. to 4 p.m. working hours and the family-like atmosphere of the small hospital in Werdau, where “everybody tells me my pronunciation reminds them of being on vacation.” Source
