training

Year family medicine established: 2003 (personal interview, 2018)

Type of Training: residency

Length of Training: Medical school for 6 years and 3 months (Study Location Heidelberg, n.d.) is required before 5 years of post-graduate training (Kringos et al., n.d.). Overall, takes 11 years to become a certified GP/Family physician

Number of institutions that offer family medicine: 36 universities in Germany teach family medicine (Brekke et al., 2013)

Number of family medicine residents graduating each year (2018): 1300 family medicine residents (personal interview, 2018)

practice

Number of family doctors in country (2016): 80,503 family physicians (Eurostat, 2016)

Physician to population ratio (2006): 99.1 family physicians per 100,000 people (Masseria et al., 2009)

On average 1 GP has contact to 900 patients during a period of 3 months, there are no formal lists but this is about half of the practice population (personal interview, 2018).

DALY: 12,536 per 100,000 individuals (Due to all Causes).

Life Expectancy:

• Females 2017: 83.5 years

• Males 2017: 78.6 years

Mortality rate 2017:

• 2015 Males: 92 per 1,000 male adults.

• 2015 Females: 50 per 1,000 female adults.

Infant Immunization-HepB3: % of 1-year-old children received: 87%.

College of Family Physicians (Y or N):

• Yes: DEGAM - German Society for General Medicine and Family

training

In German medical schools, there are 2 weeks spent in practice, and 12 hours in didactic, a 1 month elective known as Famulatur, and variable participation in further teaching, like prevention and geriatric aspects. Post-graduate training is a residency that consists of 18 months in general medicine, 18 months with direct patient contact, and 24 months of general practice. There is no Master’s program for post graduate education. Family medicine teachers include professors, assistant professors, and GP’s with special training. CME is not mandatory, but if CME points are not achieved there is reduced compensation from health insurance companies. 60 points must be achieved within 5 years (personal interview). There is less desire to become a family physician leading to fewer students specializing. Less than 10% of medical graduates choose to enroll in family medicine post-graduate training (Kringos et al., n.d.)

practice

In 2006, 99.1 family physicians per 100,000 people were recorded, (Masseria et al., 2009) and 80,503 family physicians in 2016 (Eurostat, 2016). These physicians offer continuous and comprehensive care. Most patients see physicians for long term care, but there is free movement of patients (personal interview, 2018). Other primary care deliverers in Germany include pediatricians, gynecologists, and ambulatory care doctors (Kringos et al., n.d.)

On average one GP has contact to 900 patients during a period of 3 months; there are no formal lists but this is roughly half of the practice population (personal interview, 2018).

There is no gatekeeping system used in Germany. The country uses a model where GPs work in a practice team with nurses, called medizinische Fachangestellte, and one (about 60% of practices) or more GPs (mostly 2-3), led by GP who owns the practice in most cases (personal interview, 2018).