Proposed Exchange Program for German and Austrian Medical Students to Address Numerus Clausus Debate

In the debate about numerus clausus “refugees” from Germany studying medicine in Austria, the President of the Tyrolean Medical Association, Stefan Kastner, comes up with an unusual suggestion: He proposes an “exchange or exchange program” that would be used by Germans studying in Austria and those studying in Germany Austrians are mutually brought back during their studies, said Kastner in the APA interview.

With his suggestion, which could also be used to counteract the shortage of doctors, the President of the Tyrolean Medical Association alluded to those Austrian students who do not pass the medical test in this country, but who fulfill the numerus clausus in Germany and start studying there: “These are quite a few. We’re not bringing them back at the moment, although the majority would certainly prefer to study here.” On the literally “other side” this also applies to those hotly debated German numerus clausus “refugees” who come here and clear the hurdles to study in Austria.

Bringing students back at the beginning of their studies

The “exchange program” should ideally take effect “from the time the course is awarded”, i.e. right at the beginning. “Let’s take the Tyrolean who is studying in Essen or the German who is starting her studies in Innsbruck. They could then swap places again if they want to. It should be easy in terms of IT. There should be platforms, with which the students can get in touch with. Or mutual exchange offers. We have to take the opportunity to bring people back at the beginning of their studies or during their studies,” explained Kastner.

Because it is obvious that those who study medicine in their home country are more likely to stay in that country after completing their studies and work as doctors than those who come from another country. This procedure should be considered, said the head of the Tyrolean Medical Association: “We are happy for every doctor. We have to fight for everyone.” Kastner, on the other hand, cannot do much with the push by Lower Austria’s governor Johanna Mikl-Leitner (ÖVP) to apply admission restrictions for numerus clausus “refugees” from Germany and thus put a stop to them. He doesn’t think it’s “legally solvable.”

Too few training places for prospective doctors

With regard to the apparently rampant shortage of doctors, the President of the Medical Association pointed out what he believes to be a central problem: “We pick up too few prospective doctors from the universities. The hospital operators offer too few training positions.” Stronger political pressure and corresponding financing are needed here.

Kastner no longer believed in a health care reform with necessary, far-reaching, structural changes. Health Minister Johannes Rauch (Greens) had apparently “failed”. The minister is also right that in the health sector in Austria, given “too many players” – federal states, social insurance, municipalities, “yes, also the medical association” – a structural reform is difficult to implement.

The measures recently presented, such as 100 new statutory health insurance positions by the end of the year, are primarily about “announcement policy” and “really a drop in the bucket.” Since many cash registers are already vacant, “an additional 100 will probably not do much.” “In 2013, the government at the time launched the ‘Health Target Control’. The patients should be taken to where they can be cared for best and most efficiently. We are now further away from that than we were then,” Kastner drew a sobering conclusion.

Make health insurance more lucrative

Kastner saw many construction sites. On the one hand, doctor’s practices need to be made more attractive. In this area, there is finally a need for a “reasonable, uniform service and fee catalogue, which also takes adequate account of conversational medicine”: “The health insurance system must become lucrative”. And you finally have to “start controlling” the patients. “We have the patients in the wrong places. This is frustrating for the patients, and also for the doctors and health workers.”

There is a “hooliganism” and nobody knows “where the patients are going. And since the introduction of the e-card, they can go anywhere”. Due to a lack of control, far too many would continue to flock to the hospitals instead of to the private practice, although this is not necessary from a medical point of view. “It’s about treating the patient quickly, well and still cheaply. It finally needs a controller,” appealed Kastner.

“The hospitals must be cleared out and relieved,” he also demanded. A structural change that could bring about this would be, for example, the “financing of outpatient hospitals and private practice from a single source.” This would eliminate the “problem that a patient is cheaper for the insurance company if he goes to a hospital outpatient clinic.” But that would also mean that the entire payment and billing would go through the health insurance company and the power of the federal states would be restricted. “But it would perhaps be more lucrative for the cash register to set up more checkout offices that are also better funded so that they can handle these things.”

One should also take a role model from other countries when it comes to the distribution of the range of services: in Germany, for example, chemotherapy and radiotherapy are offered efficiently in the private sector. This would probably also be “finer and more comfortable for patients, for example being able to carry out chemotherapy in an outpatient clinic or in a specialized surgery.” Preventive check-ups, for example in the field of colonoscopies, would also be such a field: “It’s about breaking new ground. You have to think: Where does it make sense to efficiently place a medical offer outside of the hospitals.”

Kastner also identified a blatant need to catch up in the area of ​​digitization. He called the ELGA electronic health record an “old horse with too many holes” that all too often keeps doctors and other staff from doing their actual work – with too many necessary clicks and too much bureaucracy. “It needs a holistic, modern IT system,” demanded the head of the Tyrolean Medical Association: “It is often more tedious to enter something electronically than by hand in a curve.” However, Kastner welcomed the mandatory diagnosis coding in the private sector announced by Minister of Health Rauch.