Dermatology in Germany (11% of GDP)
- The world is always changing (population ages, economies grow stronger or weaker), and healthcare systems adapt. In the United States since the economic crisis of 2008 the “Obama-care” health system arrived, bringing with it the advantages and disadvantages of a centralized government-controlled managed-care model.
…Let’s talk about dermatology in Germany.
- Like Switzerland the healthcare system is:
- compulsory.
- allowing anyone to access high quality outpatient and inpatient medical care.
- direct and does not require a direct referral to a dermatologist.
Dermatology in Germany
- For patients:
- high earners (over 4350 Euros per month) have the option of opting out completely of the centralized public healthcare and take private insurance
- For dermatologists:
- Many hesitate to move into private practice as basic consultation fees for medical dermatology are a meager 15Euros per trimester ! Without investigations, surgery as well as cosmetic procedures it is safer to stay in a hospital-based setting.
- regulation is done at the institutional level, not at the state level.
- Mohs surgery here is of the “slow” type. This means that histological slides are parrafin embeded and thus it is longer. The advantage is that it allows to measure the depth of the skin cancer, and thus be more-or-less aggressive in its removal.
- For trainees:
- Contrarily to the US trainees, “assistant doctors” are given many responsibilities at an early stage and learn by experience. This is detrimental to education as approval of diagnostic and management by a supervisor, enhance transmission of valuable experience, which is essential in dermatology.
- Inpatient dermatology is promoted which allows trainees to follow-up on a day-to-day basis the progression of a skin disease in a more rounded manner (diagnosis and management).
Contributors
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information: 2013 (08) – Carruthers J, Dermatology in Germany – Dermatology World.
