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Human Resources in Medicine and in the Mirror of Digitalization

Shortages of skilled labor are a growing problem in many sectors of the economy, especially in medicine. What problems in the everyday workings of clinics and hospitals arise as a consequence, and what alternatives are there to people as a “resource”? And what role can digitalization play?

Shortages of skilled labor are a growing problem in many sectors of the economy, especially in medicine. What problems in the everyday workings of clinics and hospitals arise as a consequence, and what alternatives are there to people as a “resource”? And what role can digitalization play?

“We are indeed heading for a shortage of doctors because far too few physicians are being trained in Germany,” predicted Karl Lauterbach, now Germany's health minister, in the Saarbrücker Zeitung on 4 May 2019. “If you compare the need for new physicians to the number of medical school graduates, we see a gap of as many as 5,000 physicians per year. This is not really due to a decline in willingness to work full time — it is largely attributable to demographic trends.” (Prof.)

The unabated trend toward part-time work, the rising average age of the physician workforce, and, above all, demographic change are the main reasons for the shortage of physicians. Moreover, although the number of medical students has been rising steadily since 2007, too few are ultimately being trained as medical doctors. Approximately 25 to 30 percent of medical students switch to alternative careers during medical school and at the beginning of specialist training. Whereas in the past physicians in full-time positions frequently worked overtime at no extra charge, the generation now following them no longer accepts this as a normal part of the profession. These young people place more emphasis on work-life balance and the compatibility of family and career. Calculations based on the number of physicians are no longer meaningful; this figure has been replaced by the number of physician hours per capita. And this figure is falling significantly. As the graph of the ZI panels reveals, the weekly working hours of self-employed and employed physicians vary tremendously. The latter in particular are obviously working more often in part-time positions.

Furthermore, Germany has one of the oldest societies in the world; a further increase in the need for treatment can be expected in the coming years. At this time, the German Federal Statistical Office projects that the proportion of the population over the age of 67 will increase to as high as 42 percent by 2040. This will be reflected in more physician contacts on average, a factor that in conjunction with the trend to more part-time work will further exacerbate the physician shortage (physician statistics per 31/12/2020 from the German Medical Association).

Nursing shortage and no improvement in sight

The greatest shortage of medical professionals is found among nurses. A shortage of nurses was determined as early as the period between 1960 and 1989. Just as then, attempts are now being made to remedy the problem by recruiting nurses from abroad. The current need is estimated at 30,000 to 50,000 additional nurses (Deutsches Ärzteblatt 2018;115(12)A-505). However, an additional 187,000 full-time nurses will be needed in Germany no later than in 2030 (report “Situation and Development of Nursing Care Until 2030” from the German Hospital Institute).

The causes of the shortage in nurses are manifold. As described above, demographic change is causing the number of people in need of care to rise while the number of people training for care professions is declining. The substantial physical and psychological stress associated with the profession also prompts many caregivers to change careers to safeguard their own health. As a result, significant workload intensification can be observed throughout the health care system.

Shift and weekend work is the rule

Recent years have seen significant wage increases for nursing staff in the public sector; between 2020 and 2021, there was a percentage increase of 8.7 percent, and this rise peaked at about 10 percent for intensive care staff (source: MFA salary collective agreement/VmF-Online.de). Salaries for medical assistants as well have risen, posting growth of nearly 18 percent over the past three years. Such figures make it questionable whether remuneration is the overriding cause of the shortage of skilled workers in these occupational groups.

Physicians and nurses suffer more from the demands made on their time and the burdens imposed by the profession itself. In particular, the considerable intensification of the workload and the huge numbers of administrative tasks cannot be reconciled with the official descriptions of these professions. The work pressure is no less stressful. For example, almost half of the doctors in Germany complain of feelings of physical, emotional, and mental exhaustion. Twenty-four percent say they suffer from “depression” and “depressed moods.” Nine percent describe their symptoms as a combination of burnout and depression.

Huge amounts of administrative paperwork lead to high workload

International surveys have shown that physicians perceive administrative tasks in particular as a major burden. Too many working hours, lack of recognition in the social environment, too much profit orientation, and insufficient remuneration are other factors that increase stress.

The rising number of administrative tasks and the complexities of the German health care system mean that fewer and fewer specialist physicians are entering private practice. Instead of becoming entrepreneurs themselves, they frequently decide in favor of part-time models. Yet private practices are precisely the sites where the bulk of medical treatment in Germany takes place — approximately one billion physician-patient contacts per year. The shortage of physicians is therefore especially striking in private practice.

Serious consequences for everyday work in clinics and private practices

The lack of personnel sets in motion a spiral of work intensification and staff attrition that is further exacerbated by cost pressures in both clinics and private practices, leading to higher incidences of employees’ absences because of illness and terminations. Beds in hospitals must be blocked or wards must be closed, forcing the postponement of treatment. Practices must reschedule appointments to later times, resulting in longer and longer waiting times to see specialists, regardless of the patients’ insurance status.

The higher collective wage agreements lead to significant cost increases as personnel costs account for approximately 70 percent of the expenses of a health care facility. While the costs for nursing staff in clinics are covered directly by the health insurers, these items are included in the budgeted remuneration for private practices, and wage increases can be compensated to no more than a severely limited extent, driving further the spiral of work intensification and cost pressure.

Digitalization as one solution approach

Ultimately, various approaches to solving the problem are needed. For one, more physicians and nurses must be trained; for another, the administrative burden, which stands out as being first and foremost the cause of dissatisfaction among medical staff, must be reduced. With the aid of digitalization, the second can be achieved much more easily than the first. All that is required is the implementation or expanded use of IT solutions that can be accessed easily and operated intuitively.

Digitalized personal patient education can free medical staff from administrative tasks and release more time for the actual treatment of patients. Robots and robotics are already being used to replace or at least support staff — in some cases, even during the treatment of patients. This can significantly reduce the physical strain on nursing staff in particular. Such solutions are utilized, for example, for the autonomous cleaning and preparation of operating rooms, for the transport of medications or laboratory samples, or for support of complex operations.

The possibilities do not end with the automation of processes, however; artificial intelligence (AI) will profoundly change our working world, including the practice of medicine. One example is the analysis of findings from imaging technologies using AI. If used correctly, digitalization in the medical field in conjunction with education can make a key contribution to relieving the burden on the health care system.

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