Pediatrician Steffen Lüder has four minutes to spend with a child. That means he sees up to 150 children a day. “Of course, you can’t always do justice to the little patients.” That would have earned him one or two bad reviews on Google; “assembly line work” was sometimes mentioned. “But it’s important to me that I don’t send any patient home! For me, if you are in the practice half an hour before the end of the consultation hour, you are guaranteed to still get there.”
There are a lot of things going wrong in Germany’s pediatric and adolescent medicine. This became particularly drastic last year, when the RSV wave was particularly violent. The clinics were full, and the young patients sometimes had to be moved hundreds of kilometers to the nearest clinic. It didn’t end well for everyone.
“Our health system accepts that more children will die after Tom”
Lüder reports on six-year-old Tom. The boy suffered from an initially harmless infection, which then got drastically worse. “But there wasn’t a single free bed left in a Berlin children’s clinic; all nine were full,” says the pediatrician. So Tom should be moved to Brandenburg. “When they got there, however, they classified him as a case for the children’s intensive care unit – and the Brandenburg Children’s Hospital couldn’t do that. So back to Berlin.” The six-year-old became an emergency in the meantime. “Tom had to be resuscitated during the transport. When he arrived in Berlin, the doctors and nurses fought for his life for hours. But in vain, they lost the fight. Tom died.”
Could Tom have been saved if he had been spared the transport? Lüder also admits that this question cannot be answered. “But he would certainly have had a better chance of surviving if the first children’s hospital had had a bed for him straight away.” His criticism: “Our health system accepts that more children will die after Tom.”
Children have had to be moved this winter too
Overloaded children’s hospitals are not uncommon. Due to the season, “from O to O”, i.e. October to Easter, is an exceptional situation. The reason is the many respiratory infections that plague the little ones and can be particularly dangerous for them. The Dr. von Haunersche Children’s Hospital in Munich had to transfer sick babies and children again this winter. “This is a systemic problem, there is a lack of nursing staff here – like everywhere else,” says pediatrician Johannes Hübner to FOCUS online. 20 to 30 percent of the beds could not be operated for this reason alone. The background is that the so-called minimum care limit – “actually a good thing” – ensures that beds are blocked. “This means that we have free beds in a clinic, but we are not allowed to operate it if there are not enough nurses.”
“Unfortunately, in principle you can’t make any money in pediatric medicine,” says Hübner. One reason is the much higher holding costs. “In the summer, children’s hospitals are often half empty, in the winter we are constantly overcrowded. The capacity of children’s intensive care beds is always too low in winter, but maintaining these beds is of course expensive. Hospital groups that need to make profits naturally downsize these areas.”
The so-called flat rates per case – which allows clinics to bill for each treatment case – simply do not pay off here. “This does not reflect the additional time and attention that a child needs.” Fundamentally, a “profit-oriented or profit-maximized health system can never meet the needs of children,” he believes.
There is a lack of pediatricians and practices
There is also a lack of resident doctors, emphasizes Lüder. The number of pediatricians has increased continuously, by more than 25 percent since 2011. But more and more people are working as salaried employees and part-time.
According to the National Association of Statutory Health Insurance Physicians, 58,000 doctors and psychotherapists are currently working part-time – this corresponds to an increase of 285 percent in the last ten years. The number of employed doctors also recently rose to 46,000, an increase of 141 percent compared to ten years ago. “In Berlin pediatric practices, for example, over 30 percent are already employed,” says Lüder.
In the Berlin district in which the pediatrician works, the number of young patients has also increased significantly – “from 33,000 to 52,000 since I started my practice in 2008, at the same time the number of pediatricians and adolescent doctors fell from 23 to 22.” In addition, there is a growing number of preventive examinations and an increased need for vaccinations, says Lüder. “It doesn’t add up.”
Holding costs, more staff and money: What has to change
But what could help? “More staff, more attention, more time certainly play a big role,” says Hübner. It would also make sense to compensate the higher maintenance costs in children’s hospitals differently. “For example, the fire department: They don’t just get money when they put out a fire. Provision costs are paid just for the readiness. That would also be desirable for the children’s hospitals and would take the financial pressure off.”
Lüder calls for the legally fixed requirements planning, which determines how many doctor’s offices a region receives, to be adapted to the changed reality. In addition, the distribution of doctor’s seats in a district should be homogeneous. In addition, 20 to 30 percent more medical study places would have to be created. Both also consider the nursing training reform introduced by then Health Minister Jens Spahn (CDU) to be a mistake. The three individual strands of geriatric care, health and nursing care, and health and pediatric nursing became a generalized nursing training. If you want, you can add a one-year specialization after two years. “But the care of babies and children is technically much different than that of seniors. “The quality suffers, and the training can also cause frustration or mean that someone who wants to work with children prefers to go to daycare,” says Lüder.
The pediatrician, who also provides emergency services in the statutory health insurance children’s rescue center at a Berlin clinic, also holds parents responsible. “There is a lack of social knowledge. “Many parents simply no longer know what a healthy diet is, when children really need to go to the doctor and when bed rest and warm or cold compresses are enough,” he criticizes. “And the emergency room or the child rescue centers are for acute, serious cases of illness, not because little Peter has a mosquito bite.”
Despite everything: “It is and remains the best job in the world”
Something has to change now, both demand. The reform ideas from Health Minister Karl Lauterbach (SPD) are a first step. However, it remains to be seen what will ultimately arrive at children’s clinics and practices.
Stress, overtime, anger – have you ever thought about giving it all up? “Absolutely not,” says Lüder. “Playing with the children, watching them grow up, coaxing something out of them that then embarrasses the parents – it is and remains simply the best job in the world!”