Expenses for medical practices in Germany have surged while revenues have declined. This trend may worsen the country’s ongoing doctor shortage, as fewer doctors are choosing to open private practices.
Rising practice costs and shrinking profits
Medical practices in Germany are facing increased financial pressure, with expenses rising by 11% in 2022 compared to the previous year. According to data from the Federal Statistical Office (Destatis), the average expenditure per practice reached €466,000, up from €420,000 in 2021. This increase outpaced the 6.9% rise in the consumer price index over the same period. The surge in costs affected individual and group practices, as well as medical care centers, with dental and psychotherapeutic practices being the exception.
At the same time, practices saw lower net revenues. Although average earnings per practice rose by 5.3% to €796,000 in 2022, the growth was smaller than the increase in expenses. As a result, the average net revenue per practice fell by 1.5%, dropping to €331,000 from €336,000 in 2021. Notably, half of all practices reported net revenues of €230,000 or less.
Smaller practices, especially individual ones, were hit harder. These practices employed an average of 8.5 staff members and saw their net revenue decrease by 2.5%, falling to €315,000 from €323,000 the previous year. It is important to note that net revenue is not the same as profit; it represents the practice’s annual result.
Fewer private practices, more part-time doctors
The decline in private practices is exacerbating the doctor shortage in Germany. Many patients with public health insurance are already facing long waits for specialist appointments. Rising costs could discourage even more doctors from setting up their own practices, worsening the situation.
Dr. Dominik von Stillfried, chairman of the Central Institute for Statutory Health Insurance (Zi), highlighted this concern earlier in the year: “We are in the middle of a ‘war for talent’ across Europe, competing for trained medical professionals. It will become even more challenging to maintain today’s level of medical care and prevent rural areas from being disadvantaged.” His proposed solution is to recruit more specialists from abroad to address the shortage in Germany.
Additionally, an increasing number of doctors are opting for employment in group practices or medical centers. According to AOK, half of all physicians in statutory care now choose these options. Part-time work is also growing in popularity. Over the past decade, the number of employed doctors has more than doubled, rising from 19,601 to 46,109. This trend is expected to continue, as many medical students prefer salaried positions and part-time work over running their own practices.
Geographical disparities in doctor availability
The availability of doctors varies significantly across Germany. In city-states like Hamburg, Berlin, and Bremen, there are over 300 doctors per 100,000 residents, while in larger states like Brandenburg and Thuringia, there are fewer than 200 doctors per 100,000 residents. In Hamburg, each doctor serves an average of 313 people, compared to 526 people per doctor in Brandenburg.
The Zi warns that by 2040, Germany could face a shortage of around 50,000 doctors, which would severely impact care for the country’s 70 million public health insurance holders. The availability of medical care could drop to 74% of its current level. “Our analysis shows that past failures in training will be impossible to correct in the next decade,” said Stillfried. “The extent of the shortage will depend on how well we create attractive working conditions and encourage doctors to remain in practice for longer.”
