All over Germany, children’s hospitals and intensive care units are currently reaching their limits. As Steffen Lüder, a pediatrician in a Berlin practice, reports in an interview with Focus online, it is a system error that can only be ironed out by politicians.
Lack of staff, absenteeism and too few beds – this is what it looks like in Germany’s children’s hospitals at the moment. The clinics are overwhelmed, parents are sent home with their sick children, and seriously ill children are driven all over the country.
“That is the sad reality of care,” says Steffen Lüder, Berlin pediatrician and helper at the city’s child rescue centers, in an interview with Focus online. The doctor had voluntarily closed his practice in the Berlin district of Lichtenberg just last week – because his budget was exceeded and he was overworked.
“I’ve been in the practice since 2008, but this number of patients has completely exceeded my previous experience,” says Lüder. As the doctor reports, more than 1,850 children have come to his practice in the past two months alone – the average number of patients in Berlin in the fourth and first quarter of a year is usually 1,000 to 1,150 children.
“For example, we recently had a day where 146 patients presented within seven hours – that’s almost two and a half minutes per child. I have a private practice with two Medical Assistants (MFAs) on duty. It’s just not feasible,” reports the doctor. The situation is like mass processing, and there is hardly any time left for the individual patient.
“We worked like crazy, but at some point we too will reach our limits. My staff urgently needed a vacation. That’s why I closed the practice – voluntarily, not because I had to”. For Lüder, the practice closure is a “political statement” – to show that things can’t go on like this anymore.
However, he continues to help out in the emergency services of the city’s Association of Statutory Health Insurance Physicians. “If I voluntarily help out in a children’s clinic outside of my working hours, then I’m only exploiting myself, but I can’t and don’t want to do that with my employees,” emphasizes the pediatrician in an interview with Focus online.
The situation that Lüder experiences in his practice is not an isolated case. There is a shortage of pediatric nurses, medical assistants and doctors throughout Germany. Even in clinics, the staff are reaching their limits. Specialists in children’s wards are understaffed, overtime is now the norm, stress and overwork are evident in all departments.
As Lüder reports, sick children would no longer be admitted to the children’s clinics, but only the “seriously ill of the seriously ill”. “Children sometimes lie on examination beds in the emergency departments at night. Such an examination table is 70 cm wide and 180 cm long – and not really suitable for sleeping. If a child rolls over at night, it falls out. So the mothers sit in front of the couches and make sure that nothing happens,” he describes the situation.
“If a night nurse in a Berlin intensive care unit is alone with seven children and works 14 hours a day, it’s only a matter of time before mistakes happen,” warns Lüder. That is human and the result of circumstances. “We can all make mistakes, but the greater the workload, the greater the risk.”
The colleagues in the clinics can no longer accommodate the children because there is no free bed in the city. Patients are transferred to Frankfurt, but car transport is associated with risks, especially for seriously ill children.
There has already been a death in Berlin – possibly because of this. Lüder reports on a six-year-old child who recently presented to a Berlin hospital with a respiratory infection. The child’s condition deteriorated drastically the following day, but the children’s ward could not admit the child due to lack of capacity. The child was transferred to a children’s clinic in Brandenburg. Here the condition continued to deteriorate, stabilization was not possible. The child was transported again – this time back to Berlin, but died here shortly afterwards and could not be resuscitated.
“Of course, the child could have died like that,” said Lüder. “But when you transport a child back and forth in this condition, you ask yourself whether the loss of time is bearable – and if you didn’t have a chance to save the child after all. That always stays in the back of your mind.” Any long-distance transport should be avoided unless otherwise possible, emphasizes the pediatrician.
The causes of the current situation date back years and are multifactorial. Since reunification, the number of medical study places has drastically reduced. The shortage of doctors means that there are too few doctors for too many patients. Although the number of study places has increased by two percent annually since 2017, Lüder emphasizes that there is still a deficit of 11,000 places. The federal and state governments have still not managed to set up more medical study places in the long term. According to current statements by Health Minister Karl Lauterbach (SPD), Germany lacks around 5,000 university places per year, but he is not responsible for creating them.
Due to modern working time models such as part-time or flextime in an increasingly fragmented society, the training period to become a specialist in child and adolescent medicine is also lengthened. As Lüder explains, it sometimes lasts up to ten years.
Unfortunately, the number of medical specialists for the practices does not increase with the number of children to be cared for. Trained in practices, they are often enticed away by clinics that pay better.
“We need more people in the medical system. Nurses, MFAs, elderly care people and doctors,” says Lüder. You have to come back to special training.
“Unfortunately, medical education has been standardized. In the past, a nurse trained for three years, after which she was able to enter the profession competently. Today there is a three-year generalized training in the nursing field of adult nursing, geriatric nursing and pediatric nursing. It is questionable how good the performance in the individual areas, for example in pediatric nursing, is in the end when you have only half learned a lot, criticizes Lüder.
In addition to the lack of doctors and medical professionals, Lüder criticizes the medical system. Paediatricians receive a so-called euro standard service volume per quarter. It defines the upper limit of the amount of services that a panel doctor can provide and be paid for. If a doctor treats more patients, however, he does not get more money. “The normal payment rate in Berlin for paediatricians is currently 82 percent,” explains Lüder. “You get paid 15 percent for performance over budget in Berlin. If there are seven regular patients who were not there in the quarter, then only one will be paid.”
There is also a deficit on the part of staff remuneration. Health insurance companies in particular should provide funds for better pay. “The MFA remuneration is poor, in the collective agreement it is less than 2000 euros as an entry-level salary (first level) for a full-time position. The MFA tariffs have increased in recent years, but without counter-financing from the health insurers.
In metropolitan areas, doctors can no longer find MFAs, even if they are paid well above the standard pay scale due to the high cost of living.”
Politicians must also clarify their view of the situation: “A children’s rescue center is there for acute cases – and can only be permanently available for these. Treatment for minor illnesses cannot be offered 24 hours a day, seven days a week. The capacities are not sufficient for that.” In the course of this, assessment and awareness of health and illness must also be better trained. When is it necessary to take my child to the doctor – and when is the medicine cabinet sufficient? A lot of knowledge has been lost here.
“We manage a system of shortages, which has been driven to the wall in total over the years and is collapsing in the current wave of influenza and RSV” – the responsibility for this problem is complex and lies primarily in the hands of politicians.
Parents of sick children in medical practices and hospitals currently have to be patient and calm. The waiting times are significantly longer than usual, and there is hardly any more consultation time. “Consultation is a luxury that we can’t afford at the moment,” says Lüder. Add to that the lack of medication. “Standard antibiotics such as amoxicillin, penicillin, but also fever syrups are not available in many pharmacies.”