Education researcher Gero Federkeil estimates that around 7,500 Germans study medicine abroad. He demands that politicians pay more attention to this group.

Students sit at individual tables in a hallway and wait for worksheets for the medical exam.

Waiting for the admission process to study medicine in Vienna in July 2023 Photo: Martín Juen/Sepa Media/imago

taz: Mr. Federkeil, human medicine is one of the most popular careers in Germany. Currently, around 50,000 people apply each year, but only about 12,000 are accepted. What do those who leave empty-handed do?

Gero feather wedge: Most rejected applicants wait and hope to get a place through a replacement procedure. However, we now know that many of those who cannot complete the NC in Germany also go abroad and study medicine there.

According to their calculations, there are currently around 7,500 people. Traditionally they go to study in Austria because German is spoken there and there are no tuition fees. What other countries are still popular?

In fact, Austria is the most popular, for the reasons you mentioned. Almost a third of Germans who study medicine abroad do so there. Almost the same amount goes to Hungary, about 2,000. They are followed by Poland with 800, the Czech Republic, Great Britain and Lithuania with just over 400. Italy, we have heard, is also attractive to German medical students. Unfortunately there are no numbers.

If you want to study in Germany, you usually need to have a GPA of 1.0, although universities now also take other criteria into account, such as professional experience. Do you think the selection process is fair?

It's at least fairer than the previous model, when only GPA counted. And I'm glad that people without a high school diploma can now become doctors and that the education system here has become more permeable. The downside of the current admission restrictions is that many students abroad have to pay sometimes very high tuition fees. For example, in universities in Southeast Europe that offer special courses for international students. In some cases up to 20,000 euros per year must be paid. Only the most economically well-off families can afford it.

61 years old, he heads the international projects department of the Center for University Development (CHE) and is co-author of the CHE study Medical Studies in Europe 2024.

The policy could allow more people to study. This would make the path to employment more socially fair, and this would make a lot of sense given current forecasts. According to Robert Bosch, Germany will disappear in 2035 Foundation around 11,000 general practitioners.

In fact, the number of study places is increasing and several new medical schools have been created in recent years, for example in Oldenburg, Bielefeld or currently in Cottbus. But overall the expansion is manageable. Of course, medical study places are also very expensive, especially when it comes to the laboratory and clinical training phases. The high costs are undoubtedly a crucial point that explains why politicians are quite cautious when it comes to expanding university places.

Critics respond that the investments would pay for themselves two or three times over. Patients would receive better care, staff would be relieved overall, and the state would ultimately benefit from increased tax revenue.

You assume a very rational understanding of politics. (laughs). However, several actors with very different interests are involved in this issue: The Federal Ministry of Health is responsible for the supply of doctors. The states, in turn, are responsible for study places and financing. The ministries of Science and Finance will then have to reach an agreement. This triangle makes many things difficult.

Health Minister Karl Lauterbach (SPD) believes that the states have a responsibility to address the shortage of qualified workers and regularly calls for 5,000 additional study places. Would this solve personnel problems?

I'm afraid not. I think it is indisputable that there is a lack of study places, especially at the beginning of training. But the deficiency also arises in other places. Not all those who study medicine in this country end up working as doctors in Germany. Some go abroad, for example to Norway or Sweden, where working conditions are much better. Additionally, in recent years more and more doctors are working part-time. This can also lead to limited supply. The lack of study places is just one of the many reasons why we have a shortage.

Currently, it is foreign doctors who keep our healthcare system running. According to the German Medical Association, their number has doubled to more than 60,000 since 2013.

On the one hand, of course, it is good that these doctors exist. But I have also heard that there are problems due to lack of language skills. I can't judge if that's really true. However, the increase in the number of foreign doctors is an indication that we are not training enough. We, as a society, are asked how much we want to spend on training future doctors.

A cynical answer would be: we even sent some of them abroad to save on training costs.

You can see it like this. In fact, politicians pass on to students the costs that they themselves are not willing to invest in study places. We know that the vast majority of these students go abroad due to high NC. Therefore, it can be assumed that most of them would be happy with a place to study in Germany.

Is it really known what will become of the North Carolina refugees? Will they all return to Germany and then work here as doctors?

There is no data on this. We hoped to provide an overview of the state authorities responsible for the recognition of qualifications. But half of the federal states did not even respond to our request. And for the other half, not everyone had figures. In general, affected students do not appear to play a role in policy planning. We, at the Center for University Development, were the first to show that it was not just a few, but one in every ten to twelve medical students studying abroad.

What do you think should happen now?

I think it would be good for politicians to clarify this great mystery with the help of a study. It would then be clearer whether, for example, there are problems accessing the German healthcare system or what role people can play in the shortage of skilled workers. In fact, we wanted to debate these issues with political actors as part of a public debate event. But most of them did not want to participate in this debate.

What politicians like to talk about is the so-called rural doctor quota. Hence the offer to keep some of the study places free for people who in the future commit to ten years of service in the country. But often there are not many places. In Brandenburg, for example, 18 per semester. It sounds like a drop in the ocean.

That's right. Although now there are similar programs with foreign universities. In Saxony, for example, the State Medical Association covers the tuition fees of a small number of Germans studying at the University of Pécs in Hungary if they agree to work outside Leipzig and Dresden after studying in Saxony. However, the quota for national doctors will only be able to help in a very selective way. Especially since the quota of rural doctors does not increase the total number of medical graduates.

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