How German finance ministers are harming our health and safety

Gudrun Widders has been in charge of Spandau’s health department since 2011. The qualified doctor with several specialist qualifications has been fighting unsuccessfully for a doctor’s fee in the public health service for even longer. Gerd Engelsmann

Political decisions are transparent and understandable. It is often claimed. However, anyone who wants to know why Berlin health authority specialists are paid less than their hospital colleagues will run into rubber walls. Only the consequence of the worst position is clear: as of December 31, 2021, 112.6 of the 399.46 planned physician positions were vacant, reports the Senate Health Department. More than one physician position out of four in the regional health authorities was therefore vacant.

Huge to-do list for health authority doctors

A look at the law clearly shows that the lack of doctors in the public health service (ÖGD) causes gaps to the detriment of Berliners: the health authorities are responsible, among other things, for monitoring hygiene in hospitals, protect against infection or protection against chemicals hazardous to health.

They participate in civil protection and pest control, are supposed to control the funeral system and look after the physical and mental health of children, the mentally ill and the disabled in a broad and preventive way.

If you want to see all the tasks, click here. There is a lot to read.

Gudrun Widders (64) heads Spandau’s health service. The chief doctor is vice-president of the association of doctors of the Berlin-Brandenburg public health service and is clearly annoyed by this subject.

Spandau’s health service has offices in the house on Carl-Schurz-Strasse in the foreground and in the town hall next door. Gerd Engelsmann

In your office alone, which is scattered across Spandau, 7.25 out of 24 medical positions are vacant. There is a lack of specialists, among others, in protection against infections, in the child and youth health service, in the social psychiatry service. She is happy that two doctors have just signed their employment contract.

Widders explains that a wide variety of bodies – from the Association of Municipal Employers, the District Council, the Association of Towns and Municipalities to the States Tariff Community (TdL) – have been holding back at scale for decades. national when it comes to a separate doctor’s tariff for the public health service goes.

Due to the infinitely complicated national collective bargaining system, for the sake of simplicity, only the TdL should be mentioned: the collective agreement for the civil service also regulates the payment of specialists from the Berlin health authorities.

And in such a way that they are treated on an equal footing with administrative employees.

Big words from the Minister of Health twelve years ago. Effect? Zero!

Widders: “As early as 2010, the conference of federal and state health ministers decided that ÖGD should be strengthened and that there should be a medical tariff for ÖGD. ,Great!’ was the impression then. We are now in 2022 – and nothing has changed.”

At the end of May, Health Minister Karl Lauterbach (SPD) campaigned for a medical tariff in the public health service with the German Medical Association. dpa / Sina Schuldt

A few weeks ago, Federal Minister of Health Karl Lauterbach (SPD) again came out in favor of a separate medical tariff. Widders is skeptical of the chances of success.

Because the “Pact for ÖGD”, which the federal and state governments concluded in September 2020 and which aims to provide the system with four billion euros nationwide, has also had an impact on the tariff situation. doctors from the ÖGD, despite the praise it contained for the services in the corona pandemic did not change anything either.

Some ministers decide something, other ministers are indifferent to the decision

Why things aren’t progressing first fades into the fog. It is obvious that the finance ministers of the federal states are blocking a collective agreement for doctors for the ÖGD.

The Lower Saxony Ministry of Finance, whose press office speaks on behalf of the TdL, refers to Berlin colleagues when asking the reasons for Berlin’s misery. You can ask there.

Big secret on why finance ministers don’t want a doctor’s tariff

The local Senate Finance Department of Daniel Wesener (Greens) responded in somewhat more detail, but equally unsatisfactory: “Berlin presented the topic to the TdL’s general meeting in autumn 2017. (… ) But there was no majority to start collective bargaining. We are not allowed to provide information on the positioning and voting behavior of different countries within the TdL.”

The issue was discussed again in 2020 because the Marburger Bund doctors’ union also wanted to start negotiations on a collective agreement in Bavaria and Baden-Württemberg. The result was the same.

At the request of the KURIER concerning better remuneration for doctors, the health administration of Senator Ulrike Gote (Greens) spoke at length about the need to raise awareness of the useful work of the ÖGD. As far as money for doctors is concerned, however, she remains reluctant: “The introduction of a collective agreement for doctors for the ÖGD would certainly be a suitable means.”

Hans-Jörg Freese, spokesperson for the Marburger Bund, and his tariff expert Christian Twardy bring some light to the darkness.

Secret protocols, secret reasons for pricing decisions

They point out that ministers of finance delegate collective bargaining matters to employees of their ministries, who represent them in the collective bargaining community of the federal states. And this anonymous group, whose electoral behavior is kept secret, is carrying out a goal that has been in place for more than 15 years: no extra sausages in collective agreements.

According to Twardy, this is due to the fact that in 2006 the Marburger Bund succeeded in obtaining a collective agreement from doctors in university clinics in serious disputes, including a doctors’ strike.

After that, the federal states swore never to allow such special regulations again. And that is why the doctors of the ÖGD were still looking financially.

Because of this, a doctor in a hospital would usually have no interest in switching to ÖGD, because he is suddenly put on the same footing as an administrative employee and immediately earns around 1,000 euros less.

If the doctor was the chief medical officer of the clinic, the loss is even greater. According to Freese, doctors in the medical service of mutual insurance companies also receive 1,000 to 1,500 euros more than an ÖGD doctor.

Bad salary after twelve years of training and development

Reminder: We are looking for specialists who studied after school and then followed a specialized training which lasted a total of ten years. And who – see above – have to deal with a very wide range of tasks.

Neighborhoods must offer regulated working hours, subsidized company tickets or sports lessons during working hours in order to attract anyone.

The Berlin Senate therefore resorted to its rucksack to make the service of the health department more financially attractive, even having to painstakingly pursue the resistance of Berlin’s main staff council in court.

Berlin no longer wants to be excluded from the collective bargaining community of the federal states

The trick: The Senate hasn’t agreed to its own collective bargaining agreement because it desperately wants to avoid being shut out of the federal states’ collective bargaining community again, as was the case between 1994 and 2013 – at the time because of the West pays for Employees of the East.

On the contrary, since February 2020, in “justified individual cases”, newly hired specialists in the health authorities can receive a salary outside the collective agreement up to what a doctor from a university hospital receives.

According to Twardy, this represents around 6,500 euros in the first year. The lowest level in the Länder collective agreement, on the other hand, is well below 5000 euros gross.

According to the Senate administration, however, a rat’s tail of conditions must be fulfilled for the conclusion of such contracts, and as of March 1, 2022, it was possible to conclude exactly six of them in all of Berlin.

Only those who successfully apply to leave Berlin can top up their salary if they decide to stay

Specialists already hired can also receive a monthly allowance of up to 1,000 euros in “justified individual cases”. A settlement so far granted to 57 doctors, but which will expire at the end of 2023.

Gudrun Widders not only has the shortage of doctors in her practice ahead of her, but also the corona virus is still and increasingly on her back. Gerd Engelsmann

Widders won’t mourn her: “She won’t be eligible for retirement and will cause resentment when colleagues who are equally qualified but earn different sums sit across from each other.”

But above all, according to Widders, the path to this allowance for existing staff is winding: “Colleagues must first have applied successfully outside Berlin in order to then be able to take advantage of the non-tariff regulation in Berlin.”


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