How ecophobia is hindering the development of outpatient medicine in Germany

What it’s all about

The German healthcare system, particularly in the area of doctors in private practice, is undergoing rapid change, driven by digitalisation, regulatory changes and changing patient expectations. Against this backdrop, GPs and specialists are faced with the question of how they can align their practice management with change in the short, medium and long term in such a way that they retain active control over the organisation of their practice work and do not become “victims” of the changes. The strategy required for this is entrepreneurial practice management in the form of professionally implemented best practice practice management. However, the reality of implementing this approach in German medical practices has so far been very limited; one even has to speak of a kind of “ecophobia”, a fear or strong aversion to dealing with economic and management issues of one’s own practice management.

What does entrepreneurial practice management mean?

In this context, the term “entrepreneurial practice management” refers to the systematic use of validated methods, instruments and behaviours in GP and specialist practices which, taking into account the practice’s objectives, are both future-proof and flexible.

the best possible quality of medical care for patients,
a balanced and motivating quality of work for doctors and medical assistants and
ensure economic success.

This form of practice management is geared towards always acting proactively and successfully in the complex world of healthcare with all its uncertainties – and not just reacting passively without greater decision-making freedom. However, very few doctors adapt the entrepreneurial role for themselves and utilise the tools.

Examples of necessary but lacking entrepreneurial thinking and action

Lack of practice strategies

For example, only around 20% of German doctors have a defined practice strategy. But without such guidance, practices are navigating the complex healthcare system without a compass, which significantly limits their ability to proactively respond and adapt to change.

Deficit in the implementation of digital strategies

The digitalisation of healthcare offers immense opportunities to increase efficiency, improve patient care and expand services. Yet few practices have developed a comprehensive digitalisation strategy. This failure means that many practices are not even able to benefit from the technological advances available to them beyond the legal requirements of the telematics infrastructure (TI).

Insufficient application of best practices

On average, GPs and specialists only implement half of the best practice standard in their practice management. This validated guideline describes all regulations, instruments and behaviours that are essential in the areas of practice management, from planning, market research, organisation, management, patient care and marketing to controlling, for work to function smoothly even under changing requirements. There are many reasons for this, ranging from a lack of time to a lack of awareness to resistance to change. As a consequence, ecophobia in this area leads to the well-known negative effects that doctors, employees and patients experience on a daily basis.

Neglect of professional staff development

Another example of ecophobia can be found in the area of staff management: only very few doctors use professional feedback meetings, even though this is what most MFAs want. The consequences are demotivation, inefficient work processes, impaired patient care and staff turnover.

Why German GPs and specialists pay so little attention to the entrepreneurial side of their practice management

Medical training and focus on patient care

One major reason lies in the nature of medical training. During medical school and subsequent specialist training, the focus is almost exclusively on medical care and clinical practice. Economic and business management topics are often only dealt with marginally, if at all. Many doctors leave university without a sound knowledge of practice management, finance or personnel management. This deficit leads to doctors concentrating their careers mainly on what they have learnt: medical care.

Lack of time and workload

The everyday life of a doctor in private practice is characterised by a high workload. The large number of patients that have to be cared for on a daily basis leaves little room for additional administrative tasks. Examinations and treatments take up most of the working time, and the remaining time is often used for necessary administrative tasks that are directly related to patient care. This supposedly leaves little to no time to deal intensively with business management issues.

Complexity and lack of clarity in administration

The healthcare sector is characterised by complex regulations and statutory provisions. The multitude of billing modalities, legal requirements and bureaucratic hurdles pose a considerable challenge. Many doctors feel overwhelmed by the administrative complexity and do not know where to start in order to organise their practice more efficiently. This is why business management issues are often put on the back burner.

Lack of business management support

While large companies have specialised departments for finance, HR and administration, doctors in private practice are often left to their own devices. Although support from business consultants is offered, many doctors shy away from the additional costs or have difficulty finding the right consultant. The fear of excessive fees or inadequate results also prevents many doctors from seeking external help.

Risk avoidance and uncertainty

Running a medical practice harbours economic risks that many doctors would rather avoid. Uncertainty with regard to business decisions often leads to doctors preferring to rely on tried and tested methods, even if these are not optimal. The risk of suffering financial losses as a result of wrong decisions prevents many physicians from focusing more intensively on the entrepreneurial side of their practice management.

Lack of motivation and prioritisation

For many doctors, patient care comes first and the entrepreneurial side of practice management is seen as secondary. The intrinsic motivation to help patients and solve health problems often outweighs the motivation to optimise the practice economically. As a result, the business management of the practice is often seen as less important and accordingly less attention is paid to it.

Lack of business knowledge and skills

Even if there is an interest in business management issues, many doctors lack the necessary knowledge and skills to tackle these issues effectively. Business knowledge must be actively acquired and constantly updated, which is an additional burden for many doctors. The need for continuous training to keep up to date can act as a deterrent and lead to neglecting business management topics.

Psychological barriers

Finally, psychological factors also play a role. Many doctors identify strongly with their role as physicians and see themselves primarily as healers, not as entrepreneurs. The idea of dealing intensively with economic issues often contradicts their self-image and professional ideals. This psychological barrier can make it difficult to focus on the entrepreneurial side of practice management.

Conclusion

Without professional entrepreneurial behaviour, doctors will find it increasingly difficult to position themselves successfully in a rapidly changing healthcare system, to ensure the quality of patient care and to guarantee the future viability of their own businesses.