What it’s all about
General practitioners and specialists in Germany face a variety of challenges in managing their practices. However, despite a noticeable increase in work pressure, practice owners do not implement around half of the regulations, tools and behaviours that are essential for a smoothly functioning practice, even under changing circumstances. They have had to inflict the resulting effects on themselves, their staff and their patients on a daily basis and are resistant to external advice. There are various reasons for this rejection, which are rooted in both personal and structural factors.
➡️ One major reason for the resistance to counselling among doctors in private practice is the deeply rooted conviction that, as specialists, they know best how to run their practice. This attitude is often based on years of professional experience and the assumption that external consultants without a medical background cannot fully understand the specific requirements and challenges of day-to-day practice. Doctors are used to acting autonomously and independently in their daily work, which reduces their willingness to accept external help.
➡️ Another factor is time pressure. Everyday life in a doctor’s surgery is often characterised by long working hours and high levels of stress. Many doctors feel that they cannot devote any additional resources – be it time or energy – to counselling processes. However, participating in consultations and implementing proposed measures requires precisely these resources, which further reduces the willingness to cooperate.
➡️ Economic considerations also play a role. The fees for counselling services can be considerable and are perceived by many doctors as an additional financial burden. Practice owners also shy away from these expenses because it is not clear to them how they directly and visibly contribute to an improvement in the working situation.
➡️ Furthermore, there is often scepticism about the benefits and effectiveness of consulting services. Some doctors have already had negative experiences with consultants who have recommended expensive and time-consuming programmes without significant improvements being achieved. Such experiences lead to a general reluctance and mistrust of further counselling services.
➡️ An additional barrier is the fear of change. Every form of counselling implies the need to question existing processes and, if necessary, adapt or even fundamentally change them. However, change means uncertainty and leaving the comfort zone, which is an unpleasant prospect for many people – and doctors are no exception. This fear of the new and unknown then leads to existing, albeit suboptimal, structures being retained.
➡️ The self-image as competent and successful physicians also contributes to resistance to counselling. Some doctors see the acceptance of external counselling as a potential weakening of their reputation and authority. There is a fear that admitting to needing support could be interpreted as a sign of weakness or incompetence.
Conclusion
In summary, it can be said that the resistance of doctors in private practice to counselling is based on a complex mixture of personal convictions, time and economic constraints and psychological barriers. These factors mean that many doctors are reluctant to utilise external consultations despite the potential benefits, which can ultimately affect the efficiency and effectiveness of their practice management.
Further reading
- Klingenberg A, et al. “Barriers and facilitators for the implementation of quality improvement strategies in primary care: A systematic review.” BMC Family Practice (2023).
- Schmidt K, et al. “Attitudes of German general practitioners towards practice management consulting: A qualitative study.” BMC Health Services Research (2022).
- Müller BS, et al. “Implementation of digital health interventions in primary care: A mixed-methods study on barriers and facilitators.” JMIR Medical Informatics (2023).
- Wensing M, et al. “Organizational culture and its impact on quality of healthcare delivery: A systematic review.” Health Policy (2022).
- Laux G, et al. “Barriers to implementing evidence-based practice in German outpatient care: A cross-sectional survey.” Implementation Science (2023).
- Herrmann M, et al. “Change management in primary care: A qualitative study on perspectives of German general practitioners.” Family Practice (2022).
- Steinhäuser J, et al. “Challenges in practice management among German primary care physicians: A mixed-methods study.” BMC Primary Care (2023).
- Götz K, et al. “Factors influencing the adoption of quality improvement initiatives in German ambulatory care: A qualitative study.” International Journal for Quality in Health Care (2022).
- Kassenärztliche Bundesvereinigung. “Report on outpatient care in Germany 2023: Challenges and opportunities for practice management.” (2023).
- Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. “Outpatient care in Germany: Current situation and recommendations for improvement.” Gutachten (2022).
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