Tag: Medicine

Working as a doctor in Germany: things to know before you start

Despite little activity on my blog these days, I’ve noticed that one old text has been getting an increasing amount of attention since I published it some 3 years ago: Surprising things about being a doctor in Germany.

In addition, I’ve been getting a number of personal e-mails from medical students and junior doctors from around the world asking for more information and advice on the subject of potentially starting out as a doctor here in Germany.

So, here are a few of my personal experiences and tips from the perspective of a British-trained doctor who moved over to Germany in 2009. I have a fair bit of information to share, so I plan to write about it over a series of texts. I hope this helps some of you.

Before you start

1. Have I got a good chance of getting a job as a doctor in Germany?

Short answer is yes. Germany does need doctors at the moment. It of course depends on your speciality of interest and your place of interest. The chances of getting a job in smaller or less attractive cities is obviously higher than for example a renowned university teaching hospital. But it’s a big country and there is a lot of choice at the moment.

2. Is my medical training recognized in Germany? What documents do I need?

Before you start actively looking for a job, it would be best to check with the regulating body here what the requirements are for having your medical degree recognised and subsequently obtaining a license to practice.

Each ‚Bundesland‘ has its own governing body (for example ‚Ärztekammer Nordrhein, Bayerische Ärztekammer etc). I suggest you pick your place of interest in Germany and enquire at the local Ärztekammer there, but bear in mind that there may be differences between the states.

Applying from a member state of the EU

In general, applying from within the EU is more straightforward than from outside and incorporates getting high school/university certificates translated, references from bosses, security checks from your home country and assurances from your governing body that your medical degree is in line with the standards set by the EU. The usual occupation health issues such as HIV status, immune status against hepatitis as well as a medical certificate from a doctor assuring a good bill of health is also required. The Ärztekammer I applied to refused to look at any documents until they were officially translated from English into German to tell me if they were the correct ones (despite the fact that they could clearly read and understand English). This is therefore a costly and time-consuming process (both in terms of money and your nerves). In the end I got my registration one day before I was due to start work.

Applying from outside the EU

For those outside of the EU, things can get a little trickier. Depending on the structure of your medical training, it can require extra (un-paid) placements and a medical viva to check your knowledge and skills, in addition to the above paperwork. I would check all of this out before your decision to move here so that you can plan your finances and expectations appropriately. From what I gather, things seem to be decided on a very individual basis.

3. How good does my German have to be to work here?

Germans institutions often ask for the Goethe-certificate level B2. This is a requirement for university entrance and acquiring citizenship for example and is a good rule of thumb before you start work here, regardless of whether it is an official requirement or not. For your own sake. It is a level which just about gets you by in conversation and in reading and writing although far from ensuring an easy start. I found that whilst doctor colleagues and allied healthcare professionals spoke and understood english at varying levels, patients (especially the older ones) generally did not and furthermore expect, quite naturally, to be communicated with in their native language.

Tips for improving your German language skills

Like all languages, your German will only get better through use. If like me at the time, you are starting from scratch, there is nothing like living in the country, reading local newspaper, watching Germany films and making friends to improve your fluency.

I did a one month intensive language course (level B2) before I started work. It was a brilliant way to start my life in Germany and is a September I look back on with immense fondness. I made some great friends from this course from all over the world and went to some great parties. It was the ERASMUS year I never had. Aside from the social side though, it was a good foundation for my language skills.

Throughout the year, I met weekly with a friend from Argentina who had been living in Germany for a few years and wanted to improve her English. We would talk for 30 minutes in English and then 30 minutes in German. Over the years, this turned into wonderful evenings of drinking red wine over bowls of delicious pasta in favorite local restaurants and a lasting friendship. And of course we improved our language. It’s quite easy to find a so-called ‚Stammtisch‘ through Facebook groups days to achieve something similar.

That’s it for today. I will write about the medical training system in Germany and some practical tips about looking for and applying for jobs in further posts!

Being Mortal – by Atul Gawande

1. What is your understanding of the situation and its potential outcomes?

2. What are your hopes and what are your fears?

3. What are the trade-offs you are willing to make and not willing to make?

4. What is the course of action that best serves this understanding?

photo (72)With these questions Dr Atul Gawande describes in his book Being Mortal how doctors and families can help patients and loved ones in their decision making and help to achieve realistic and wanted goals. Not only in illness but also in the often underestimated process of growing old and planning elderly care.

Being Mortal struck me instantly on many notes. It struck me firstly as being a book that I could have written myself. Because it speaks so many truths that I have seen in my day to day medical life. It struck me because Gawande is a surgeon, and surgeons are supposed to be arrogant, drive fancy cars, flirt with nurses and be far less interested in what happens to their patients outside of the operating theatre. And it struck me because with the 4 questions above, it seems like a clearer text may be possible in many of the difficult situations and decisions that patients routinely face.

Gawande uses not only examples from his medical career, but also personal examples of his own father and his wife’s grandmother. Thus, it is far from just a doctor preaching about his insights into the world. It is just as much the story of a son and of a husband dealing with the issues which at some point will touch every family.

Not long ago, a nurse on our ward stated that she felt that we were not making any of our patients better, and for that reason, she found it harder and harder to work there. This initially sounded more than a little esoteric to me. Sure, we deal with a lot of chronic lung diseases, which are at times sadly and frustratingly incurable and progressive. In many cases, this comes with an extremely poor prognosis and inevitably a death caused by the disease.

But on the ward, we were making lung cancers smaller (even if only for a limited period) with our treatment, treating episodes of infection and making breathlessness manageable enough to enable a discharge home. Didn’t that count as making people better?

Quite often, yes. But in many of the more gruelling cases, I wonder retrospectively if our patients achieved their goals and realised the price they were paying for it.

Hospitals are however taking steps to acknowledge this. In my current hospital, we are lucky enough to work closely with a clinical psychologist, because we realise just what an impact physical illness (particularly chronic disease) has on metal health. Social workers are equally crucial in the team.

In my previous hospital, we tried out a so-called ‚Wegbegleiter‘ or sort of a hospital companion: a doctor who was there most afternoons to spend time talking to patients and their families, accompanying them through their hospital stay, discussing their hopes and fears, liaising with the nursing and medical team, without being in any way responsible for their medical treatment. A ‚medical middle-man‘ who has the time to explore issues which are invariably not part of the daily ward round. It was a huge success. It improved patient satisfaction and it made the life of the physician in charge notably easier.

As Gawande point out, medicine in many parts of the world has gone beyond simply the prolongation of life. It is just as much about maintaining a quality of life which is deemed to be acceptable. When I get back to work, I will definitely keep in mind the 4 questions above and be better prepared to tackle the difficult but crucial conversations that doctors and patients sometimes fail to have.

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