Last week we interviewed Daniel Hefel about his new primary care venture in Germany.
LillianCare was recently set up with the mission of addressing Germany’s GP shortage, which is particularly severe in rural areas. Currently it has just three clinics but the plan is to expand to 200 over the next five years.
The model Hefel and his fellow co-founders have gone for is to make much greater use of physician assistants for carrying out consultations.
Hefel says that about 60% of the GP workload can actually be done by an assistant working on their own. Despite this, primary care providers in Germany are not really making use of them. Nurses exist in primary care, but generally aren’t authorised to carry out consultations by themselves.
“The US has about 180,000 physician assistants, the Netherlands is also using them, as are the Nordic countries. But in Germany we don’t delegate any work. We do have physician assistants but they’re mainly in hospitals,” he said.
Germany is similar to other European countries in that it has a severe GP shortage. It is estimated to need about 5,000 additional GPs, and this could rise to 11,000 in ten years by some estimates.
The shortage is not evenly distributed: almost all rural areas face a severe shortage of primary care services, whilst cities generally do not. LillianCare has found that in the three rural locations it has set up clinics they have been oversubscribed with waiting lists of 500-700 people even before opening.
But Hefel says that if all primary care providers were making proper use of physician assistants, Germany actually wouldn’t need any more GPs.
According to the OECD, the use of ‘advanced practice nursing’ (APN) in primary care has made strides in certain OECD countries in the past decade, particularly in the US and Canada, but most EU countries remain hesitant.
Several barriers stand in the way. Most notable is the resistance from the medical workforce — doctor associations often oppose giving nurses greater autonomy — and outdated regulatory barriers.
It’s not only primary care that faces this issue. Almost every part of healthcare is facing a severe shortage of doctors, and part of the solution must be to delegate more work to nurses and assistants.