A U.S. Medical Student’s Experience in Germany

As a medical student from the U.S., it is always fascinating to experience how medical care is delivered in other countries. As our health care expenditures balloon to unprecedented levels, the topics of medical care and medicine in general have never been more pervasive. From this dialogue, comparisons between the U.S. and international health care systems are naturally made, but few people outside of those who do medical tourism, international rotations, or medical humanitarian work actually experience the differences firsthand. Experiencing medicine in countries with drastically different systems than the U.S. is highly valuable for U.S. medical students, both in clinical practice and in understanding the business and legal aspects of medicine.
Many medical students spend their summer between first and second year catching a glimpse of medicine in a different light, whether it is through working as a teaching assistant, conducting laboratory research, or going on medical mission trips. In coordination with my local AMSA chapter, I was given the unique and eye-opening opportunity to travel to Rostock, a port city and college town in rural northeast Germany, to do a one month, full-fledged rotation in the Internal/Tropical Medicine ward at the University of Rostock. Since so many changes are slated to occur in health care policy in the U.S., I was especially curious about the implementation of health care in Germany, and had a multitude of questions. Why are their health outcomes, statistically, “better” per dollar spent when compared to the U.S.? What are the flaws in their system? Are there enough physicians to serve their population? How does health care differ within Germany, specifically between the rural and urban regions? I was fortunate enough to rotate in a department full of attendings and residents who could shed light on some of these topics.
When I first embarked on the trip, I, like many Americans, expected German hospitals and clinics to have long lines and the rationing of health care to the detriment of their citizens. However, I quickly realized that those expectations were commonly not found in Germany and that what many Americans believe about government-run health care does not always exist. In fact, patients were well taken care of, and many were very pleased with the service they receive from their physicians and hospital care providers. Physicians were not only able to achieve better outcomes with their patients, but patient satisfaction in my particular hospital was very high. Unlike many American clinics and hospitals, which force physicians to minimize their time with patients, the German hospitals allows physicians to spend more time with patients. Undoubtedly, the amount of attention patients receive from their physicians contributes greatly towards achieving better clinical outcomes and higher patient satisfaction. As I relentlessly sought answers from my attending physicians at the hospitals, other differences also became clear.
At the heart of the matter, the differences between the U.S. and Germany seem to lie in the bottom line. The U.S. health care system is arguably underpinned by profit-driven insurance companies, while the German health care system is more tightly controlled by government oversight. In Germany, reimbursement was simpler and much more reliable, allowing physicians and the clinics to accurately and efficiently account for their income and expenses. A higher proportion of health care expenditures in Germany was also spent on preventative care, as seen in the higher proportion of primary care physicians in the workforce. Finally, fewer bureaucratic issues and better malpractice laws also contribute to a much better controlled health care system. In general, these factors favor the treatment of patients before critical conditions begin or worsen and more usage of inpatient care for treatment of conditions that are normally treated on an outpatient basis in the U.S. Uniquely, the German medical system also cuts cost by offering more practical emergency medicine services. There are no ambulances in Germany; instead the German Krankenwagen are not only operated by public hospitals, but are staffed with physicians as well as paramedics, translating into more effective emergency care without burdening individuals with extravagant medical bills.
The education system in Germany was also very different. In addition to the exceedingly low cost of medical education, to the point where it is almost free of charge, students may enter medical school without undergoing a bachelor’s degree beforehand. While earning the medical degree in Germany is a lengthier 6 years as opposed to four in the U.S., having candidates skip undergraduate studies effectively shortens the time period by 2 years overall, at the very least. As a result, graduates enter into practice sooner than U.S. graduates and, with almost no debt to repay, are much more likely to pick primary care as their specialty.
The experiences in Germany have proven to be and will continue to prove invaluable in my future practice here in the U.S. As I gained a better understanding of the health care delivery systems from across the pond, it will to continue to shape my medical practice. While the current system in the U.S. does offer certain advantages over other health care systems, its shortcomings are much more obvious than its successes and, unfortunately, are more pervasive as well. The U.S. system does not place as much emphasis on prevention of diseases, but on treating them as they become more severe. As other countries have proven, prevention is a key step in reigning in cost of care. A successful system would likely combine elements of the current American system with a system similar to that of Germany’s. As public policy on health care continues to change, students and physicians with experience in studying medicine or practicing medicine abroad may provide very valuable insight into the health care discussion. It will be interesting to see what system the U.S. will end up with once the bickering and fighting is over.