German doctors leave Germany and go to Britain - because doctors in Britain get paid more.

The Times January 19, 2006

Striking doctors on the march

By Roger Boyes

50,000 surgeries closed as GPs threaten to desert Germany and head for Britain, reports our correspondent

THOUSANDS of German doctors threatened yesterday to desert Europe’s most modern health system and work in Britain, rather than put up with declining wages and longer hours.

The doctors, many wearing operating masks, marched through the centre of Berlin to besiege the Health Ministry in the first big demonstration against Angela Merkel’s coalition Government. Hospitals worked at half strength and about 50,000 doctors’ surgeries across the country were closed.

“It’s no longer bearable,” Andreas Dahmen, a 31-year-old orthopaedic surgeon, said. “I earn €2,800 [£1,920] a month here after taxes. I’m moving to England where I can earn double that amount for much less work.”

In Britain, he said, he could expect to earn £3,000 a month after tax, with the promise of bonuses bringing his earnings to £4,500. The hip specialist was speaking in a sea of placards held aloft by his colleagues, announcing: “England, we’re on our way!” and “If you want to see a German doctor, come to England!”.

A third of all German doctors now earn less than €2,000 (£1,373) a month after tax. Junior doctors are using cheap airlines to fly to Britain on a Thursday night, working as a locum for the weekend, and returning on Monday morning.

They earn up to £2,000 — the equivalent of a month’s salary. “Recruitment agencies are already trawling our country, hunting for up to 10,000 doctors,” Jürgen-Dietrich Hoppe, the chairman of the German Doctors Association, said. “And I’m sure they’ll get them — English working conditions are so much better.”

Under NHS’s Out of Hours scheme, health trusts can fly in foreign doctors to relieve British GPs who do not want to work in the evenings and at weekends. There is also a desperate shortage in Britain of doctors in areas such as radiology and diagnostics.

The German doctors stopped work yesterday because of government reforms that seek to restrain them from prescribing expensive medicines, cap the individual budgets of surgeries and force hospital administrators to make widespread use of unpaid overtime.

Medical staff worked more than €2 billion worth of unpaid overtime in German hospitals last year, and further reforms planned by the Government will put even more strain on them. Another measure would financially penalise doctors who administer costly drugs.

There are 4,127 German doctors registered in Britain, which has become their European destination of choice, ahead of Switzerland and Scandinavia. Some spend their summer holidays in Britain working as locums, others do so for about a year.

Far more are weekend commuters and are drawn from across the medical spectrum. “We’re thinking of setting up a mobile anaesthetic unit,” Christof Kouidis, a demonstrator, said. “Working in Britain for a week could cover our practice costs in Germany for the rest of the month.”

The influx of British patients to Germany trying to avoid NHS queues for hip replacements has encouraged German doctors to cross the Channel.

Stefan Krukenberg, from Hanover, is planning to replace hip joints in Britain on a freelance basis. “I get €65 for preparing an artificial hip joint — that’s for at least two hours work. Now I’m seriously considering going to Britain on a Friday, preparing three or four hip replacements a day over the weekend and effectively doubling my monthly income.”

The only way he would be able to break even under the new tight German costing rules is by preparing 1,000 hip prostheses a month. “And that’s impossible. What we’re doing at the moment amounts in financial terms to a mere hobby. We have to earn the money to live somewhere else.”

The paradox of the German medical crisis is that doctors are now abandoning rural and eastern areas to work abroad, leaving many active but underfunded surgeries in decline. The German Doctors Association estimates that 32,000 surgeries are on the brink of bankruptcy.

“We are soon going to have a real shortage of doctors,” Uwe Gremmler, a cardiologist from Peine, said. “Older doctors are taking earlier retirement because it has become impossible to make a living. The younger doctors are moving to Britain and, at the same time, as Germans live longer, there are more and more patients to be treated. The Government should act now before we all disappear to England.”


Average annual GP salary
Germany £54,940 (€80,000)
UK £80,000 (€116,509)
Poland £9,000 (€13,107)

A third of registered German doctors earn less than €2,000 (£1,373) per month after tax, not including pension deductions

A German doctor working an extended weekend shift in the UK (Thursday night to Monday morning) can earn £2,000 (€2,913)

Sources: The Times; Norman Niven, managing director of Charter Health Recruitment