Good grades = good physician?

Report: Karoline Laarmann

Above average grades or lots of patience - whoever wants to study medicine in Germany needs at least one of the two. That’s because some 40,000 school graduates apply for just 9,000 places to study medicine every semester. The coveted places are assigned by the central office for university admissions (ZVS): 20% go to the top graduates, 20% are granted on the basis of a waiting list, and 60% are granted by the universities themselves.

German Health Minister Philipp Rösler calls for abolition of numerus clausus...
German Health Minister Philipp Rösler calls for abolition of numerus clausus in medical study selection

German Health Minister Philipp Rösler calls for abolition of numerus clausus...
German Health Minister Philipp Rösler calls for abolition of numerus clausus in medical study selection

The current numerus clausus (NC), the average 1.4 grade needed to be considered for a place in medical school, is very high. Federal Health Minister and physician Philipp Rösler (Free Democratic Party - FDP) argues that the NC should be abolished and selection interviews given more credit in the application process. ‘The grade average alone does not say much of anything about whether someone will make a good physician,’ he said in an interview with the daily Frankfurter Allgemeine Zeitung. ‘Actually quite different factors are more important. For example, the capacity to listen to people plays an enormous role. If you choose a profession to help people and then find you spend more time with quality assurance sheets and forms than with patients, then one is justifiably angered.’

The President of the German Physicians’ Association (Bundesärztekammer), Professor Jörg-Dietrich Hoppe, supports Dr Rösler’s reform plans. ‘Other criteria have to be added to the Abitur (see box) grade for admission to the study of medicine,’ he told Die Welt. ‘Thus, commitment to healthcare as a nurse or paramedic and a related course of study compatible with medicine ought to be given more consideration.’ In his opinion the establishment of selection interviews by the universities is essential.

Universities can already admit some students through selection interviews, but they rarely do because of the additional effort required. Therefore most universities use average grades as the decisive selection criterion and assign selection to the ZVS. Thus, in the German healthcare system, personal suitability and inclination for the medical profession are inadequately assessed. Prof. Hoppe thinks that a fair number of first class Abitur graduates only find out once they have entered practice that they do not like the medical profession or are unsuited to it.

Dr Rösler also raises the spectre of an impending physician shortage as a principal argument for his proposal to abolish the NC. ‘In coming years, a large number of physicians will reach retirement age. Action has to be taken to counteract this effect.’ According to 2008 Federal Statistical Agency data, 390 physicians per 100,000 inhabitants was well above the international average. Dr Rösler admits that the desperate physician shortage is mainly local in nature, with a surplus in urban areas and a noticeable shortage in rural areas. He wants to introduce a rural physician quota in which a certain portion of university places would be granted to those who make a commitment to practice in rural areas upon graduation.

Opponents argue that abolition of the NC might create equality of opportunity among Abitur graduates -- but it will not change the actual physician shortage. The reasons lie above all in the poor remuneration and amount of overtime, according to the federal association of health insurer-licensed physicians.

Many German-trained physicians emigrate. Professor Wilhelm Schmitz, dean of the medical faculty at Münster University, expresses concern that the new Working Hours Protection Acts also reduce the physician’s potential: ‘Whereas in the past it was not unusual for physicians to work 24 to 36 hours straight, today more posts are needed to care for the same number of patients. The healthcare system has yet to respond adequately to these developments. In addition, the increasing feminisation of the profession also leads to a shortage of practising physicians. Nearly 70% of incoming students are women, yet only about two thirds actually end up working with patients after completing their studies.’

Simplified access to medical studies solely by abolition of the NC probably cannot significantly create more physicians: the NC is merely an indication of how desirable a place to study medicine is and that there is little capacity for medical training. Therefore the discrepancy between supply and demand appears to be a far greater problem -- however hard to solve financially. But there are already some signs of initial success: the largest federal state, North Rhine Westphalia, for example, intends to create 100 new places -- a five percent increase -- for medical students by 2011.

Dr Rösler’s NC reform is still supposed to become policy within this legislative period. The Christian-Democratic Union (CDU), senior partner in the German government coalition, intends to support the Federal Health Minister’s planned measures. ‘We welcome the proposals and we, in the coalition, should be able to agree on the key points before the summer recess,’ said CDU health policy expert Jens Spahn.


Numerus clausus (NC) -- The numerus (Lat. number) clausus (Lat. closed, blocked) designates a limit to admissions in certain academic subjects for access to study at universities or polytechnics. These limits are usually based on capacity. In Germany there is a nationwide limit to the number who can be admitted for medical study due to far more applicants per semester than universities can accept. The NC is measured anew each semester. All applicants are sorted by Abitur (school leaving certificate) average grade; those with the highest average are admitted. The grade of the worst candidate admitted constitutes the so-called NC.


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