Endocrinology in Germany

is on the verge of extinction. At most 2 university hospitals can still afford an endocrinologist as head of clinic (C4). In the other universities, endocrinology is managed by a senior physician who does not have a clinical budget. He is bound by instructions in the clinic, research and teaching.

Why? How could it come to this? In the 1980s, we had 2 full professors at the University Hospital in Düsseldorf (one as an endocrinologist, the second as a diabetologist). Both together had up to 7 C3 senior physicians, each endocrine organ was taught and researched by a specialist. A question about a patient? the accumulated knowledge was at your disposal. The duration of an inpatient stay until the diagnosis was clarified or treatment initiated was often several weeks. The determination of hormones was in the hands of those who had contributed to the development of the analyses, thyroid scintigraphies and radioiodine therapies were carried out by endocrinologists who had also developed them. And nobody else was interested in the widespread diseases of diabetes and osteoporosis (after all, diabetic training and bone density measurements could not yet be billed).

And today: we only need a few days at most for diagnostics in endocrinology, but on an outpatient basis. Training for diabetics on an outpatient basis, of course! Why do we still need beds? However, the staffing ratio of a clinic is determined by the number of beds. If you don’t need beds, then you don’t need medical staff. If the outpatient care of patients also costs the clinics a lot of money and the services are only remunerated with a small lump sum at best, then such a discipline no longer pays off for a clinic. If you then take away the tools of the endocrinology clinics and centralize all laboratory tests in the central laboratory, the heads of administration will think that it is better not to have any more endocrinologists.