Dr. Frank Ulrich Montgomery, director of the Marburger Bund, says that overworked doctors are a prime concern for his organization and the medical community.

"Everyone knows about the catastrophic working conditions in hospitals and the exhausted doctors, who even after a 30-hour shift are forced to treat patients," he says, but the government has done nothing to improve the situation.

The Marburger Bund wants to change what many doctors have come to regard as a "matter-of-fact" work load. In a highly-publicized action, the association for German doctors has given the government an ultimatum: pass a law regulating doctor’s working hours or else we’ll strike.

Dr. Montgomery justifies the ultimatum by pointing to a law passed by the European Court in October 2000 regulating doctors’ working hours. In the law, the EU says doctors may only work a fair number of hours and that "on-call" time needs to be calculated into the overall work hours.

In Germany, a doctor’s working week consists of his normal working hours (at least 40) plus the hours he has to remain "on-call", ready to run to the hospital and take up his duties whenever an emergency occurs.

In most other European countries such as in France and Denmark, "on call" time is calculated into the doctor’s work week. In Germany this is not the case, even if the doctor spends his on-call time in the hospital.

German hospitals and health insurance providers resist equating on-call time to work hours, because they know that every German doctor would be working far more than 40 hours a week and demanding extensive overtime pay. Most hospitals do not have enough money to pay for overtime, and insurance companies are worried about keeping costs down.

The Marburger Bund, speaking on behalf of 75,000 doctors, urges the government to pass a law regulating work hours to include on-call time, hire 15,000 new doctors to alleviate the work load, and increase hospital budgets by at least one billion euro.

Strike

The Marburger Bund, which is the largest doctor’s association in Germany and Europe, has threatened the government with a Computer Strike if its demands are not met in the next health reform bill scheduled for March.

For the first phase of the strike, doctors are being called upon to document all their overtime and to submit requests for overtime pay in hospital personnel departments. Doctors should also demand that hospital directors establish concrete guidelines on overtime work.

This way the government will be forced to examine the proof of the "shocking" work situation in German hospitals. According to the Marburger Bund, doctors work some 50 million hours overtime without pay each year.

If the government still does not do anything to stop the "exploitation" of doctors, Dr. Montgomery warns that they will strike by refusing to do paper work, including the filling out of formulas for health insurance providers. This would obstruct the entire financial apparatus of the health care system.

Say no to more paper work

A good portion of a doctor’s work week is spent filling out paper work for insurance providers. The companies have a very detailed list of codes, one for each type of sickness, treatment and medication.

Doctors are required to use the codes for describing how they care for a patient. The entire insurance payment plan is based on the code system. A false code can lead to an incorrect reimbursement of funds from the health insurance company.

Encoding medical care is a timely process. Doctors are supposed to document every stage of a patient’s treatment, including the initial consulting, check up, laboratory work, diagnosis, treatment, prescriptions and whatever else comes up

"Every time I have to fill in the codes, I need to check them up in the giant code book. And they’re constantly changing. Last year, for example, a heart attack was I20.8, this year it’s I20.3, or something like that. I spend about one and a half hours a day just filling out the forms for the health insurance companies. I’ve become a secretary," Dr. Hirschler says.

With its Computer Strike, the Marburger Bund supports overworked doctors who lay down their paperwork and say "enough! Let me do what I was trained to do: take care of people."

The issue of overworked doctors goes beyond a mere discussion of economics. It concerns the quality of health care in Germany. If the only problem on politicians’ minds is the bottom line, patients will suffer. The planned Computer Strike and paper boycott is a drastic step, but will certainly attract the government’s attention.