The care package aims to make the care profession more attractive. This also applies to the status of physicians on the panel. Health and Social Affairs Minister Johannes Rauch explains how this should be done and what other plans he has for improving the health and care system.
AUSTRIA. 76,000 nurses missing by 2030, fewer panel doctors: the health system is faltering. Social Minister Johannes Rauch (Greens) explains in an interview with Meinbezirk.at what reforms he is planning in Austria.
RegionalMedien Austria: The amendment to the Health and Nursing Act was recently introduced in an initiative motion in the plenary session of the National Council. This measure of the second part of the care reform includes, among other things, that qualified nursing staff who are employed can, in the future, independently prescribe medical devices. Why shouldn’t this also apply to self-employed caregivers?
Johannes Rauch: Of course, the new regulation also applies to all qualified nursing staff, including the self-employed. Our goal is to give well-trained people more nursing skills. This also affects, for example, the ranking on the Care Grant application or activities for which there were initial reservations. We’re not done yet. There will also be a next step in the Health and Nursing Act. We want to have more faith in people who have a good education. This applies to all areas. When it comes to care, the following applies more than anywhere else: the more outpatient, the better. After all, people want to be taken care of at home as long as possible!
Does this mean there will also be these improvements for self-employed caregivers?
Yes of course. The bill makes no distinction whether qualified nursing staff are self-employed or employed. We invested a billion euros with Care Package One and have already contributed to better working conditions. We also invest a lot in training. It’s working. The demand for these internships is increasing. In the second package, powers were extended, and in the next five years it is also a question of safeguarding the measures that have been decided upon. We will need an additional 76,000 nurses by 2030, which poses major challenges for us.
So we come to the next point. The relief organization demands that skilled workers be brought in from abroad as soon as possible. Austria has brought only 130 skilled workers from third countries since 2017, while Germany has around 20,000. What are other countries doing better? What stumbling blocks are still in the way? What is the role of the Red-White-Red Card in this context?
For too long in Austria we have maintained a policy of defense against everything that comes from outside. They didn’t want anyone in the country. It was said that foreigners were dangerous. There, everything was mixed up: asylum policy, foreign policy, immigration. We now feel a competitive disadvantage compared to Germany and many other European member states. In plain language: Anyone who says we don’t need skilled recruitment from abroad is lying to the people and is responsible for the fact that we have a nursing shortage. We need foreign nurses, we have to actively recruit them.
And how is that supposed to work now? What are the concrete plans. or stumbling blocks?
We will facilitate the recognition of professional training abroad. Currently, this is bureaucratic and very difficult. We want to look at how we can better manage the active recruitment of personnel from abroad through a federal institution, as is the case in Germany. Because, in my opinion, it doesn’t make sense if each nursing home or each federal state does its own search. In other words, we want to offer active nursing staff recruitment, training and language acquisition abroad, and let people know that they can also get further training in Austria and will find good working conditions here. We have to make ourselves more attractive, otherwise we won’t get the skilled workers.
Assistance for the Disabled: Last year, you announced that, based on needs assessments in the federal states, your ministry would work on the keys to a one-stop shop for personal assistance by 2023 at the latest. Has the pilot project started yet? Is there a single point of contact for support offers?
Personal assistance is now being normalized in work and leisure, namely in salaried work and not in precarious work, ie part-time work or marginal work. That’s a milestone. We are starting in the three federal states of Tyrol, Salzburg and Vorarlberg and this will be rolled out across Austria. In addition – and this is also part of the financial equalization negotiations – we are considering how we can improve conditions for people with disabilities in general. For example, it is wages rather than allowances for people with disabilities who work in institutions, so that they are not tricked out of a few euros, but protected in terms of social security and pension rights.
In order to improve medical care across Austria, the expansion of primary care facilities (PVE) must be accelerated. That means: tripling to 127 centers by 2025. And as part of the health system reform, an additional 100 places are planned for panel physicians. The president of the Medical Association of Upper Austria, Peter Niedermoser, views this critically because it is not the centers that are lacking, but the doctors.
Even the representatives of medical associations already consider the PVE a model for the future, also due to the extended opening hours, because they can be reached quickly by everyone and the range of services for patients is very wide. We already have 40 PVEs, 33 more are currently planned, five of them for children. This simply means better service to the population, even in rural areas. And that’s what it’s about. It is no longer so easy to find a country doctor who will take care of everything himself. In the future, different professional groups will exchange ideas and offer the best possible service in the shortest possible time. That’s why we invest a lot of energy and money here.
But where are we to get the doctors from? We don’t want to create any “ghost centers”.
The fact that we have few doctors in Austria is misinformation. We are really among the best in the EU. We have always trained the same number of doctors in Austria over the last 15 years. However, there is a trend to no longer go to the health plan’s office, but to the alternative doctor’s office, because there are better opportunities to earn money because you can set your own office hours there. That’s why we now want to improve working conditions for resident physicians. We want to invest more money in this area. In return, the supply will increase.
Can you imagine general practitioners also being recognized as specialists?
That’s exactly what we’re working on right now. The specialization for general practitioners is an essential step that is in its final phase. That will come too. This is an old wish of doctors and the medical association.
ÖGK President Andreas Huss is considering abolishing the elective medical system because “this non-transparent mixing of the two systems – public and private health” does not exist across Europe, as he said at the RegionalMedien discussion round on care. Will the ban on sideline cash register jobs be lifted?
Part-time work is particularly a problem when doctors work in state hospitals and run a private practice at the same time. Regulation is the responsibility of the federal states. I don’t believe in prohibition, I believe in improving working conditions. Therefore, it should become more attractive to obtain health insurance contracts. On the other hand, opening a private practice should become less attractive. The chosen physicians will also be connected to ELGA in the future.
Few Austrians pass the medical entrance exams, mainly because German colleagues enroll here. At the same time, they return to their homeland and leave a hole. Specifically: 35 percent of the approximately 15,380 medical students in Austria are foreigners. More than three-quarters of German medical students leave Austria after completing their studies, as shown by a new study commissioned by the state government of Lower Austria. Are you in favor of restricting access to study for German students, as is currently required in Lower Austria?
We have to move forward on the basis of European legislation. There is a freedom to study or settle down. Therefore, the ban on coming to Austria and studying here is problematic. We are struggling with the problem of foreign students leaving because working conditions in Switzerland, England and Germany are better. Our job is to make working conditions so attractive that people stay in Austria. A second point concerns admission regulations for medical studies. These should be more practical. In addition to memorizing, soft skills should play a more important role here. This is a matter for the Ministry of Education now. The most important point is that we must be able to ensure that people who complete a medical course also enter the private sector, that is, accept health insurance contracts, and not all go into private practice.
According to the ÖGK, 97% of the more than 8,000 checkout counters in Austria are already occupied. So we’re actually talking about just three percent, which is lacking here, particularly in rural areas. How can such a small number of vacancies lead to a shortage of statutory health doctors with – in some disciplines – months of waiting for appointments and the number of elective doctors (currently 11,000) has been steadily increasing for years because there is obviously a market for them ?
Firstly, there are regional differences, also at the subject level. We have a huge shortage of pediatricians. In the future, two pediatricians could join forces with a representative of another health profession and form a basic child health unit. In principle, we have to establish a new logic for patients: the first point of contact must be digital, then outpatient, then inpatient. This means that digital and outpatient services are to be expanded, for example, so that you can get in-depth help via digital services or telephone (1450) and the path through the Austrian healthcare system is shown. So that, if you have certain symptoms to report, you can make an appointment with a doctor residing within a radius of 20 kilometers to clarify the cause there. In other countries, like Finland and Israel, this works fine. You don’t need to go to the hospital right away if you have symptoms.
Is it an option that physicians can only practice privately if they are employed full time?
Yes, it would be an option. But the employers in state hospitals are the federal states. I think it takes a little courage to do that. It is also a matter of working conditions and pay. Nursing staff and the medical profession are often heavily overloaded and also covered by bureaucratic obligations. A lot needs to be digitized so that these professional groups can be there for what they should be, namely working directly with patients and not on the computer or on paper.
Is this also another step in the direction of telemedicine? Because in Austria we are still relatively far away.
There is huge potential there. And there is a lot of rapid development all over the world. We discussed this at the WHO conference in Geneva with European health ministers. This has the potential for patients to obtain accurate clarification much more quickly, including the possibility to compare findings in Austria with international databases. For example, dubious cancer findings can be analyzed with artificial intelligence with an accuracy of over 90%, rather than just over 80%, as is currently the case. And I think it also has the potential to get help quickly, easily and easily rather than having to go to the hospital.
Are there concrete plans for Austria?
On the issue of digitalization, there is a plan in conjunction with Secretary of State Tursky to make the ELGA system suitable for this. Because with ELGA we have a system that works very well and therefore an advantage. It doesn’t matter if it’s an X-ray, medicine or findings: these things must be collected for patients throughout their lives in a place where they can always be accessed in a secure system, available at all times. That is the goal.
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