A Hard Day's Night

The past two days have been nonstop. Yesterday we visited the Hannover medical school and nephrology department in the main city hospital. We listened to a lecture on Germany's current health care system and took a tour of their research facilities. We had another lecture on nephrology research and ate lunch in a nearby cafeteria. In the afternoon we took a trip to the zoo and got to go on a guided tour given by one of the head veterninarians. It was snowing and was about 15 degrees so we didn't know how it was going to go but it was amazing. Because most of the animals were inside because of the weather, we got to go behind the scenes to see them. We saw hippos, rhinos, and gorillas and afterwards went to this winter park they had set up in the corner of the park. They had awesome sledding and ice skating, it was unlike anything I had seen at a zoo before.

Needless to say, we had a blast but it wasn't over yet. We got to eat dinner at a fraternity that houses mostly veterinary and medical students. The guys, and a few girls, were really nice and welcoming. We had a blast. Today was a bit different, we had a lecture on the Nuremberg Doctor Trials which was pretty interesting (would have been more interesting if I wasn't so tired) in the morning and took a tour of an animal testing facility next to the hospital we visited yesterday. It was also really cool to see, it reminded me of my old job at the cardiovascular surgery research lab at Texas Heart Institute. After that we headed back to the hotel and finally got a chance to do some laundry. I had to wash nearly everything I brought, so my packing was evidently pretty good. Tomorow we're off to Goettingen in the morning and then to Amsterdam that night... should be interesting.

Okay, back to the health care system once again. Ever since I started my med school interviews I've been brushing up on our health care system currently and each presidential candidate's position on the issue. So going into this trip I was eager to hear about Germany's system and didn't expect a lecture like this at all. The German system, which has only been in place for about 6 years, is a nice mix of public and private health insurace. Basically, all working citizens are covered by a uniform benefit system that is not optional and exactly the same for anyone. This makes it easier for employers, who don't have to spend time coming up with attractive packages, and employees, who don't have to switch insurance every time they change jobs. The amount of the premium is 15.6% of the employees salary. Insurance companies give money based on a system called Diagnostic Related Groups (DRGs), in which insurance companies give a standard amount based on the cheif complaint.

This sounds a lot like socialized medicine, and it would be if the system stopped at that, but there's one more facet of the system. If a citizen makes over between 60,000 and 70,000 euros a year, they can opt out of the public insurance and go private or be uninsured. Private insurance premiums vary based on salary, and the perecentages go down as the citizen's salary goes up so that wealthier individuals aren't paying a ridiculous amount of money for health insurance.

Here's the catch, doctor's salaries are much lower here than back in the states. Fellows make around 62,000 euros a year (just under 80,000 dollars a year) and a head of a department makes about 120,000 euros a year (about 150,000 dollars a year). That would sound terrible for an American doctor, but that's partly because doctors in America come out of school with, on average, over 100,000 dollars in student loan debt. In Germany, medical education is pretty much free. I think students pay about 500 euros a semester for their education, a ridiculously low number compared to the states. So it balances out more that it sounds when everything is taken into consideration. Quality of care in Germany is good, but not great. Doctors in Germany speak great English because almost all have received some kind of medical training in the states. The hospital was pretty nice and my impression was that patient's received good care in spite of their health care system.

Anyway, that's my two cents. It will be interesting to see what happens in the next few years in America and abroad. I know I'll be paying very close attention. I love and miss everyone back home and hope you're all doing well!

PEACE

Asher