According to federal statistics, there is an oversupply of medical supplies in many places. The general practitioners and paediatricians are horrified: the numbers are completely wrong.
Federal Councilor Alain Berset comments on the shortage of doctors during question time in the National Council.
The situation of medical care in the canton of Friborg is dramatic, at least that’s how the French-speaking Swiss consumer organization FRC put it. In Freiburg it took thirty calls before there was a positive answer. A similar picture emerges in the canton of Zurich. Recently, media reports about long waiting times in the emergency rooms of the children’s hospitals have been piling up. And parents complain that they can no longer find a doctor for their offspring.
The figures on the “regional levels of care” that appear in a recently published report by the Swiss Health Observatory (Obsan) and the BSS consultancy are all the more astonishing. According to the paper, which was commissioned by the Federal Office of Public Health, there is a coverage rate of 99.9 percent for general practitioners in the canton of Friborg and 111 percent for paediatricians in the canton of Zurich. Basel, Zug, Schwyz and Ticino also have a coverage level of over 100 percent for pediatricians.
“A Fata Morgana”
The medical profession reacted with an outcry to the publication of the numbers. The Medical Association FMH speaks of an “own goal”. And the Association of General Practitioners and Paediatricians accuses the BAG of having produced a mirage. He writes sarcastically: “The searching patient rubs his eyes, the patient is surprised if he or she consults the list of levels of care: In most cantons, based on this list of levels of care, the shortage of general practitioners and pediatricians has miraculously disappeared. And many parents could breathe a sigh of relief, pediatric care is guaranteed in the majority of cantons.”
MFE President Philippe Luchsinger criticizes that the numbers are simply wrong, the calculations are incorrect and therefore useless. The anger of the doctors is mainly due to the fact that the levels of care could have real political effects: they are intended to serve as a basis for controlling the freelance doctors. From next year, the cantons will have the right to ban the opening of new practices if there is an oversupply in a medical area.
Health Minister Alain Berset is trying to calm things down. In response to a question from the Green National Councilor Léonore Porchet, he said on Monday that the levels of supply should not be overinterpreted. They are just one element among others that the cantons take into account when assessing health care.
The authors put it into perspective
The authors of the Obsan report also referred to the limits of the degree of coverage as an indicator. This only shows how many medical services the population of a canton consumes in comparison to national averages and taking into account the age structure or the burden of illness in the population (e.g. the number of hospital visits).
So you start from the current state, not from an optimal state. The authors state that the degree of coverage can only be interpreted as a measure of under- or oversupply if the assumption is made that the nationwide supply is at the right level. In most cases, this assumption is critical. “Therefore, a below or above average level of supply is not a sufficient reason to assume undersupply or oversupply.”
Less urgency?
This relativization hardly reassures the general practitioners. Philippe Luchsinger knows that the specialists are more likely to be stopped because there tend to be too many of them and their services are particularly expensive. “But theoretically, Health Director Natalie Rickli could now say that there are more than enough paediatricians in Zurich.” In addition, the medical profession must defend itself against the impression that there are no supply problems in some cantons. “Otherwise politicians will see less urgency to take countermeasures.”
In 2020, Luchsinger’s association published a study on the state of basic medical care. In all parts of the country except Ticino, a majority of the doctors surveyed stated that there was a shortage of general practitioners. And the medium-term prospects are bleak: More than half of the general practitioners working today will probably retire in the next ten years.
From 2030 there is hope
In addition, there is a serious shortage of medical practice assistants (MPA). “Anyone who is successfully looking for an MPA for their practice today must be very lucky,” says Luchsinger. With regard to basic medical care, Switzerland could therefore enter a critical phase as early as next year, warns the President of General Practitioners. “Patients are likely to have more trouble getting an appointment with a family doctor or a pediatrician.”
In the long term, however, there is hope. There could be a recovery from 2030 if Switzerland achieves the goal of offering 1350 places to study medicine by 2025 and one in five young doctors chooses primary care. “If we can keep those who are interested in family medicine on board, then things won’t look so bleak,” says Luchsinger.