Page 43 - Rebrame - 2022 - Ed. 1

Revue E

The German system use a liberal medicine that seems better Senior doctors (“oberartz”) are paid around €4,500/month,
distributed on the territory and better controlled. assistants (“assistenzartz”, interns after 1 years of training)
€3,500/month and first-year interns (“Artz Im Practikum or
• Pre-hospital emergencies, with the regulation of
non-medical urgent calls and a significantly variable “AIP”) €1200/month. Guards are paid in addition to salary.
organization depending on the region, Assistants have the same level of responsibility as interns
in France. - All doctors are employees under contract. -
• Intra-hospital emergencies, which are neither a Doctors work (in theory) 38.5 hours per week.
specialty in their own right nor an independent service.

The German healthcare system has been based on SPAIN:
compulsory health insurance since its foundation by
Bismarck in 1883 . • (Sub)Specialty: 1988
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• N of Doctors/inhabitant: 3.87‰ (+91% in 30 years)
There are 2,260 hospitals with about 572,000 acute
hospitalization beds, corresponding to an average of 7 beds • Number of emergency physicians: > 8,000 (2021)
per 1,000 inhabitants in 1998 (figure varying according to
the Länder, nevertheless very clearly above the European Spain has one of the most efficient health systems in
average which is 4.5) . the world according to the Bloomberg Health Efficiency
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Index (2018).
There is no recognized EM specialty in Germany: an
emergency medicine sub-specialty with 2 years of One of the main reasons for this achievement is the
additional training (anaesthesia, general medicine, internal Electronic Health Records (EHR) system implemented
medicine, neurology, pediatrics or surgery), including 6 more than 20 years ago in the country. This system has
months of training in an intensive care unit, interdisciplinary improved communication between patients and healthcare
theoretical courses, 50 outings in medical ambulances professionals and helped accelerate research by enhancing
under the responsibility of an experienced doctor and a the ability to diagnose disease and improving clinical
final exam. This qualification is not mandatory to work in accuracy and outcomes. Another key success factor for
emergency medicine. the digitalization of healthcare in the country are the many
startups that are present there. For example, Doctoralia is
There are 2 types of emergency physicians a recognized digital platform, born from a Spanish startup,
.10:
helps around 200 million users a year to find doctors and
• hospital employees and practice in different specialties get appointments in 20 different countries.
(anaesthesia, surgery, internal medicine) they must
respond to urgent calls, for which they are not paid if General medicine seems better organized, totally public,
they occur during their working hours at the hospital; with health centers and emergency consultations 24 hours a
• The other doctors practicing in the ED, better trained, day. But the long waiting times encourage patients to resort
more experienced, more motivated, and paid for each too systematically to the emergency room. 2/3 of Spanish
intervention . population (20 million) call on the emergency services
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each year with a part that should be taken care of on an
Germany presents a uniform emergency system for each ambulatory or primary care.
Länder, with legislative provisions regulating the structure
of the service, the qualification of the personnel and the Emergency room consultations are completely free for
financing of the system. The emergency medicine system patients. There are generally too many doctors in Spain,
must be accessible to all citizens. The state can delegate except in the ED. With 3.4 donors per million deceased
this responsibility in whole or in part to other organizations, inhabitants (28.7 in France), Spain (particularly Barcelona
such as the fire brigade, the German Red Cross (DRK), and Madrid) has held the world record for organ donation
including private emergency medicine companies. The and grafts for 30 years.
emergency rescue service or “Nottfallrettung” and medical Emergency services funded by hospitals, operating with
transport form a set of secondary prevention health dedicated staff. Emergencies are separated into 2 distinct
organization 13,15. Hospitals organize their emergencies concepts: - “urgencias”, corresponding to urgent situations
freely, but the majority of emergency rooms correspond to not involving vital risk, - the “emergencias”, where the vital
reception areas attached to internal medicine departments, risk is committed.
with nurses assigned to the department and doctors from
other disciplines taking turns on duty. Patients are sorted General practitioners have a legal obligation to perform
upon arrival, according to symptomatologic criteria specific night shifts, on Sundays and on public holidays, but in this
to the service, by an experienced nurse, then referred to obligation is not respected in large cities.
the appropriate specialist according to the level of urgency.

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