Eyeworld

EW INTERNATIONAL 78 December 2016 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer current economic pressure is leading to optimized surgical outcomes because much like the product optimization on industrial assembly lines, doctors who churn out cata- ract operation after cataract opera- tion generally offer higher quality results than doctors who operate less. Production lines, however, only work with standardized parts. As we know, there are many exceptions to surgery, and complex patients need the right care, too. In the current system, choosing patients who require additional care is a compet- itive area, as these cases are more lucrative," he said. What he sees as potentially dan- gerous is medical decision-making under economic pressure. Indica- tions for cataract surgery or epireti- nal membrane surgery, for instance, are not clearly delineated and can allow the eye doctor to decide at will what is to be done for the patient. "Deciding if a patient is indicated for cataract surgery or epiretinal membrane surgery can massively increase your operation numbers. It is hard not to be lured this way, especially in light of new laws that reduce our incomes for these and other ophthalmologic procedures. But we need to keep things in per- spective. Ask yourself what you'd do if you were responsible: How would you organize the health care system? There are endless things to spend money on in health care—decisions need to be met, increasing demands, needs, and possibilities—making it all very challenging." German policymakers promise German patients all-encompassing free health care. Dr. Helbig thinks that ideal has not been executed for some time. The reality is that patients feel inadequately cared for and doctors have little time for their patients. It seems more like patient care has been reduced to compensa- ble diagnoses and procedures. "Cataract surgery in Germany is thought to encompass 700,000 op- erations a year, making it the most commonly performed surgery of all, with the highest success rate. We restore vision—and it costs as much as half a dental implant. We eye doctors are important contributors to our patients' health care, and in spite of the economic pressure we endure, we take profit losses into problems are all a consequence of the medical system being budgeted." Medical doctors, whether employed or in private practice, are entrepreneurs in their own right, according to Dr. Helbig. Like in any other business, goals are set and need to be met. He explained, "Busi- nesses have goals, so what are ours? These days, our main focus seems to be staying out of the red zone, as opposed to taking more care and better care of our patients. Economic success is the goal of any business— profit. In medicine the primary goal is no longer the patient. Patient care has become a means to an end—that end being profit. At the same time, you have to ask yourself if your enterprise is a non-profit organiza- tion. Ask yourself: How much do you feel like you're part of a business venture?" In a health care system straining under high costs, doctors do their share of adapting and compromising while maintaining their livelihood through a business. Dr. Helbig said that business-like adaptive behaviors in ophthalmology included actions like selecting choice cases, making medical decisions according to affordability or profit, rationalizing structures and processes, and scoring success using input/output business models. "The private conservative office is disappearing. The health care system is encouraging and financial- ly supporting surgical centers that draw on multiple satellite offices as patient feeders, especially for cataract patients. This is the most affordable and efficient setup. The on to pursue an academic career in ophthalmology are now far more likely to consider an additional de- gree in business administration just to survive, Dr. Helbig said. "When I started out, doctors got involved in clinical trials and research because we were always questioning the 'why' and 'how' of things. Today the most common question among doctors seems to be 'How can I get compensated?' These days we all need to think this way. Today's problems arise from three places: flat rate compensations, subpar educational rewards, and the reduction of medicine to a market service." Losing steam Dr. Helbig thinks that the current flat rate compensation system pays doctors at ridiculously low rates, for both private practitioners and hospital doctors alike. Flat rate compensations do not account for different patient needs, professional care is devalued, and is unbalanced on the whole. "Education costs us money, time, effort, and dedication, and although it's the most important as- pect of institutes of higher learning, Germany does not subsidize edu- cation adequately for residents and operators. The irony of this is that it would seem that education has no value because things that do not get financed are not worth financing. Furthermore, reducing medicine to a service changes the trust relation- ship between doctors and patients. It reduces the vocation of a doctor to a job and the patient to a client. These German doctors are taking change and economic pressures in stride and staying focused on what matters most: the patient G erman eye doctors are try- ing to stay focused on their patients. But with medical expenses going up and physician compensation continually going down, it comes as no surprise that doctors are starting to lose their steam. Speaking at the 2016 German Ophthalmological Society (DOG) meeting opening cere- mony, DOG president and director of the Regensburg University eye clinic, Regensburg, Germany, Horst Helbig, MD, and invited speaker Dr. Roland Batz, a Catholic priest and director of the Caritas Association of the Regensburg Diocese, discussed their concerns about compassion, quality patient care, passion for the profes- sion, and the future of research. Losing incentive "The health care system in Ger- many is undergoing changes that strongly affect the ophthalmologic profession, scientific research, and the overall livelihood of eye doc- tors," Dr. Helbig said. "One of the outcomes from the changes we are experiencing in Germany is that young eye doctors are losing their enthusiasm for academic ophthal- mology, which will cause problems in the near future. The number of applicants for medical professorships is currently drastically reduced to single digits. An applicant is as likely to get a professorship now as he was to get a position as an intern 20 years ago." The DOG is dedicated to promoting young researchers by awarding scholarships and funding. The society focuses on advancing scientific progress in ophthalmol- ogy through research and support of scientific projects for the optimi- zation of patient care and medical practices. Presently, however, Dr. Helbig fears that with the changing medical landscape of fewer rewards and the far greater challenges of an aging population, doctors who once aspired to round out their medical know-how with a stint in a univer- sity physiology department and go Reigniting passion for the profession Presentation spotlight continued on page 80

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