Syrian Doctors Are Saving German Lives — and That’s a Problem
More than 1,500 Syrian physicians are working in Germany. Could this be the death knell for Syria’s medical system?
At first glance, all seems well in German health care. In 2013, the country had 4.1 doctors per 1,000 residents, the fifth-highest rate among OECD countries. The following year, the number of doctors in the country rose by 2.3 percent. These figures, however, belie wide disparities and worrying trends.
Germany’s population is aging rapidly: Over 20 percent of people are 65 or older, and at 46.5, the country has one of the world’s highest median ages. A growing number of senior citizens thus require medical care. Many doctors, however, will soon retire — an estimated 51,000 by 2021 — and the proportion of young physicians is shrinking. In 1993, nearly 27 percent of doctors were under 35. Today, that figure has dropped to 18.3 percent. Meanwhile, some 3,000 physicians emigrate each year for employment opportunities abroad.
Among those who stay, many gravitate toward cities, which tend to offer better medical facilities and higher salaries, among other benefits, than small towns do. A 2015 report by the nation’s labor agency showed that Germany’s three city-states — Berlin, Hamburg, and Bremen — are the only regions not already facing doctor shortages. Towns like Sonneberg, 60 miles from Germany’s border with the Czech Republic and home to 24,000 people, bear the consequences. “I’m leaving no stone unturned in trying to bring doctors here,” says politician Christine Zitzmann, Sonneberg’s district administrator. “I tell them that we have a perfect location, incredible transport links, excellent opportunities to build homes.” Yet area hospitals currently have 14 doctor vacancies, including two that have been advertised for more than six months.
Shortages aren’t helped by the fact that doctors are working less: In 2011, some 54,000 doctors worked part time, up from 31,000 a decade prior. In no small part, this is because female doctors limit their hours in order to raise families. “What the statistics don’t show is that the volume of work [physicians] perform is stagnant,” explains Hans-Jörg Freese, a spokesman for Germany’s main doctors’ association, the Marburger Bund. A particularly endangered species is the general practitioner, a role of decreasing prestige in comparison with specialists in fields like neurology. Only 11 percent of medical students say they plan to take up general medicine, according to the newspaper Die Welt, though 40 percent of doctors currently fill that niche. (Germany’s governing coalition recently launched a plan to make medical school more practice oriented and to increase the study of general medicine by 2020.)
Fearing a crisis, the Bundesärztekammer and Marburger Bund have demanded that the government, which funds medical schools and caps the number of students, increase enrollment of doctors-to-be by at least 10 percent. About 10,600 students embark on medical education each year, roughly the same figure as in West Germany before reunification.
Officials have found success in attracting foreign talent. Today, some 4,000 Romanian doctors, 3,000 Greek ones, 2,700 Austrians, and 2,000 Poles are practicing in Germany. (The nation recognizes medical degrees from EU countries.) Several hospitals use recruitment agencies and foreign trade fairs to fill vacancies. In the state of Saxony, the local physicians’ union has launched a project to train 20 doctors annually at Hungary’s University of Pecs; the students receive tuition money in exchange for the promise of working for at least five years as general practitioners in Saxony’s rural areas.
For Syrians, Germany’s doctor enthusiasm comes in the form of relatively low barriers for entering the country. It took Abu Mohammed 30 days to get a short-term travel visa pasted in his passport, which could be replaced by a student visa once he arrived. In March 2015, he boarded a flight to Frankfurt.
A German Foreign Office official, who spoke on background for this story, said Syrian doctors do not get special treatment in the immigration process. Yet other Syrian physicians report experiences similar to Abu Mohammed’s. Arij Mulhem, a vivacious 25-year-old from Damascus who received her German travel visa in Beirut, arrived in the city of Leipzig in March 2015 and completed her language training by the end of the year. Mulhem now insists on speaking German, which she does with skill. “Germany gives us doctors the opportunity to arrive in something other than a dinghy,” she says.
Support networks are forming. Mosab al-Shakaki, another old friend of Abu Mohammed, was studying for a doctorate — on top of his medical degree — in the German state of Saarland when Syria’s war erupted. After completing his studies and an internship, Shakaki began work as a cardiac surgeon at a hospital in the city of Kaiserslautern. He now considers himself something of an informal guide for his compatriots. “It’s not easy to know, ‘Where do I stay? How do I organize myself?’” he explains. “I say, ‘Send me your CV, and if I hear of vacancies I will forward it.’” It was Shakaki who helped Abu Mohammed, whom he’d known since medical school, sign up for his first language class when he arrived from Turkey.