The career expectations of medical students: findings of a nationwide survey in Germany.

BACKGROUND: Demographic change, technical progress, and changing patterns of service use influence the future demand for physicians in the German health care system. The attitudes of medical students towards their later work in the health system is important for current health care planning. For that reason a nationwide survey aimed to identify major trends in preferred specialty, workplace characteristics (regional location, hospital) and perceived hindrances for clinical work. METHODS: A questionnaire consisting of 34 closed questions was developed at the University of Mainz in 2009 and administered over the Internet in June and July 2010 to all medical students in Germany. The questions addressed the students' intentions regarding specialty training, location of practice, workload, and regional preference, as well as potential reasons why they might choose not to practice clinical medicine in the future. RESULTS: 12 518 web-based questionnaires were filled in (approx. 15.7% of all medical students in Germany in 2010). The mean age was 24.9 years, with 64% female and 36% male. Favored specialties were internal medicine (42.6%), family medicine (29.6%), pediatrics (27.0%) and surgery (26.8%). Nearly all respondents (96%) stated that they attached importance to compatibility of work and family life. Working in a salaried position (92.2%) was preferred to working in private practice (77.7%). General practice, in particular in rural locations, was significantly less favored than work as a specialist in cities. CONCLUSION: Although the coming generation of physicians anticipate working in clincial settings in the future, shortfalls in the areas of primary care and in rural locations are likely if medical students adhere to their preferences stated in the questionnaire.

[Medical service centres: are they really the future of ambulatory care in Germany?]. / Medizinisches Versorgungszentrum--Ausnahmefall oder Regelversorgung der Zukunft? Eine Bestandsaufnahme.

Due to governmental regulation in 2004 new options to establish ambulatory care facilities have become available and are widely used by healthcare providers. Medical service centres (Medizinische Versorgungszentren, MVZs) are characterised by the obligation for interdisciplinary teams of physicians, extended options for the employment of physicians and finally by flexible avenues of investment regarding the establishment of medical service centres. Medical service centres aim to improve ambulatory healthcare provision via an integrated service approach and offer opportunities for hospitals and third-party payers to set foot into the ambulatory healthcare sector. The rise of MVZs has therefore been closely and quite sceptically watched by the medical profession. The spread of MVZs is constant but limited to a modest growth rate. 250 MVZs are set up annually; in summer 2009 a total number of about 1300 had been reached, which is fairly small compared to 92,000 individual and group practices. The prominent specialities include general medicine, internal medicine, and surgery. The majority of MVZs are located in urban and suburban areas. Especially hospitals have, however, been using this approach to establish and operate ambulatory care centres with employed physicians. It remains to be seen whether and to what extent MVZs will improve service provision to the benefit of patients or mainly represent a new business model compromising existing structures. Continuous evaluation of trends is therefore essential for the further development of new ambulatory care structures.

Total-body irradiation--role and indications: results from the German Registry for Stem Cell Transplantation (DRST).

BACKGROUND AND PURPOSE: Total-body irradiation (TBI) is a key part of the conditioning regimen before hematopoietic stem cell transplantation (HSCT). The exact role of TBI as part of the conditioning regimen is largely unclear. In order to determine the relevance of TBI, the status of TBI utilization was analyzed on the basis of a nationwide registry. MATERIAL AND METHODS: 14,371 patients (1998-2002) documented in the German Stem Cell Transplantation Registry (DRST) were analyzed regarding TBI utilization prior to autologous or allogeneic transplantation, underlying disorder, type of donor, stem cell source, and size of the treatment center. RESULTS: For autologous HSCT approximately 10% of the patients (873/8,167) received TBI, with chronic lymphocytic leukemia (CLL, approximately 80%, 171/214) and low-grade non-Hodgkin's lymphoma (l-NHL, approximately 35%, 330/929) being the most important disorders. In the allogeneic setting 50% of the patients (2,399/4,904) received TBI, with acute lymphocytic leukemia (ALL, 85%, 794/930), acute myeloid leukemia (AML, 45%, 662/1,487) and chronic myeloid leukemia (CML, 49%, 561/1,156) being the key indications. The type of donor, stem cell source and center size did not strongly influence the use of TBI. CONCLUSION: TBI has only a limited role for the conditioning prior to autologous HCST. For allogeneic HSCT TBI is widely accepted with no major changes over the observation time. The use of TBI is generally accepted for ALL, whereas approximately half of the patients with CML or AML received TBI. Although a considerably large database was analyzed, no clear determinants for the use of TBI could be distinguished.