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Germany

Frauenheilkunde und Geburtshilfe (Germany)


  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       

     

    Yes. We have examined the rules set out in the (Model) Speciality Training Regulations on speciality training for doctors. Speciality training for doctors involves the imparting of medical skills to professionals who have already gained a doctor’s qualification, followed by the granting of a licence that allows them to practise the relevant medical activity. In order to undertake speciality training for doctors, a licence to practise the profession of doctor must be held.

    As bodies organised under public law, in Germany, the medical associations of the Länder are responsible for all matters of speciality training for doctors. The (Model) Speciality Training Regulations drawn up by the German Medical Association merely serve as a recommendation to the medical associations of the Länder. Doctors are legally bound by the Speciality Training Regulations of the Länder medical association  to which they belong, not by any other.

    The (Model) Speciality Training Regulations upon which the Speciality Training Regulations of the Länder are based are neither directly nor indirectly discriminatory on the basis of nationality or place of residence. This is substantiated in the answers provided below.

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
         
    • Public health
    •    
    • Protection of consumers and recipients of services

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       

    The Speciality Training Regulations serve to

     

    1. protect public health and patients

    2. ensure the quality of patient care and

    3. act as a guide to members of the public/patients.

       

      They ensure that no significant damage to health, and no material or non-material damage occurs as a result of poor quality health services provided by doctors who have not received adequate training.

       


    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       

    Länder law has established, for example, medical associations for doctors, which serve as professional bodies. These are bodies organised under public law. All doctors are members of their respective medical association.

     

    Under the relevant laws, the medical associations of the Länder represent the professional interests of their members, check that professional requirements have been met, promote further training, and play a part in public health care. In this way, they ensure that the health services provided in the area covered by their professional association are consistently of a high quality, in order to protect public health, patients, and recipients of services.

     

    One of the key tasks of the medical associations of the Länder is thus to regulate speciality training in their Speciality Training Regulations. Speciality training is essential in order to ensure that healthcare services remain of a high quality.

     

    The role undertaken by the professional associations is therefore vital for the provision of high-quality medical care for the general public, and for ensuring a high level of protection for patients.


    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

       

    The training that is provided on the basis of the respective Speciality Training Regulations focuses in each case on the practical application of medical knowledge in outpatient, inpatient and rehabilitative care. Speciality training is conducted at licensed training facilities, where trainees undertake the relevant medical activity on a full-time basis, receiving adequate remuneration. The training is provided by authorised doctors and involves practice of the medical activity and theory lessons and, in some cases, requires trainees to pass recognised courses. Successful completion of the speciality training to be documented is attested upon the basis of written assessments drawn up by the person authorised to provide training, as well as an examination. If the speciality training is completed successfully, a certificate recognising this is issued. The designation of the speciality training course acts as evidence of the skills acquired. It serves to ensure the quality of patient care and acts as a guide to members of the public/patients.


    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       

    Yes. The Speciality Training Regulations developed by the medical associations of the Länder serve as vital guarantees that doctors are trained to a consistently high degree of quality and that the quality of the health services they provide are also consistently high.


    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       

    Performing the tasks of this medical specialty requires a high level of expertise and implies direct and substantial risks for patients’ health and safety.

     


    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       

    For the purposes of answering this survey, the ‘Speciality Training Regulation of the medical associations of the Länder’ is understood as one measure. This question is therefore not applicable.


    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
         
    • Other, please specify

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       

    The Speciality Training Regulations of the medical associations of the Länder have proved their worth. Given that this is an area of particular public interest, for which the highest levels of protection are sought, there

    are no other alternative mechanisms that could be used to achieve the desired outcomes. In particular, we cannot accept that the common training framework under Article 49a of the revised Professional Qualifications Directive can lead to the introduction of parallel structures that allow private organisations to make use of a ‘delegated act’ to set their own training plans and requirements and thus to level out the quality of patient care. The quality standards that must be met under the professional and training regulations in force guarantee a high level of patient protection. This must not be allowed to be subject to individual interests and market forces.

     

    In accordance with the laws on medical professions and medical associations passed by the parliaments of the Länder, it is incumbent upon the medical associations of the Länder to regulate, supervise, and conduct training, including content and examinations. A democratic decision was taken to confer this responsibility to the medical associations – the reason being that it is the medical profession which holds the expertise and which should take on complete responsibility. When setting the relevant requirements, the medical profession should ensure a balance of interests between all of the doctors. The common training framework under Article 49a of the revised Professional Qualifications Directive, on the other hand, enables private organisations, which are not subject to any state supervision whatsoever, to exert an influence on the setting of these requirements, although they have no legitimacy in doing so. Ultimately, the common training framework, in actual fact, turns the idea of the medical associations having complete responsibility to ensure a balance of interests – as originally prescribed in legislation enacted by the Länder – into something farcical.


    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Maintain current system

       Explain where relevant:

       See answer to question 9.

    11. Any other comments?
       None.
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