International Guest of Honor: German Association of Ear-Nose and Throat Surgeons

The German Association of Ear-Nose and Throat Surgeons—the Political Think Tank of German ORL

Dirk Heinrich, MD, PhD, President

In 1950, the German ENT surgeons felt the need to organize themselves because a new medical fee schedule was to be implemented on the federal level. Due to its statute, the scientific society of ORL was not allowed to deal with this matter, and in 1951, the German Association of ENT Surgeons (Deutscher Berufsverband der Hals-Nasen-Ohrenaerzte e.V.) was founded. In the beginning, the task was to take care of the economic aspects of the profession. But in 1967, the Association held its first convention. The purpose was to provide continuous medical education to all ENT surgeons. The lectures and the practical courses for new methods and skills were greatly accepted.

Today, the convention of the Association also includes the largest industrial exhibition of ENT-related equipment, medication, and machinery in Europe. There are about 6,000 ENT Surgeons in Germany, of which 4,347 work out of their own private practice and 1,467 work in a hospital. In Germany, outpatient care is done by ENT surgeons who have their own private office/practice even though they see mainly patients who are insured by the mandatory sickness funds. Hospital-based doctors deal only with patients who were admitted to the hospital. Over the years, the Association has become the home of about 90 percent of all ENT surgeons with a private practice, but also a good number of hospital-based doctors have joined the Association. Currently, it has about 5,000 members.

The Association is the partner of all major players in the medical field in Germany, including the Chamber of Physicians, the Sickness Funds Doctors Association, the Sickness Funds, the Government, the Minister of Health, and numerous other organizations. It negotiates the medical fee schedule for ORL and all other rules and guidelines in the medical field. Whenever necessary, these activities are coordinated with our scientific society, the Deutsche Gesellschaft fuer Hals-Nasen-Ohrenheilkunde.The president of the Association is on the Board of Governors of the scientific society, and vice versa. The Association is organized on the federal level as well as on the state level, because rules in the medical field are often different in the 16 states of the Federal Republic of Germany. The Board of Directors consists of the 16 regional chairs and two representatives from the scientific society. The two organizations also run the German ENT Study Center in order to direct these studies more toward the evidence gaps in ORL.

ORL in Germany faces major challenges. Compared to other countries, the number of hospitalized patients is significantly higher. The government is clearly heading toward more ambulatory care. This will lead to structural changes in ORL. Hospitals will be closed. Surgical procedures will be done in joint ventures of hospitals and private practices. It is the purpose of the Association not only to monitor these upcoming changes, but also to influence them as much as possible—or even invent and manage model ventures to overcome the division of outpatient and hospital-based patient care in Germany. Most medical specialties in Germany have a scientific society but also an association. These associations form a very powerful organization on the federal level, the Spitzenverband Fachaerzte Deutschlands, the top association of all medical specialists, which represents 150,000 physicians. Currently, the president of the ENT Association is also the president of this top association.