Lots of German Doctors Head to the U.S., Few to California

Germany is facing a shortage of doctors as physicians leave the country for higher pay and better conditions elsewhere. Many end up in the United States; but KPCC's Susan Valot explains why relatively few of them land in California.

Susan Valot: People in town greet Doctor Uwe Ruehlow as he walks to his office in the shadow of an 800-year-old church in Bergen. It's surrounded by lakes and farms on Germany's largest Baltic Sea island, Ruegen.

Ruehlow's a rarity in these parts – a young, general practice doctor who's opted to stay in former East Germany. He followed in the footsteps of his dad, who also was a doctor.

Uwe Ruehlow: If you have no, no roots here, you have no reason to get a job here. You can get to the West side, and everything is a little bit easier and a little bit better.

Valot: That's why Germany's facing a doctor shortage, particularly in the rural areas of the former East.

Ruehlow: We have to work more for the same money. And we get 80% from the West Germany money. And we have 125% of the patients.

Valot: Doctor Ruehlow says money isn't everything. He's staying put. But more than 12,000 German doctors have already left for greener pastures in other countries, like the U.K. and the U.S. Lars Weber teaches economics at the Technical University in Cottbus, southeast of Berlin. He's studied the German healthcare system.

Lars Weber: It's not very attractive for a young doctor who has finished his university to be a general doctor, because he has to face a lot of challenges, like traveling a lot, earning less money, doing a lot of social things to patients.

Valot: Things like good old-fashioned house calls, all for a pay structure that nets less than half of what an American doctor makes. German doctors also complain they're overrun by paperwork and bureaucracy. Doctor Markus Schwan, who works at a pediatric hospital in northern Germany, says training's an issue, too.

Markus Schwan: Sometimes it seems that training, especially the young doctors, is just a sort of side effect of working there. That's, I think how it is still sometimes seen over here. It's not very, uh, very well organized.

Valot: Doctor Tareg Bey at UC Irvine Medical Center agrees those are all problems that send German doctors packing. He says it's especially tough for new doctors trying to build careers in what used to be East Germany.

Tareg Bey: Because the people lived there kind of locked away for 40, 50 years, it's also about their way of living with each other. It's almost like these people speak the same language, but they're quite different in daily communication in their views. And a lot of the westerners have a lot of problems, especially when they come from awestern city going into an eastern rural area. They find themselves like almost displaced on another planet.

Valot: Bey knows what it's like to resettle. The German-native came to the U.S. more than a decade ago to practice medicine. He says foreign doctors must meet both national and California standards before doing a residency here. If you already did your residency in Germany and want to just move your practice, forget it.

Bey: You have to start from scratch. Even if you have worked in your country of origin even 5, 6, or 7 years, all what you will bring is your experience. But none of your post-graduate credits are accepted and you would have to start over as an intern.

Valot: Even though parts of California are facing physician shortages themselves, lawmakers haven't relaxed immigration rules for doctors. Immigrant physicians need a sponsor in order to stay in the U.S. under current J-1 visa rules. Attorney Greg Siskind helps foreign doctors maneuver through the visa system. He says the government limits sponsored doctors to 30 per state, per year to work in underserved areas.

Greg Siskind: Thirty is a drop in the bucket for what California needs. And for most doctors, I know they don't even look at California when they're dealing with the J-1 because there's no point. They're not gonna get a waiver. There's not enough available. So they might as well spend– better off spending their efforts on a place that's more realistic.

Valot: Siskind says doctors can try to apply for a different kind of visa, an H-1B. But for every one available, two to three people apply. Some experts predict in the next decade, the Golden State will be 17,000 doctors short. As more and more of California's doctors retire, the state's grappling with ways to fill the gap. New medical schools, like the one planned at UC Riverside, might help. But others argue the shortage needs a booster shot now, in the form of relaxed immigration rules for physicians.