General practitioners in stress: free choice of doctor versus quick specialist appointment!

General practitioners in stress: free choice of doctor versus quick specialist appointment!

The topic of the healthcare system and the search for a specialist is currently being intensively discussed. On June 16, 2025, heated debates took place in the representative meeting of the National Association of Statutory Health Insurance Physicians (KBV) about the planned primary doctor model, which was presented by Health Minister Nina Warken. The General Practitioners Association criticized the model because, in their opinion, it has “loopholes” and leaves many questions unanswered, especially for patients who want to retain the freedom to choose their doctor. Medical Tribune reports that the KBV system is politically robust. The KBV board remains unimpressed by the critical voices and emphasizes that 90% of medical fees are generated through collective agreements with statutory health insurance (GKV).

The nervousness of the panelists was palpable. In the VV, a position paper on outpatient patient management was passed with only seven votes against and three abstentions. The focus of the debates was the “compulsory primary doctor system” and the possible restriction of the free choice of doctor in the selective and collective income system. Now many want to know how this will affect their healthcare, especially given the current vacancy of around 5,000 GP seats. Dr. Petra Reis-Berkowicz, one of the vaccination speakers, does not see this as an obstacle to introducing the primary doctor system.

Patient care and efficiency

The coalition plans aim to increase the efficiency of the health system. Warken agrees that family doctors in particular should have to overcome fewer bureaucratic hurdles and that digitalization should be promoted. The primary doctor model provides basic care, with the only exceptions being gynecologists and ophthalmologists. What is also new is that in cases where a specialist appointment is not available promptly, there should be the option of switching to a hospital.

However, it was also warned that the planned changes could overwhelm the existing structures. The German Medical Association in particular expressed concerns about treatment coordination. Medical President Klaus Reinhardt pointed out that many patients are solely responsible for organizing their care. Only a third of Germans currently seem interested in a primary care system; the remaining majority would like to retain the freedom to choose a doctor.

Welcome reforms or a bureaucratic brake?

A survey showed that 68% of Germans would be willing to trade their freedom of choice of doctor for faster specialist appointments. This could be a sign of a change in ideas about the healthcare system. The popular appointment service point 116 117 could become a decisive point, especially for insured people without a family doctor. At the same time, there is criticism of the primary doctor model, with the numerous exceptions being viewed as critical. According to Tagesschau there are demands for co-payment for uncontrolled access to specialists in order to change patients' behavior.

But what do the numbers really look like? With 213 hospital admissions per 1,000 inhabitants in 2022, Germany is well above the EU average. This shows that there are major challenges in outpatient care. According to vdek, the proportion of diseases such as diabetes or heart failure that could also be treated on an outpatient basis is worryingly high. At the same time, our healthcare system works well for many patients – access is high and there are relatively few untreated patients.

All of these aspects show that it is time to take a close look at the healthcare system and develop thoughtful reforms to both improve patient care and relieve the burden on the structures. What will happen next with the primary doctor system remains to be seen. In any case, it is clear that the discussions surrounding this topic have only just begun.