Wages: Children have to wait: OP strike by ENT doctors continues

“What?” the lively four-year-old with blond pigtails asks almost every minute. “What did you say?” The little girl from near Munich has fluid in her middle ear after a cold, which has reduced her hearing by 30 percent. In such cases, a small standard operation can help. But the ear, nose and throat doctors (ENT doctors) in Germany have called for a strike in certain “children’s surgeries” – with unlimited duration. And there is no end in sight.

OP is not the same as OP

The reason for this is a dispute about money, but the causes lie deeper. The National Association of Statutory Health Insurance Physicians (KBV), which is the umbrella organization responsible for all financial matters relating to the care of patients with statutory health insurance, had determined in December that only around 107 euros instead of the previous 111 euros would flow for certain interventions. Other OPs, on the other hand, have been upgraded. The ENT doctors complain that the interventions to remove so-called polyps and to insert tympanostomy tubes had already been miserably paid. After the devaluation, they are no longer economical in many places.

For this reason, many doctors are already no longer offering the service, argues the professional association of ENT doctors, who, by their own admission, want to use the strike as a last resort to draw attention to the problem that has been known for a long time. He sees the care of the children in the future at risk.

The bottom line is that the surgeons have only had an average fee of around 10 to 20 euros before deduction of taxes and pension provisions. “When you operate on children, that’s usually the main thing you do, then you’ve adjusted all your processes to it,” says association president Jan Löhler. “That’s why it doesn’t help the child surgeons much if any other operations are upgraded.” The result: Many people reoriented themselves, expert knowledge from doctors and pediatric anesthesiologists was lost.

Number of surgeries nationwide plummeted

In Hamburg, for example, the number of tonsil and middle ear operations has fallen by 76 percent within three years, the association reports, citing accounting figures. The number of operating ENT doctors fell from 50 to 20 from the second quarter of 2019 to the second quarter of 2022. In Baden-Württemberg, outpatient children’s surgeries fell by almost 53 percent, and the number of surgeons by almost 29 percent. In Bavaria, the total number of ENT operations on children fell by almost 32 percent during this period – and thus without corona effects – and that of the doctors operating these services by around 22 percent.

According to a survey by the association, affected children already have to wait more than three months for an appointment in large parts of Germany. With consequences: Enlarged tonsils and pharyngeal tonsils can lead to breathing disorders with breathing pauses and sleep disorders. If a tympanic effusion – an accumulation of fluid behind the eardrum – persists for a long time, speech and language development can be delayed, especially in small children.

The children hear badly, do not react or react inappropriately, and their pronunciation often seems slurred. “You have to try harder with muffled hearing. Some children also get restless because they realize they don’t hear well. It annoys them subliminally, but they can’t consciously reflect on it, especially since it doesn’t hurt,” says Susanne Daniel, Head of the Hearing Impairment Working Group in the Federal Association of Speech Therapy, the consequences.

Interactions could also be difficult. “If you don’t know why the child isn’t reacting, you can also think it doesn’t want to hear,” Daniel knows from experience. “The child doesn’t do it on purpose.” The situation has a particularly serious effect on children who do not have German as their mother tongue.

Deadlock

The central association of statutory health insurance companies had castigated the indefinite strike of the professional association, which, according to an internal survey, around 85 percent of the outpatient surgeons in the association wanted to join, as “excessive and unethical action”. “We are defending ourselves against the argument about money being carried out on the backs of children,” said a spokesman.

A possible solution to the impasse seemed to be the inclusion of the OPs in the new area of ​​the so-called “hybrid DRGs” with more comprehensive financing of the service – but the negotiations, which continued until the end of March, failed. Now a word of power from the Federal Ministry of Health (BMG) could remedy the situation. “The option of substitute performance is currently being examined in the BMG,” it says on request. But since up to seven institutions have to do the groundwork before any legal regulation is passed, it is reasonable to assume that the children and their families will still have to wait.