German hospitals struggle with strict outpatient care rules and staffing gaps

Hospitals in Germany face strict rules when offering outpatient care, which is normally handled by local doctors. Special permits are required for hospital physicians to treat outpatients, usually for complex treatments not available in standard practices. At SRH hospital in Sigmaringen, this system has led to temporary solutions—including leased specialists—to fill gaps in care. Outpatient care in Germany mostly falls under the responsibility of private practitioners. Hospitals can only provide it in exceptional cases or with a specific permit from the Admissions Committee. These permits are granted to individual doctors, not the hospital itself, allowing them to offer specialised services like advanced procedures or treatments requiring equipment not found in typical clinics.

SRH hospital in Sigmaringen currently runs outpatient services in six areas: urology, cardiology, gastroenterology, gynaecology, surgery, and oncology. However, since February, the oncology department has relied on leased oncologists due to the absence of a permanent chief physician. This arrangement has particularly impacted legally insured cancer patients needing outpatient treatment. In cardiology, Jan Prillinger has been overseeing care for patients with pacemakers and defibrillators. But this service will end on October 1st, when he leaves to join the Hanfertal practice community. The hospital acknowledges that treating outpatients is less profitable than inpatient care because of higher associated costs. Despite financial challenges, SRH expects outpatient treatments to grow in the coming years. This shift aligns with broader health policy aims to expand outpatient services. The hospital's leadership stresses that these offerings are meant to complement—not compete with—local doctors, stepping in only when private practices lack capacity.

The system of hospital-based outpatient care remains tightly controlled, with permits tied to individual physicians rather than institutions. SRH hospital's reliance on temporary solutions highlights the challenges of maintaining consistent specialist care. As demand for outpatient services rises, hospitals may play a larger role—but only within the limits set by regulators.