Studenten der Medizin (Medizinstudenten) nehmen am Anatomie-Kurs bei Dr. med. Martina Plaschke im Fächerverbund Anatomie der Charité in der Philippstraße 12 in Berlin-Mitte teil. Aufgenommen am 14. Januar 2016. Foto: Kitty Kleist-Heinrich

Karl Lauterbach does not shy away from conflict when he believes something is right. He is currently taking on the Standing Vaccination Commission again, which has only declared a fourth corona vaccination to be useful for people over 70. The SPD Minister of Health countered this in Der Spiegel: He would also recommend the renewed booster to younger people, “you simply have a completely different level of security there”.

Whether it is appropriate for a Minister of Health to play Stiko is debatable. In any case, it is irritating that Lauterbach lets tasks that undoubtedly belong to the core of his job description slip. Even if they are also of great importance for the long-term well-being of society.

Five and a half years ago, the federal and state ministers for science and health decided on the “Medical Studies Master Plan 2020”. After years of poker. Because his 37 points not only spelled out the general overhaul of medical training, which was overdue at the time, but above all with an early practice orientation “to the patient and his needs”. But the reform, that was already clear at the time, would be expensive.

So expensive that the federal and state governments, science and health politicians have been arguing about the bill ever since. However, the exact amount is itself a matter of conflict. The Medical Faculty Association (MFT) has calculated one-time “transformation costs” of around 175 million euros, plus a permanent 32,000 to 40,000 euros more per first-semester student place and year – because better supervision conditions are necessary, more intensive teaching also in the outpatient area and more complex examination formats.

If the MFT is right, that would mean around 400 million euros more per year in the long term. While the German Society for General Practice and Family Medicine (DEGAM), in a much simpler calculation, comes to just under 6000 euros more per student, but considers the information from the faculties to be “incomprehensible”.

Either way, many had placed great hopes in Lauterbach that he would work towards a compromise once he took office. The vehicle: the amendment to the medical licensing regulations, which his predecessor Jens Spahn (CDU) did not get beyond a draft bill torn apart by countries and associations. It is intended to define essential requirements for the reform of medical studies. And at the same time clarify the question of costs.

But Lauterbach puts the brakes on. At the MFT annual meeting in mid-June, the health minister said only that he would “like to move the amendment forward”, without giving details or a timetable. Does he want to sit it out? In view of the estimated four or five years in advance that countries and faculties need for the comprehensive restructuring of medical training, even renaming the “Master Plan for Medical Studies 2030” could ultimately prove to be too optimistic.

But behind the scenes there were signals from the Ministry of Health to the federal states on the subject of additional costs: The federal government pays nothing at all. Which, in view of the monetary magnitudes discussed in the countries, causes bewilderment. And fuels the conflict there.

Because just as the federal and state governments play poker, so do the relevant ministries. The health side sees the responsibility for financing above all in the ministries of science. The science ministries say they already have too little money to adequately finance the universities.

If they were left with the costs of the reform, other disciplines would have to bleed for the medical reform. Or, more likely, the number of medical school places would have to decrease. Although the shortage of doctors has become blatant due to the corona pandemic at the latest.

The prime ministers would hardly allow a cut, but the threat alone shows that the science ministries feel cornered. While Karl Lauterbach is the courageous advocate of patient interests, thanks to his involvement in medical studies in 2022 nothing will change.