Interview with a Medical Student in Germany

Mr. Moritz Westermeier is a medical student in Germany and was so kind to let me ask him a few questions about what medicine is like in Germany. He’s a particular interesting dude who is a bit disheartened by the way medicine is shaping in Germany. He reports average patient visits lasting 7 minutes and physicians increasingly being motivated by money.

Western style medicine has infiltrated the UK, Germany, and even Spain. Physicians are feeling the time crunch of practicing medicine in such countries where the economy has matured but healthcare has regressed.

At least now I know that it’s not the “greedy fucking doctors” of the US who are to blame for the state of healthcare affairs.

In Spain, where physicians make €2,500 per month, the same complaints exist. Here, there is a little less direct to consumer advertising but patients are starting to suffer from lifestyle diseases. Diabetes and obesity is starting to increase.

What about Germany? That used to be my hood! Shoutout to Göttingen. Cutest little city which was super bike friendly. Let’s see what Moritz has to say about practicing medicine in Deutschland, while studying at Justus-Liebig-University.

How did you find my website? What were you searching for? What made
you get online to look for answers?

I found your website several times on Google, when i was searching for digital nomad possibilities as a physician and when i was looking for the newest developments in
telemedicine.

Every time I landed on digitalnomadphysician.com by Dr. Mo. And was fascinated by the interesting articles, podcast, and the down-to-earth style of the writer.

I wanted to figure out, what I can do after med school, since i don’t wanna do the typical clinical career. My views, goals, wishes and the world we live in changed since I started med school in 2013 and so has my idea of a career in medicine. At this point, I can’t imagine anymore to work in a typical hospital or doctor’s office like atmosphere for a longer period of time for many different reasons.

The rush-through-mentality in patient contact, where time is money, the failing/fake empathy and arrogance of so many doctors, and also students, who skip greeting the cleaning ladies on the hospital floor, it’s not the kind of medicine I see myself practicing.

For example the patient is offered a new blood pressure medication instead of being offered a lifestyle intervention like adherence strategies for more physical activity or empowerment to a healthier nutrition and way of life. The health system now seems to me to be willing to compromise too easily. It works a little bit like an auto repair shop, everyone gets a quick solution i.e. the patient gets a recipe and the physicians get through more patients.

That is not the way I want to practice medicine in my own practice. But maybe I’m just too soft for the depressing atmosphere and agony of a hospital. This is made worse by the fact that my parents both got ill while I went away to medical school.

In any event, it seems that telemedicine could be an interesting and attractive field for my future in health care. I want to figure out a way to get into that.

How did you stumble on a career in medicine?

My path to medicine was longer than for most students since I waited for 6 years to get a place at a University in medicine. After my Gymnasium (higher level high school in Germany) I did an apprenticeship as a dental technician to bridge the time before I could get permission to
study medicine.

I chose dental technology because I was not sure if I wanted to choose dentistry or medicine since my father and sister are dentists and my mother is a Geriatrician. My decision to get into medicine was multifactorial: my parents are super satisfied with their jobs and always recommended it to me.

The job conditions and salary in medicine seem to be good, as well as the payback. Patients are generally grateful. And also we don’t have any special talents in our family, aren’t geniuses in maths or something, so I thought it would be a good deal to study medicine.

If I disregard all the above-mentioned points and went just by interests, then sport studies, veterinary medicine, and police would probably have made the list as well. But the opportunity to help and heal people, doing something real good and meaningful as a job for a living seemed to be the best option so I chose medicine.

Tell us a little bit about yourself. Are you German? Were you born
there? Where did you learn English so well? Are you married. Kids, dogs, plants?

I’m 31 years old and born and raised near Dortmund and Münster in the state of North-Rhine-Westphalia in Germany. I learned English in high school and used it since then, mainly when traveling for holidays to the US and Mexico. Besides med school, I’m obsessed with fitness and sports in general. I’m an active competitor in Physique/Bodybuilding and dad to a cat
and a dog.

I have a gorgeous Congolese-German girlfriend by my side who is still in university as well.

What’s medical school like in Deutschland? How much does it cost to
get through medical school? What entrance exam do you take to get into
medical school? How do you select your residency?

Medical school in Germany lasts usually 6 years and ends with the third state examination. It is divided into a 2-year pre-clinical phase and a 4-year clinical phase. The last year is exclusively in the hospital where you run through different disciplines.

The costs to get through medical school are not so high as in the USA. We have to pay study fees per semester which in the summer semester for 2019 are €277. Living costs for food, housing, and transportation depend on the city you study in.

If you take me as example, I pay €320 per month for my apartment, transportation with bus/train is included within my state but not free for whole of Germany, which is a big pain in the ass.

Food cost depends much how your lifestyle is. I’m not a suitable example because i spend more than the usual student on food because of the sport and the higher costs for protein rich nutrition. But I try to be frugal there too and I think i spend approximately €300 per month when I try hard. Cottage cheese and oats do a good job.

Additional to that you can add money you spend on having a blast. Well, this is not so much, because we are in med school and we are in Germany, so we don’t have a blast 🙂 All joking aside, entertainment here isn’t expensive because student activities are mostly cheap, like
20 bucks for the gym or cheap drinks from the grocery store.

Some students can get money via BAföG (The German Federal Training Assistance Act) which provides educational opportunities. The level of BAföG support depends on various factors. The maximum award per month for students in higher education is currently 735 euros. It depends on
the student income and the income of the parents. If you get BAföG you have 20 years time to pay the money back to the government.

If you are not so lucky to get it, you have perhaps parents who sponsor you or a student job. To work beside med school is not a joke because you have to learn your ass up. A friend of mine from Cameroon gets nothing from her parents or institutions and had to earn €600 minimum which is incredibly stressful, especially because of the difficulty to study on a foreign language like German. And that’s just one example, the foreign students have it by far the hardest, and they get my biggest respect.

I got into medical school by the waiting method. I didn’t have an entrance exam. There is a distribution key for 20% with the best high school grades, 20% for people who are on a waiting list for a very long time (like me), and the last 60% are chosen by an individual selection method which is different in every of the 37 universities which offer medicine. In 2020 they will abolish the chance to get into medical school through waiting. So it will be solely high school grades and
individual selection.

First I got a study place in Dresden/Saxony in Eastern Germany but after one year I moved heaven and earth to change the city to Giessen/Hesse near Frankfurt and could get a study place on the Justus-Liebig-University. I am happy, that I did this because the people in Giessen/Hesse seem to be more open-minded and tolerant in general, especially to foreigners.

In the rare occasion of free time, typical student activities for medical students in Giessen are clubbing, chilling at the Lahn river, playing soccer, going to the gym or hiking. The metropole Frankfurt is just 45 minutes by train so this also offers countless opportunities to having fun as students. It must be awesome to have more time for this stuff once student life is over.

When I finish medical school, I am not sure if or which residency I should choose. They last 5 years which is a damn long time. But medicine is incredibly versatile and there are a lot of interesting disciplines which enables you to help people and to be happy/living the good life at the same time.

Options for me for residency are at this moment: radiology, children and adolescent psychiatry,
rehabilitation medicine. But my perfect residency don’t exist now. As I mentioned above, I want to do something in the telemedicine field, where people can consult me especially in terms of fitness/nutrition and lifestyle. It would be great to prevent health issues before they
occur. I would also love to work with (injured) athletes as a physician since I’m an athlete too, and hopefully will always be.

I am looking forward to learn more about the telemedicine opportunities as physician. I think it’s not just a great tool to treat older, immobile people or people who live in sparsely populated areas, but also to offer an even better service in terms of taking more time for the patient.

Furthermore it’s very attractive for physicians who want to use their working time flexible, want to be independent as a worker, in terms of living place and in terms of working hours. The world we live in changes very fast, damn China is in process to put 20% of the world in total monitoring through their Social Credit System? Like a real life Orwell’s 1984.

I don’t know where I want to live in 30 years. So Telemedicine could also create a more flexible and enjoyable lifestyle.

So Moritz, what would you do if you decided to not go to residency? Could you take some time off and apply to residency later or is it mandatory to start right away?

I could imagine to find my niche and work independently after med school. It is possible to choose a residency whenever you want and it’s quite common to change the residency when you want.

What has been your family’s input when you tell them about your feelings regarding the current state of medicine and the daunting thought of sitting through another 5 years of residency?

It’s a little bit complicated to talk about this topic with my parents since they were so satisfied with their jobs. When I tell them that I probably want to leave the clinic when I finish med school, they don’t understand me.

As for the residency, is it 5 years? I thought that even in Germany you can have residencies as short as 3 years.

This is a list of all possible residencies in Germany:

• Specialist in General Medicine
• Specialist in anaesthesiology
• Specialist in anatomy
• Specialist in occupational medicine
• Ophthalmology specialist
• Specialist in biochemistry
• Surgery
  • Specialist in general surgery
  • Specialist for vascular surgery
  • Specialist in cardiac surgery
  • Specialist in pediatric surgery
  • Specialist in Orthopedics and Traumatology
  • Specialist in Plastic and Aesthetic Surgery
  • Specialist in thoracic surgery
  • Specialist in Visceral Surgery
• Specialist in Obstetrics and Gynecology
  • Focus on gynecological endocrinology and reproductive medicine
  • Focus on gynecological oncology
  • Focus on Special Obstetrics and Perinatal Medicine
• Specialist in ear, nose and throat medicine
• Specialist in speech, voice and child hearing disorders
• Specialist for skin and venereal diseases
• Specialist in human genetics
• Specialist in hygiene and environmental medicine
• Internal medicine and general medicine
  • Specialist for internal and general medicine (general practitioner)
  • Specialist in internal medicine
  • Specialist in internal medicine and angiology
  • Specialist in internal medicine and endocrinology and diabetology
  • Specialist in internal medicine and gastroenterology
  • Specialist in internal medicine and hematology and oncology
  • Specialist in internal medicine and cardiology
  • Specialist in internal medicine and nephrology
  • Specialist in internal medicine and pulmonology
  • Specialist in internal medicine and rheumatology
• Specialist in the field of pediatric and adolescent medicine:
  • Focus on children’s hematology and oncology
  • Focus on Pediatric Cardiology
  • Focus on neonatology
  • Focus on Neuropediatrics
  • Specialist in child and adolescent psychiatry and psychotherapy
• Specialist in Laboratory Medicine
• Specialist in microbiology, virology and infection epidemiology
• Specialist in Oral and Maxillofacial Surgery
• Specialist in neurosurgery
• Specialist in Neurology
• Specialist in nuclear medicine
• Specialist in public health
• Specialist in neuropathology
• Specialist in pathology
• Pharmacology
  • Specialist in Clinical Pharmacology
  • Specialist in Pharmacology and Toxicology
• Specialist in physical and rehabilitative medicine
• Specialist in physiology
• Specialist in psychiatry and psychotherapy
  • Focus on Forensic Psychiatry
  • Specialist in psychosomatic medicine and psychotherapy
• Specialist in radiology
  • Focus on Pediatric Radiology
  • Focus Neuroradiology
• Specialist in Legal Medicine
• Specialist in radiotherapy
• Specialist in transfusion medicine
• Medical specialist for Urology

You are right, most residencies are as long as 5 -6 years, but a few are shorter like 4 years for specialist for anatomy or specialist for biochemistry. But this is just one year shorter for a residency which will end mostly in a career at the university.

What is the average income for a physician in residency and what is it for someone who becomes a radiologist or psychiatrist? Does the income motivate you at all?

The starting salary for a physician after med school is €4,400-4,600 before taxes. After 5 years it will be €5,350-5,550 before taxes. It does not matter if you complete a residency or if you work as an assistant physician without residency.

A radiologist earns in average €31,000 before taxes per month.

A psychiatrist earns in average €13,400 before taxes per month.

I would lie if the income didn’t motivate me at all, but that’s not the biggest motivation to become a certain specialist. For me it would be much more motivating to get a residency which I love and where I am something good at so that I can help and have an enjoyable day.

Work life balance is also a very important factor for me since I realized that the idea of doing all the cool things as pensioner is not the best. Because by that age you probably become ill and or die. I saw it a couple of times in the circle of acquaintances of my family. So it would be smarter to create a lifestyle where you can have work and a good life with travel and so on at the same time.

My generation in Germany will work until their 70’s, anyway.