The most recent recommendations from the US Preventive Services Task Force (USPSTF) suggest that women at average risk for breast cancer should undergo mammograms every two years, starting at age 40 and continuing until age 74. These guidelines, detailed in JAMA, emphasize the need to address disparities in breast cancer outcomes among different racial groups, particularly highlighting the higher mortality rates among Black women compared to White women. Additionally, the recommendations call for further research into screening methods for women with dense breasts, a population that constitutes around 40% of women.

Last year, the USPSTF introduced a draft version of these updated recommendations. Previously, in 2016, the task force suggested biennial mammograms starting at age 50, with considerations for individuals in their 40s to weigh the benefits and risks of screening. The shift to recommending screening at age 40 was informed by comprehensive data analysis, including insights from the Cancer Intervention and Surveillance Modeling Network (CISNET).

The release of these recommendations has sparked discussions within the medical community, as reflected in three editorials published alongside the USPSTF report in JAMA. Lydia E. Pace, MD, MPH, and Nancy L. Keating, MD, MPH, highlight the trade-offs of starting screening earlier, noting increased detection of breast cancer but also the rise in false positives and overdiagnosis. They stress the importance of informed decision-making for women, particularly those in their 40s.

Joann G. Elmore, MD, MPH, and Christoph I. Lee, MD, MS, underline the need to address disparities in breast cancer outcomes and caution against hasty adoption of artificial intelligence (AI) tools in screening. Wendie A. Berg, MD, PhD, while acknowledging the progress of the updated recommendations, argues for more frequent screening, especially for high-risk individuals, and earlier risk assessments starting at age 25.

Despite these recommendations, uncertainties persist regarding screening protocols for older women, supplemental screening methods for women with dense breasts, and the management of ductal carcinoma in situ. While mammography remains valuable for women with dense breasts, the lack of conclusive evidence necessitates individualized decision-making in consultation with healthcare providers.

In summary, while the latest USPSTF recommendations provide a framework for breast cancer screening, ongoing research and personalized approaches are crucial to addressing the diverse needs of women at risk for breast cancer.

• Visibility: public

Recent research has illuminated a fascinating link between atherosclerosis and cancer-like transformations in arterial smooth muscle cells, potentially exacerbating the disease. Atherosclerosis, marked by arterial wall narrowing, poses serious health risks including coronary artery disease, stroke, and peripheral artery disease. Published in Circulation and supported by the NIH, the study suggests that employing anti-cancer medications could mitigate plaque buildup, a primary cause of cardiovascular issues.

“This discovery adds a new dimension to our understanding of therapeutic avenues for atherosclerosis prevention and treatment,” remarked Dr. Ahmed Hasan from the NIH’s Division of Cardiovascular Sciences. While previous studies hinted at similarities between atherosclerosis and cancer, this association had not been fully explored until now.

By utilizing molecular techniques in both mouse models and human tissue samples, researchers delineated the mechanisms driving smooth muscle cell transformation akin to cancer. These converted cells within atherosclerotic plaques exhibited heightened DNA damage and genomic instability—key cancer traits. Genomic instability, indicative of increased DNA mutations during cell division, was notably prevalent.

Moreover, the activation of cancer-related genes was observed during smooth muscle cell reprogramming, accelerating atherosclerosis in a mouse model expressing a cancer mutation. Encouragingly, administering the anti-cancer drug niraparib, which targets DNA damage, showed promise in shrinking atherosclerotic plaques in mice, as highlighted by Dr. Huize Pan from Vanderbilt University Medical Center.

Dr. Muredach Reilly, the study’s senior author, emphasized that comprehending the molecular mechanisms behind smooth muscle cell transition could offer avenues to disrupt tumor-like pathways, potentially curbing atherosclerosis progression.

This groundbreaking study not only sheds light on the intricate interplay between atherosclerosis and cancer but also underscores the therapeutic potential of anti-cancer drugs in managing cardiovascular diseases.

Source: NIH/National Heart, Lung and Blood Institute

• Visibility: public

Where illnesses or serious health impairments disrupt body awareness and prevent verbal communication, basal stimulation can often overcome the distance and create trust. This method, which is often used in nursing, establishes contact via all of the body’s senses.

This article describes how it works and what possibilities it offers.

What is basal stimulation in nursing?

Basal stimulation is a non-verbal form of contact. It addresses people’s senses by generating targeted stimuli that those affected consciously or unconsciously register or respond to. This promotes the perception of one’s own body and its shape and the boundaries to the surroundings gain more definition again. At the same time, new points of contact with the environment are created.

Depending on the clinical picture and the goal of the treatment, different stimulation routes can be considered, which can be combined with one another. The practitioner develops an individual concept for each affected person.

Origin and origin

Almost three decades ago, nursing scientist Christel Bienstein adapted Andreas Fröhlich’s concept of basal stimulation, which originally came from pedagogy, to nursing. Since then it has become increasingly established as a successful treatment method there. Interested nursing staff can learn the techniques of basal stimulation in appropriate further training.

Basal stimulation – goals and areas of application

Basal stimulation initially serves to create interpersonal contact. Building on this, it should help those affected to communicate and convey their needs and emotions.

10 central life themes

Basal stimulation targets ten different life issues, which can be more or less the focus depending on the person affected. Especially for babies and children, discovering the world and one’s own development in it is just as important an aspect as experiencing the outside world and feeling one’s own life .

People in middle or advanced age often miss the feeling of being able to shape their own lives , experience self-determination and develop their own rhythm . For all those affected, the experience of security and trust is likely to be just as essential as establishing relationships and experiencing encounters .

Especially very sensitive and spiritual people often miss the meaning and meaning of life when they are physically or mentally impaired. The final aspect of life issues is the preservation of life and development in general and again affects most people.

Basal stimulation – methods

Depending on the treatment goal, basal stimulation is used in different ways. Somatic stimulation involves addressing the body surface, i.e. the skin and subcutaneous tissue, through pressure, temperature and different textures of washcloths and other care products. Daily personal care is also part of this method to a certain extent. This can include a vibration component, provided those affected find this pleasant. Vestibular stimulation activates the balance system and can be achieved through changes in position or rocking movements. The methods mentioned are also summarized as basic elements.

In contrast, there are some structural elements that are more specifically tailored to the personality of those affected. This includes tactile-haptic stimulation, in which various surfaces or structures are placed in the hands of those affected. This results in a literal “grasping” of the object and the situation.

Other constructive methods for visual stimulation, i.e. addressing the optical system, work with light, shapes and colors in an intensity and presentation adapted to the needs and possibilities of those affected. Accordingly, acoustic stimulation is aimed at hearing. Olfactory stimulation is intended to stimulate the sense of smell and works, among other things, with perfume and other smells that are familiar to the person from their past. As with gustatory stimulation for the sense of taste, foods and spices are used that awaken memories of foods that we enjoy.

If the nurse registers a reaction from the person concerned when using a basal stimulation method, she responds, for example by touching a raised hand. If the person reacts defensively, she breaks off the stimulus or changes it until an approving gesture or facial expression and relaxation occurs. Through the joint work of the nursing staff and those affected, they notice that their answer has been understood and that they can communicate in this way.

Basal stimulation – qualification

Anyone who would like to use basal stimulation in practice can get to know the methods through a basic course and the subsequent advanced course and apply the first techniques. Both courses only last a few days. A more in-depth training course to become a basal stimulation practice companion imparts all the important knowledge in 540 hours of lessons and self-study over the course of a year. This includes both the theoretical and the practical basics that enable you to use the method, to carry out your own courses in basal stimulation and to accompany carers.

Basal stimulation – application

Areas of application for basal stimulation are various clinical pictures that affect the nervous system. Memory, perception and communication suffer as a result. These can be neurodegenerative diseases with increasing destruction of nerve structures, such as dementia and multiple sclerosis, or even a stroke.

Basal stimulation is also used in palliative care and helps to reduce anxiety in those affected and to stay in touch with life. Another area of ​​application in which a very good stimulus response is often achieved is the care of premature babies. For example, they perceive the mother’s smell or like to grab structures that feel similar to the umbilical cord.

• Visibility: public

Although Czechia spends considerably less on health than most other EU countries, its health system provides a broad benefits package and reported unmet needs for medical care are low. In 2020, life expectancy in Czechia was more than two years below the EU average, after the Covid-19 pandemic led to a temporary reduction of one year compared to 2019.

The pandemic response highlighted areas for improvement in crisis preparedness and workforce capacity, especially in some regions. The financing decisions made during 2020 alleviated the short-term financial pressure on the system.

Czechia’s health status

Life expectancy in Czechia steadily improved over the last 10 years and in 2019 was two years below the EU average. However, the Covid-19 pandemic temporarily set the country back to 2013 levels – a larger impact than in many other EU countries.

Risk factors

Nearly half of all deaths in Czechia in 2019 could be attributed to behavioural risk factors – particularly poor diet, smoking and alcohol consumption. Obesity rates have steadily increased over the past 15 years and are now around 20% for adults, contributing to high prevalence of diabetes and other diet-related diseases. Alcohol consumption is among the highest in the EU.

Czechia’s health system

Czechia’s health expenditure in 2019 was 7.8% of GDP and €2,362 per capita – both substantially below the EU averages (9.9% and €3,521). Most health expenditure is financed from public sources, predominantly through the compulsory insurance system. Czechia significantly increased contributions from the state budget into the insurance system to cover almost all pandemic-related expenses.

Effectiveness

Despite steady decreases over the past decade, Czechia still had relatively high levels of preventable and treatable mortality before the pandemic. Additional investment in public health interventions and in incentivising healthier habits among the population could help achieve further progress. Cancer survival rates are now close to the EU average, but Covid-19 led to a temporary drop in activity such as screening, which could set back this advance.

Accessibility

Prior to 2020, Czechia had one of the lowest levels of unmet needs for medical care in the EU, although some informational barriers to care existed. During the first wave of the pandemic, health services were less disrupted than in the EU overall (16% of Czechs reported having forgone medical care).

Resilience

Czechia contained the first Covid-19 wave but struggled to slow down the second wave, partly due to limited planning capabilities and insufficient clarity in its public communication. By the end of August 2021, 16% of the population had been diagnosed with Covid-19 (compared to 8% across the EU), while over half of the population (53%) had been vaccinated with two doses (or equivalent).

Home

• Visibility: public

A groundbreaking discovery by researchers at the Technical University of Denmark (DTU) and Lund University promises to revolutionize the quest for universal donor blood. Their findings, recently published in Nature Microbiology, unveil enzymes capable of eliminating specific sugars constituting the A and B antigens in human ABO blood groups, thus overcoming a major hurdle in creating universally compatible blood.

Lead researcher Professor Maher Abou Hachem of DTU underscores the significance of their breakthrough, emphasizing that these newly identified enzyme cocktails not only target the traditional A and B antigens but also tackle extended variants previously overlooked for transfusion safety. While the conversion of group B blood into a universal donor type is near realization, further refinement is needed for the more complex group A blood. Abou Hachem credits the collaboration between DTU’s expertise in gut microbiota enzymes and Lund University’s proficiency in carbohydrate-based blood groups for this milestone achievement.

The implications are profound. Universal donor blood would streamline logistical challenges in blood transportation and administration, while simultaneously curbing wastage. Martin L. Olsson, a key figure in the research team from Lund University, envisions a future where the simplified logistics of universal blood supply not only optimize resource utilization but also mitigate the risks of ABO-mismatched transfusions, which can prove fatal.

The journey towards universal donor blood has been a long one, with the concept of using enzymes for this purpose emerging over four decades ago. While previous enzyme discoveries showed promise, they fell short in addressing all immune reactions associated with blood transfusions. However, the teams at DTU and Lund University adopted innovative approaches, identifying enzyme mixtures from the gut bacterium Akkermansia muciniphila, known for its proficiency in breaking down mucosal sugars. Remarkably, these enzymes exhibit a high efficiency in targeting blood cell surface sugars akin to those of intestinal mucosa.

Testing 24 enzymes on hundreds of blood samples, the researchers are optimistic about the potential of their findings. They have filed a patent for the new enzymes and the treatment method, with plans for further advancement in their joint project. However, before commercial production and clinical application can be realized, rigorous patient trials are imperative.

Funding from various sources, including the Independent Research Fund Denmark and the Swedish Research Council, has propelled this pioneering research. Moving forward, the Novo Nordisk Foundation’s support promises continued progress in realizing the transformative potential of universal donor blood.

• Visibility: public

The term “The Great Resignation” has gained prominence recently, with many attributing it to a collective reassessment of work-life balance and purpose, often termed the “pandemic epiphany.” While this broad trend may explain a portion of the workforce shifts, the reasons behind physicians leaving their jobs appear to be more nuanced and concrete.

CHG Healthcare, a leading physician staffing company, published an article titled “Nearly Half of Physicians Changed Jobs During the Pandemic,” revealing that a staggering 43% of physicians surveyed sought new opportunities during this time. Although only 3% transitioned out of medicine entirely and 8% retired, the pandemic significantly influenced the decisions of 43% of physicians, leading them to seek alternatives.

Another notable survey by Elsevier, titled “The Clinician of the Future, Report 2022,” found that nearly one-third of respondents expressed intentions to leave their current roles within the next two to three years. Interestingly, there were notable regional disparities, with only 14% of Chinese doctors planning to depart compared to figures exceeding 40% in the US, the UK, and Germany.

While the CHG Healthcare survey indicated that 43% of physicians planned to remain in healthcare, the global survey by Elsevier painted a different picture, with 39% intending to exit the profession. Reasons for leaving included retirement (21%), transitioning to non-healthcare roles (13%), and pursuing entirely different paths (5%).

Physician Burnout has emerged as a critical factor contributing to workforce attrition, exacerbated by the stress of the pandemic. Even before COVID-19, burnout was prevalent among US physicians. A study in 2021 revealed that heightened burnout levels were directly linked to a third of physicians considering reducing their work hours or leaving altogether.

The pervasive nature of burnout, characterized by emotional exhaustion and diminished empathy, has led to an epidemic within the profession. Merritt Hawkins found that 19% of final-year residents contemplated alternative career paths, witnessing senior colleagues grappling with burnout.

Five primary factors driving physicians to leave their jobs have been identified:

1. Work/Life Balance: A growing desire for a better work/life balance has become the primary motivator for physicians seeking change. Long hours and administrative burdens have significantly impacted quality of life, prompting an 85% surge in prioritizing work/life balance since 2018.

2. Administrative Burden: The introduction of electronic health records (EHRs) has substantially increased administrative tasks, with nearly a third of doctors spending over 20 hours weekly on paperwork. This administrative burden has been linked to lower career satisfaction and burnout.

3. Lack of Support: Physicians often feel unsupported by healthcare administrations, leading to strained relationships and dissatisfaction. Issues such as poor leadership, inadequate staffing, and a lack of overall support contribute to dissatisfaction among medical professionals.

4. Negative Public Attitudes: Despite initial recognition during the pandemic, healthcare workers now face increased scrutiny and negative public attitudes, exacerbating stress levels. Cyberbullying and confrontations over medical advice further strain physician-patient relationships.

5. Financial Strain: Contrary to popular belief, many physicians face financial challenges, particularly during residency when salaries are modest and student debt is substantial. Even after completing residency, high overhead costs and malpractice insurance expenses can impact financial stability.

The Clinician of the Future, Report 2022, outlines a path forward for healthcare, emphasizing the need for support and advancement in areas such as data analytics, digital health technologies, and patient communication. By embracing these changes, the healthcare industry aims to retain and attract future generations of healthcare professionals.

In conclusion, while challenges persist within the medical field, there is optimism for positive change and evolution. By addressing the root causes of physician dissatisfaction and implementing meaningful reforms, the healthcare industry can create a more supportive and fulfilling environment for its workforce.

• Visibility: public

Defence Therapeutics Inc. has recently concluded a pre-clinical trial showcasing the effectiveness of its ARM-002TM vaccine against pancreatic cancer. This groundbreaking research highlighted the vaccine’s promising therapeutic outcomes, particularly when paired with the anti-PD-1 immune-checkpoint inhibitor.

Pancreatic cancer is notorious in oncology due to its late detection and limited treatment options, making it a formidable challenge. Symptoms often arise after metastasis, categorizing pancreatic cancer as a ‘hard-to-treat’ form of the disease. Patients grappling with this diagnosis confront a narrow spectrum of treatment choices, necessitating innovative approaches such as immunotherapy.

Conventional treatments like surgery, radiation, and chemotherapy offer limited benefits and often entail significant complications. Even surgeries to remove the pancreas require lifelong medication to compensate for lost pancreatic functions. While chemotherapy can reduce tumor size, it frequently encounters resistance and relapse.

Immunotherapy emerges as a beacon of hope in the fight against pancreatic cancer, leveraging the body’s immune system to target cancer cells. This approach offers potential breakthroughs for patients who have exhausted traditional options.

In a recent pre-clinical study, Defence Therapeutics evaluated the ARM-002TM vaccine paired with an anti-PD-1 immune-checkpoint inhibitor in animals with established Pan02 tumors. The results were striking, with all treated animals surviving beyond 40 days, a milestone equivalent to nearly five human years. Additionally, tumor growth was significantly inhibited compared to other treatments, showcasing the potency of this vaccine combination.

Sébastien Plouffe, CEO and president of Defence Therapeutics, expressed optimism about their immunotherapy endeavors, emphasizing the versatility of their Accum® platform in developing innovative immune therapies for various indications. He highlighted the adaptability of their products, exemplified by the ARM-002TM vaccine’s efficacy in impairing the growth of solid T-cell lymphoma, melanoma, and now pancreatic cancer in pre-clinical studies.

The success of Defence Therapeutics’ pre-clinical trial represents a significant stride in combating pancreatic cancer. These promising results underscore the potential of immunotherapy in tackling the challenges posed by ‘hard-to-treat’ cancers like pancreatic cancer.

• Visibility: public

In Paraguay’s capital, Asunción, The Lancet Diabetes & Endocrinology’s Commission for the Definition and Diagnosis of Clinical Obesity is on the verge of releasing new criteria aimed at distinguishing clinical obesity from its preclinical stages. The objective is to mitigate the negative stereotypes surrounding the term “obesity” and to underscore that it is indeed a disease, not merely a condition predisposing individuals to other health complications.

Ricardo Cohen, MD, PhD, who heads the Obesity and Diabetes Center at the Oswaldo Cruz German Hospital in São Paulo, Brazil, and serves as one of the two Latin American experts among the commission’s 60 members, shared insights on this initiative with Medscape Spanish edition.

The impending criteria recognize a preclinical phase characterized by cellular or tissue alterations that impact organ structure without affecting function. This stage can be gauged through parameters such as body mass index (BMI) or waist circumference.

Clinical obesity, as Cohen delineates, ensues when obesity starts impinging upon organ function and mobility, thus manifesting as a disease requiring active intervention. At this juncture, the health risks linked with excess adiposity become palpable and can be clinically substantiated.

At the XV Congress of the Latin American Obesity Societies (FLASO) and II Paraguayan Obesity Congress, various experts from the region conveyed their reservations regarding the proposed name change and its practical implications. They weighed the pros and cons of different terminologies that have been under consideration in recent years.

President of FLASO and director of the Nutrition program at the Faculty of Health Sciences of the Nuestra Señora de la Asunción Catholic University in Paraguay, Rafael Figueredo Grijalba, MD, acknowledged the existence of stigma surrounding obesity and its detrimental impact on self-esteem and clinical outcomes. However, he questioned whether altering the terminology alone would suffice to address these issues.

Proposed in 2016 by what is now the American Association of Clinical Endocrinology and the American College of Endocrinology, the term “adiposity-based chronic disease (ABCD)” garnered attention as an alternative to “obesity.” Dr. Violeta Jiménez, an internal medicine and endocrinology specialist, highlighted that the term “obese” can carry negative connotations and emphasized the significance of adipose tissue quantity, distribution, and function in determining health outcomes.

Dr. Paul Camperos Sánchez, an internal medicine and endocrinology specialist, advocated for a nuanced approach, emphasizing the importance of considering comorbidities and the multifaceted nature of obesity in treatment strategies.

In contrast, Dr. Julio Montero, a nutritionist and president of the Argentine Society of Obesity and Eating Disorders, favored the term “clinical obesity” for its medical specificity and ability to differentiate between individuals with high weight and those experiencing weight-dependent health issues.

Montero expressed concerns about the proposed term ABCD, noting its potential to oversimplify the complex interplay of factors contributing to obesity and its implications.

While debates surrounding nomenclature continue, the overarching goal remains to foster a more nuanced understanding of obesity and its management, moving beyond semantics to address the multifaceted challenges posed by this pervasive health issue.

• Visibility: public

Recent research indicates that omega-6 fatty acids could play a crucial role in mitigating the risk of developing bipolar disorder, shedding light on a potential avenue for managing this challenging mental health condition. The groundbreaking study, led by the University of South Australia, offers hope for leveraging omega-6 fatty acids to address the significant impact of bipolar disorder on millions of individuals worldwide.

Bipolar disorder is characterized by alternating episodes of mania and depression, presenting a formidable challenge to those affected. While its exact causes remain elusive, studies suggest a strong genetic influence, heightening the risk for individuals with affected family members. Global statistics underscore the widespread burden of mental health disorders, with bipolar disorder affecting an estimated 40 million people worldwide. In Australia alone, nearly 3% of the population, totaling around 568,000 individuals aged 16 and above, grapple with the complexities of bipolar disorder.

The emerging research suggests that omega-6 fatty acids may hold promise in reducing the risk of this condition. These fatty acids are commonly found in foods such as eggs, poultry, and seafood. To assess their potential impact, researchers employed a Mendelian randomization approach, analyzing 913 metabolites across 14,296 Europeans. Their findings revealed that 33 metabolites, predominantly lipids, were associated with an increased risk of bipolar disorder.

Dr. David Stacey, the study’s lead researcher, emphasized the potential for innovative lifestyle or dietary interventions based on these findings, highlighting the evolving role of metabolites in bipolar disorder and other psychiatric conditions. The study indicates that individuals genetically predisposed to higher levels of lipids containing arachidonic acid, sourced from meat, seafood, or synthesized from dietary linoleic acid, have a reduced risk of bipolar disorder, while lower levels pose a higher risk. Arachidonic acid is essential for brain development and is notably present in infant formula.

Supplementation with arachidonic acid may offer benefits for those at risk, although the optimal timing of supplementation remains uncertain—whether during the perinatal period, early life, or for diagnosed individuals. Professor Elina Hyppönen, a co-author of the study, emphasized the need for further trials to explore the therapeutic potential of arachidonic acid in bipolar disorder. She underscored the importance of rigorously assessing the efficacy of arachidonic acid supplementation, particularly in individuals with genetic predispositions.

Hyppönen stressed the significance of understanding how, why, and when individuals respond to arachidonic acid supplementation, emphasizing the potential for precision health interventions to support brain development in early life and potentially mitigate the risk of bipolar disorder. She emphasized the importance of ongoing research efforts in advancing our understanding of the connection between arachidonic acid and bipolar disorder, offering hope for improved management and treatment of this lifelong mental health condition.

• Visibility: public

Being paid outside the collective bargaining agreement can have many advantages for senior physicians. In addition to a higher salary, more vacation days or a higher training budget can also be agreed in a non-tariff contract (AT contract). AT contracts also offer advantages for the clinics: they can demand more performance for higher pay and making the remuneration more variable opens up opportunities for refinancing.
The following article explains what needs to be taken into account with non-tariff contracts and what salary senior physicians can expect.

Non-tariff or according to tariff? This is how the earning potential is structured

As you advance to senior physician, you take on more responsibility and more management tasks. This also comes with higher pay . At a university hospital, senior doctors are paid according to the collective agreement for doctors from the collective agreement of the states ( TV-Ärzt TdL ). The salary is between 8,164 and 9,331 euros gross per month. This corresponds to an annual salary of up to 111,972 euros, excluding Christmas and vacation pay. At municipal hospitals, the collective agreement for doctors from the Association of Municipal Employers’ Associations ( TV-Ärzte VKA ) applies, which provides for a gross salary of between 8,021 and 9,167 euros per month, i.e. up to around 110,000 euros per year. The exact salary depends on the professional experience. We have summarized all collective agreements in this overview.

However, the average annual income of senior physicians in Germany is significantly higher. According to the Kienbaum remuneration report 2019, it is 136,000 euros, 30,000 euros more than in the previous year. The earning potential for senior physicians is improving somewhat more slowly than for the entire medical profession, but is steadily increasing. One reason for this is that numerous clinics now offer their senior doctors the opportunity to be paid outside the collective agreement.

The non-tariff employment contract is no longer a rarity today. Many hospitals, across all providers, provide their senior physicians with an AT contract from day one. This is the conclusion reached by the consulting agency Rochus Mummert Healthcare Consulting. The remuneration is between 130,000 and 150,000 euros per year, and senior doctors can even earn around 170,000 euros.

AT contracts: Higher wages for more performance

Salaries not only differ based on professional experience, there is also a wide range between individual disciplines. The Kienbaum report quantifies the average salaries for selected specialist areas as follows:

• Surgery : 148,000 euros
• Internal medicine : 142,000 euros
• Gynecology : 135,000 euros
• Orthopedics : 135,000 euros
• Radiology : 134,000 euros
• Anesthesia / intensive care medicine : 133,000 euros
• Urology : 132,000 euros
• Pediatrics : 131,000 euros
• Neurology / Psychiatry : 127,000 euros
• Geriatrics : 111,000 euros

According to Rochus Mummert Healthcare Consulting, an AT contract can even result in salary outliers of up to 200,000 euros in certain specialist areas. At the top are specializations such as interventional cardiology, neuroradiology and spine surgery. If you add up bonuses, income from target agreements, pool activities and additional income, you can earn up to 230,000 euros per year.

In return for the higher wages, the clinics also demand more performance. Sometimes they require specialist knowledge and special medical skills, sometimes they require leadership qualities and the willingness to take on tasks such as project or department management. Anyone who meets the requirements and is willing to do more can secure additional benefits in addition to higher remuneration with an AT contract. These include, for example, more vacation days, a higher training budget or the option to complete training sessions at other locations on a set number of days.

AT contracts: negotiation skills are required

If you want to get as many advantages as possible from a non-tariff contract, negotiation skills are required. While salary and benefits are clearly defined in the collective agreement, there is much more freedom when it comes to structuring non-collective agreements. Before you decide on an AT contract, you should also consider the consequences. A collective agreement also brings with it advantages, for example the automatic salary increase based on professional experience and the maintenance of a classification once achieved. If you sign an AT contract, you usually have to negotiate each salary increase separately. In addition, the classification into a salary level can be limited. For example, your salary can decrease if you have to give up certain areas of responsibility after a set period of time.

However, senior physicians no longer have to fear legal pitfalls. If flat rates are specified in the AT contract, it must be specified exactly what they apply to. For example, if the contract stipulates a flat rate of 20,000 euros per year for overtime, the contractual partners must define exactly what number of overtime hours will be offset against this. The senior physicians are entitled to separate remuneration for each additional hour of overtime. If you still fear that you will be taken advantage of, you can have the AT contract checked under labor law. In addition to the Marburger Bund, the legal departments of professional societies also offer this opportunity. However, the institutions are keen to make their target agreements fair in order to avoid dissatisfaction.

AT contracts: Advantages also for clinics

Senior physicians can secure a higher salary and more benefits through an AT contract. However, remunerating them outside of the collective agreement also has advantages for the clinics. You also gain more flexibility when it comes to remuneration and can therefore retain talented specialists.

AT contracts also offer clinics the opportunity to refinance the increasing salaries for senior physicians and other medical specialists. By making the compensation components more flexible, they can ensure that they have more money available to compensate for the higher compensation.

Switch from the collective agreement to the AT agreement

What chance of non-tariff pay now exists for senior physicians who have already been working under the collective bargaining model for a long time? That depends on the respective employer. Some houses provide for a collective agreement with several levels. From a certain level you automatically receive a non-tariff regulation. Others do not allow switching between models or only in exceptional cases. Those who stay with the same provider for a long time and pursue a career in the same company often find it more difficult to agree on compensation above the market salary. It may therefore be worthwhile for senior physicians to consider changing employers.

• Visibility: public