Descriptive review of junior OB/GYN physicians’ work task financial compensation in German hospitals

The common occupational health problem attributed to healthcare work is infection [1‐9]. But healthcare workers also have a large variety of other job-related risk factors [10‐13]. Over the past 20 years, a number of studies reported a growing discontent in job satisfaction among young physicians in the German health care system [14‐16]. Similar reports in the field of obstetrics and gynecology were reported in other countries [17‐19]. These studies predominantly focused on factors such as occupational stress, satisfaction, and burnout [20, 21]. Parallel to these reports, a high rate of young doctors left their country of origin for foreign work places and a high number of German hospitals currently encounter problems concerning junior residents. This severe problem targets one of the key fundaments of the health service – the pyramidal system of junior residents developing into specialists who then continue to work either as hospital or outpatient consultants.

Due to the magnitude of the problem concerning the shortage of junior staff and the ongoing complain concerning working conditions, the Medical work Assessment in German hospitals (MAGRO) platform was established in 2009 [22] and has focused on a variety of clinical fields including gynecology and obstetrics [23], general surgery [24], pediatrics, psychiatry [25], emergency care [26], or internal medicine [27, 28], so far. One of these previous studies showed hat the working conditions for junior OB/GYNs are by far not as bad as previously hypothesized. In a second step, MAGRO now focuses on economic aspects in order to demonstrate that the increase in job quality is also present in this area.

In this respect, the present descriptive review focused on historic and current payment scales and relates them to the average work schedule of junior resident OB/GYNs. Since there has been a change in the status of young physicians, large differences can be anticipated and therefore, the hypothesis of the present review is that there has been an improvement in the esteem of single OB/GYNs work tasks.

The calculation of salary percentages for single work tasks of junior hospital OB/GYN doctors in a setting of a total 564:35:56 h work hours led to a wide range of values with regard to the single tarifs and single work tasks which are depicted in Tables 3, 4, 5, 6, and 7. In total, a magnitude of 2,325,556 different time points were related to the different work tasts and then the average financial compensation per work task was calculated for the different payment scales: The lowest values were found in the historic AiP payment scale. In this scale which was used until 2004, the average compensation i.e. for the work task “adminstrative work” (02:09:40 +/− 00:30:59 hh:mm:ss per day) was 14.47 € per day, 313.52 € per month and 3762.28 € per year (Table 3). By contrast, in the payment scale for physicians employed by the federal government the exactly same task is valued 36.76 € per day, 796.54 € per month and 9558.51 € per year (Table 4). In the Helios payment scale, the adminstrative work is compensated with 10,864.23 € per year (Table 5), in the payment scale for municipally employed physicians with 8833.45 € per annum (Table 6) and in the current payment scale of the German states (TdL) which is i.e. paid at the university schools of medicine in some of the 16 German states, this work category is valued 11,868.72 € (Table 7). That means that not longer than eight years prior to the last time point here observed, a physicians work force at this stage of the career was valued less than 1/3 of todays valuation.

The leading work task concerning the time is the conversation with colleagues and staff members. This time period of 2:41:56 +/− 0:33:35 h was compensated with 18.07 € per day in the AiP scale (391.54 € per month and 4698.50 € per year, Tab. 3), 45.91 € per day in the TVöD Bund payment scale (994.76 € per month and 11,937.08 € per year, Tab. 4), 52.19 € per day in the TV Helios (1130.64 € per month and 13,567.72 € per year, Tab. 5), 52.82 € per day in the TV-Ärzte (VKA) payment scale (1144.46 € per month and 13,733.55 € per year, Tab. 6), and 57,01 € per day in the TV-Ärzte (TdL) payment scale (1235.18 € per month and 14,822.17 per year, Tab. 7).

When comparing the different payment scales, i.e. by focusing on the lowest payment scale and the highest (Fig. 1), large differences are found. I.e. when analysing the pure walking time of 42 +/− 14 min per day, it can be seen that this category is currently valued 320.75 € per month (3848.94 € per year) in the TdL scale. This is even higher than the amount of money directed to adminstrative work (over 2 +/− 0.5 h/d) in the historic AiP scale (313.52 € per month/ 3762.28 € per year) which was paid for doctors of the same qualification (2 years of experience) until 2004 (Fig. 1).

Among the numerous occupational problems found in health care personel [34‐42], there are many studies that address career satisfaction and perceptions of quality among obstetricians and gynecologists [17, 19, 43‐46]. The present article does not want to add a further questionnairy-based survey which asks physicians for their attitude concerning job situation, payment or other factors but addresses a difficult area – namely the field of young academics in the field of obstetrics and gynecology – by reviewing existing real-time analysis data and correlating this data to tarfis. After having previously recorded reference values for daily work activities of junior OB/GYN physicians [23], the aim of this MAGRO review study was to analyse the valuation for the different work activities in relation to pay scales which were paid in a 8 year intervall to physicians in their second year after the final medical exams. In this respect, it is important to notice that the reference average workday of the OB/GYNs which was identified on the basis of an analysis of more than 2 million time points was found not to be longer than 9:24:35 h (SD = 1:05:05 h). This is shorter than anticipated and reported in other studies [47] and from these data, it cannot be stated that the average junior physician works more that 10–12 h per workday. Also, this amount of daily work time leads to a higher proportion of money allocated to single work tasks, as presently calculated. In this respect, we here report that i.e. the amount of salary allocated to the most frequent work task – conversation – of a physician two years after the final medical exams i.e. in the highest payment scale (TV-Ärzte TdL) is 1235.18 € per month (14,822.17 per year). This amount is more than three-fold higher than the amount allocated in the AiP payment scale (391.54 € per month and 4698.50 € per year). It can therefore be clearly stated that there is a significant increase of the esteem of the workforce of a junior physician on a monetary basis. This increase in the compensation dramatically differs to the public opinion of the current job situation of young doctors in Germany in 2007 [20]. This can also be concluded by comparing the reward for different work tasks. I.e. the pure walking time is rewared in current pay scales as high as a much more time-consuming work tasks, i.e. administrative work in the historic AiP pay scale. By comparing the exact values, it can be estimated that the increase in financial estimation is about 3-fold. In contrast to reports that state a difficult work situation for hospital doctors, the present study at least demonstrates a strong increase in the financial appreciation.

This is the first review that combines the data of a realtime workflow analysis with more than 2,000,000 time points with pay scale data in order to assess the merit of junior OB/GYN work tasks. With regard to the numerous scales that were used, it can be stated that there is an increase in the valuation of the work force of junior OB/GYN doctors of about 300%. In contrast to the multitude of studies that report stressful conditions within the daily routine, the present study adds a new context to the discussion and demonstrates that at least, the work is now compensated in a more appropriate way.