A sought-after place to study medicine, even without a top diploma, in return for the promise of becoming a family doctor, where you are needed most - in the countryside. The country doctor quota is based on this deal between the state government and university place applicants. Anyone who breaks the promise faces a contractual penalty of 250,000 euros.
But there are now numerous lawsuits pending against this regulation - at least 20 in North Rhine-Westphalia alone. The first four disputes will be heard on Tuesday before the administrative court in Gelsenkirchen. The first verdicts are also expected then. That's what it's about in detail.
What is the rural doctor quota and how many does it affect?
North Rhine-Westphalia was the first federal state to introduce the quota in 2019, and ten other federal states followed suit with similar regulations. In order to counteract the shortage of family doctors in rural areas, some of the study places are reserved for those graduates who commit to working as a family doctor in an underserved area for at least ten years after completing their further training as a general practitioner.
In North Rhine-Westphalia alone, according to the Ministry of Health, 1,188 people have so far started studying medicine beyond the quota, with more to follow this winter semester. 79 have completed their studies, around 55 are in further training, some are also in rural doctor's practices. Prospective doctors complete such further training after studying medicine in order to qualify for a specialist area under supervision in clinics and practices - in this case as a family doctor.
What are the procedures about?
According to a court spokesman, the plaintiffs want in all cases to have the contract they concluded with the country declared null and void. The main reason they cite is that the proposed contractual penalty is too high. The country argues that the punishment must be high in order to fulfill its purpose: it is intended to encourage prospective country doctors to comply with the contract.
Some lawsuits also concern graduates who would rather become pediatricians and seek further training. According to the court, there is no undersupply in this area, the state replied. According to the court, the plaintiffs are either at the home stretch of their studies or are already in further training.
But not a country doctor? What are the reasons for lawsuits?
“Life circumstances can change,” says lawyer Joachim Rau, who represents the four plaintiffs in Gelsenkirchen and a total of around 30 clients with similar concerns nationwide: They do not want or cannot fulfill the contract that enabled them to study at their desired level even without a top high school diploma. His clients - often because they saw it as their last chance to become a doctor - used the country doctor quota contract as a "blank check for a future that they could not yet foresee."
After studying and therefore at least six years later, things could have happened that now speak against the country doctor's plans: the consultations that he conducts are about the desire to have children, shifted aspects of life, sometimes illnesses or shifting interests. In addition, areas that were still considered underserved when applying for a place at university may now or soon no longer be classified as underserved.
Where do the lawsuits start legally?
From the lawyer's point of view, the contractual penalty regulation is legally vulnerable in many areas: He considers the penalty payment to be too flat and too high. One of the problems is that even the “smallest breach of contract triggers draconian penalties,” complains the lawyer.
A country doctor quota student in North Rhine-Westphalia who does not immediately begin further training after completing his studies is threatened with the same fine of 250,000 euros as someone who burns out after nine years of working in a country doctor's practice.
According to Rau, two of the lawsuits heard on Tuesday concern subsequent changes to the quota deal: In an early version, the contract also included the opportunity to become a pediatrician. But this option was subsequently deleted. “In my view, this is a clear breach of contract,” says Rau.
According to Rau's description, other proceedings concern cases in which serious chronic illnesses stand in the way of working as a country doctor. But the contracts do not provide for a right to terminate the contract in such hardship cases.
Does the country see a need for improvement in light of the lawsuits?
Upon request, the North Rhine-Westphalia Ministry of Health stated that the court's decision remains to be seen. The judicial review that is now taking place is no surprise: “In order to counteract the impending shortage of doctors, especially in rural regions, the state of North Rhine-Westphalia has broken new legal ground with the rural doctor quota and is taking a pioneering role nationwide in this regard,” said the ministry.
