The German healthcare system, renowned for its efficiency and quality of care,1 is at a critical juncture in the postpandemic era. The results of a McKinsey survey of physicians in Germany highlight substantial challenges that could be affecting the quality and reliability of patient care (see sidebar, “Research methodology”). The survey results also inspire optimism, however: most physicians believe the issues could be resolved with technology-enabled solutions, innovative organization designs, and revamped processes.
Among the key findings, respondents indicated staff shortages and high levels of bureaucracy prevent them from fulfilling their core responsibility of providing medical care to patients. They reported 40 percent of healthcare jobs vacated during the pandemic remain unfilled, with particularly acute shortages of nurses and medical assistants. Additionally, respondents reported the time they spend on administrative tasks, recordkeeping, and documentation has been steadily increasing compared with pre-COVID-19 levels, and they expect it to continue increasing. As a result, 35 percent of physicians said they are at least somewhat likely to leave their current job within five years. Among all physicians surveyed, 64 percent did not intend to pursue a clinical career if they leave their current position. Nearly 30 percent of physicians reported being burned out, although the percentage is higher among younger physicians (43 percent of physician respondents aged 30 to 39 compared with 18 percent of physician respondents aged 60 to 69).
The solutions physicians identified as most likely to overcome these challenges are nonmedical in nature and entail expanded use of technology-based tools. Specifically, respondents expressed interest in solutions such as electronic appointment scheduling, electronic health records, and online interactions that could reduce administrative burdens. According to the survey, at least two-thirds of physicians are inclined to use these solutions even though existing digital options are still underused. For example, although telemedicine is considered critical for addressing challenges (such as time constraints, lack of flexibility, and inconvenience for patients) and more than 80 percent of surveyed physicians offer it to their patients, less than 5 percent of all physician visits take place virtually, the respondents reported.
Research methodology
We conducted an online survey of 201 physicians across Germany from November 2022 to January 2023. The sample is not a representative set but rather a convenience sample. The survey was open to all physicians aged 30 to 69 who worked at least 20 hours per week. The sample included physicians from all major specialties (such as pediatrics, oncology, and cardiology) and all employment statuses (for example, self-employed, employed directly by a hospital, or employed in a physician-owned medical care center). Respondents were, on average, 50 years of age; the majority had more than 20 years of experience. A large majority confirmed they were knowledgeable about the COVID-19 pandemic’s implications on their organization (94 percent) and the overall financial position of their organization (73 percent). More than 75 percent reported they work more than 40 hours per week with a primary focus on patient care.
1. Pressing challenges reported by surveyed physicians in the current system
Respondents from various specialties painted a vivid picture of the hurdles they confront on a daily basis. Among the issues identified as most pressing were staff shortages and an increasing administrative burden. Consequential issues also included the excess number of digitization projects already under way (sometimes for years); declining revenues, which could be contributing to underinvestment in modern technology infrastructure2; and challenging succession planning as physicians nearing retirement age struggle to find enough younger doctors to take over their practices.3 Nearly a third of physicians in Germany today are more than 60 years of age.4
The survey shows that respondents’ primary challenges are staffing-related
According to the survey results, labor shortages in rural areas and high levels of bureaucracy are the top two challenges physicians expect to face within the next five years. Of the five top challenges anticipated within the next five years, four are related to staff shortages. The only challenge not related to staff during the same period is an overhang of documentation and bureaucracy.
Survey respondents reported that staffing shortages are higher than before the COVID-19 pandemic
About one in four respondents said their practice or care delivery organization has lost more than 20 percent of its pre-COVID-19 staff. According to survey respondents, less than 55 percent of staff vacancies were filled with permanent or temporary staff, leaving 40 percent of those positions open despite active recruiting efforts.
Role-specific staff shortages
Although open positions for medical assistants, nurses, and medical specialists were cited as the most difficult to fill, respondents said they are experiencing acute staff shortages at every level.
Respondents reported increasing administrative tasks and high levels of bureaucracy
Survey respondents were asked to reflect on how they spent their time before the COVID-19 pandemic and what has changed. The results show that for both self-employed and employed physicians, time available for direct patient care has decreased by about 4 percent (from 72.4 percent to 69.6 percent), while time spent on administrative tasks increased.
Physicians indicated administrative tasks, such as recordkeeping and documentation, took 16 percent of their time before the COVID-19 pandemic. Employed physicians reported spending 19 percent of their time on these activities (compared with 12 percent for self-employed physicians).
2. Potential consequences of the challenges facing surveyed physicians
The survey revealed a spike in attrition among surveyed physicians. Thirty-five percent of respondents said they were contemplating leaving their current role within the German healthcare system. Factors such as demanding work schedules, inadequate staffing levels, the allure of higher-paying opportunities elsewhere, and deteriorating work–life balance could prompt healthcare professionals to consider alternative career paths.
A high level of attrition is expected among respondents
About 60 percent said they were most likely to consider a nonclinical job (41 percent of those leaving) or retirement (20 percent). When asked about possible career paths outside of patient care, respondents were most likely to cite consulting (29 percent) and pharmaceuticals or biotechnology (20 percent).
Physicians indicated clear reasons to leave or stay in their role
The survey showed that respondents want sufficient free time to have a fulfilling personal life without a lot of on-call duties. When asked the most important reasons for considering quitting, more than half of all respondents (52 percent) cited family needs or other competing life demands (work–life balance), 44 percent chose inadequate support staffing, and 43 percent cited a higher-paying position. Nearly one-fifth of respondents agreed strongly or very strongly that they had not been adequately prepared or trained for the requirements of their role (18 percent).
The most important reasons for staying in the profession included having meaningful work (75 percent), being able to work independently (73 percent), and being able to take care of family (68 percent). However, more than one-third of respondents (36 percent) indicated a lack of better job opportunities was a strong or very strong factor in their decision to stay.
Surveyed physicians reported high levels of burnout
Results showed surveyed younger physicians suffer more from symptoms of burnout (43 percent of physicians aged 30 to 39 compared with 18 percent of physicians aged 60 to 69). Separately, more than a third of respondents aged 30 to 39 reported feeling their work is insignificant or meaningless, and more than six out of ten said they work more for money than for personal fulfillment.
Overall, more than one-fourth of surveyed physicians (28 percent) reported feeling burned out, with higher rates among oncologists (45 percent) and intensive care physicians (43 percent).
3. Creative remedies including technology-enabled solutions
To surmount the challenges highlighted in this survey and to mitigate any far-reaching consequences, respondents pointed to a variety of actions that the German healthcare system could explore.
Digital tools and innovation. The survey underscores that solutions focusing on administrative improvements could address many pressing issues. These innovations not only streamline operations but also enhance the overall patient experience by reducing wait times and paperwork hassles.5 Conversely, the survey revealed that respondents perceive digitally enhanced decision support tools and biotechnological innovations such as 3D printing to be less helpful in addressing the current challenges.
Supportive leadership and good working conditions. Within healthcare organizations, supportive leadership and good working conditions play a pivotal role in retaining and attracting healthcare professionals. The survey highlights that physicians value leaders who genuinely care about their well-being and communicate transparently. Furthermore, non-task-related factors, including lifestyle considerations, salary, and autonomy over work schedules, featured prominently in respondents’ decision-making processes when considering offers from other organizations.
Respondents said solutions to challenges are available
Surveyed physicians said that solutions and innovations focused on administrative improvements are more likely to help address reported challenges than medical and nursing innovations. For example, 73 percent said patient self-services (for example, electronic appointment scheduling) would be a big or very big help, and 62 percent said the same for paperless data (for example, unified electronic health records).
Conversely, respondents identified digitally enhanced decision support and biotechnological innovations such as 3D printing and robot-assisted surgical procedures as among the least helpful solutions.
Surveyed physicians said they were open to administrative and medical solutions
In addition to seeking to understand physicians’ attitudes toward solutions, we asked about their willingness to use them. The survey confirmed that most surveyed physicians would be willing to adopt most of these innovative solutions. For example, 86 percent reported they were willing to use patient self-services, and 75 percent said they would use paperless data.
Surveyed physicians indicated a willingness to adopt innovative solutions using digital tools
The survey found that most surveyed physicians already offer at least one form of digital solution to their patients (78 percent), with 43 percent offering video consultations and 63 percent offering audio consultations. However, the amount of virtual care provided remained small. Adopting these solutions at scale will require a holistic approach to awareness, education, and change management for physicians and patients alike.
According to surveyed physicians, use of telemedicine is increasing
A majority of surveyed physicians (64 percent) would like to spend at least a few hours a day or one dedicated day a week on virtual care. Responses varied by age; while 66 percent of respondents aged 30 to 39 indicated they were willing to spend time on virtual care, just 43 percent of respondents aged 60 to 69 said the same.
Surveyed physicians expect tech giants to enter healthcare markets and telemedicine use to increase
In general, surveyed physicians reported they expect substantial change in the healthcare system over the next five years as new types of companies enter the market. About two-thirds of respondents believe the entry of tech giants (68 percent) and routine appointments through telemedicine (63 percent) will have an impact. Yet surveyed physicians’ endorsement of these innovations was generally low. Only routine appointments through telemedicine seemed attractive, with 58 percent of respondents open to them.
Good leadership is important to well-being for surveyed physicians
Research has shown that employees across industries value leaders who demonstrate care and communicate transparently.1 When leaders show empathy, actively listen to their staff, and communicate openly and honestly, it can contribute to a positive work environment and improve employee engagement and satisfaction. Survey respondents reported they do not expect extraordinary things from their organizations and leaders, but they value a sense of belonging, open communication, and a positive work culture.
Surveyed physicians are in broad agreement about the factors that matter most and least
When considering offers from other organizations, surveyed physicians ranked non-task-related factors such as lifestyle, salary, and scheduling autonomy as most important. They also saw value in the ability to focus on evidence-based medicine without getting bogged down in administrative tasks. Marketing, therapy costs, and referral networks were less important to respondents considering a switch.
Respondents place high value on taking time off and finding substitute staff
When it comes to flexibility, respondents valued factors that enable them to achieve a better work–life balance, such as the ability to take leave, find staff to relieve them, and adjust their working hours and days. Physical location and work context (for example, working at multiple levels of urgency or in areas outside of direct patient care), on the other hand, were not rated as highly.
4. The path forward
Stakeholders throughout the German healthcare system could help ensure the provision of high-quality patient care by addressing the present and future challenges identified by survey respondents. Although some stakeholders may struggle to adapt, others will seize the opportunity and create value through innovation. The strategic choices stakeholders make in the next few years could determine their future success. Key considerations for these choices vary by stakeholder group:
Healthcare delivery organizations. To alleviate workforce shortages and prevent more clinicians from leaving their roles or the profession altogether, healthcare delivery organizations could continue to rethink their approaches to talent management and operational excellence. The former may entail striving to create a vibrant work culture, developing programs to attract and retain top talent with appropriate incentive mechanisms, increasing the emphasis on nonmonetary benefits such as training and education, and offering flexible working conditions. The latter may require an end-to-end strategy encompassing digitization, automation, and technology adoption to reduce administrative and documentation burdens and maximize time for direct patient care. Organizations that excel in both areas could emerge as sought-after employers and technology leaders.
Investors. Investors including private equity and venture capital firms could play a vital role in transforming the healthcare system and create substantial value by financing innovation. For example, they could invest in innovative technologies such as digital and AI solutions (including generative AI) to facilitate documentation and administration. Likewise, they could invest in innovative shared services at scale (for example, in supply chain) to boost efficiencies, access, quality, and workforce experience in their portfolio care delivery organizations. Success in this area, however, would require substantial physician trust and engagement. For example, investors could actively communicate to physicians the benefits of taking a portfolio approach, including economies of scale and access to innovative solutions. These benefits could continue to accrue to physicians as investors expand their portfolios with add-on acquisitions.
Technology and other companies. Growing demand for innovative tools to meaningfully reduce high administrative burdens and other healthcare challenges could present a substantial opportunity for technology and other types of companies to develop and grow. Companies that already operate software or platform businesses and offer solutions that could address known healthcare pain points (administrative burdens, for instance) are well positioned to participate in this attractive and growing market.
