Entry limits in medicine now a constitutional issue

A German administrative court has called on the country’s Federal Constitutional Court to decide whether the numerus clausus entry restrictions for medicine at universities are unconstitutional.

Germany’s health system is suffering from a lack of physicians for patient care, especially in rural areas. More doctors are being recruited from abroad. There are various reasons for the insufficient number of physicians available to the health system.

While Germany has never had so many medical graduates before, many of them seek to pursue a career in industry, above all in the pharmaceuticals branch, or prefer to engage in research. Growing numbers of women graduates have resulted in an increase in the share of part-time work in the health sector.

Also, doctors are having to cope with an ever-greater administrative work burden. Finally, many graduates look for better pay and better working conditions in other countries. So having more medical graduates does not necessarily benefit the patient.

Whereas places to study are rising slightly each year, they cannot keep pace with the growing number of applicants. More than 43,000 young people competed for a total of just 9,200 places to study medicine at universities this winter semester.

Applications are submitted to the Stiftung für Hochschulzulassung, an agency that cooperates with the Federal Employment Agency and is responsible for the allocation of study places in entry-restricted subjects.

The numerus clausus system is based on the average of marks in the Abitur certificate of higher secondary education, with 20% of study places allocated to those with at least an excellent average mark. A further 20% go to those who applied in the past and have waited long enough. Universities are free to decide to whom they give the remaining 60%.

It has again and again been argued that the numerus clausus system clashes with Article 12 of Germany’s Basic Law, which states that “all Germans have the right to freely choose their profession, their place of work and their place of training”.

Moreover, the Federal Constitutional Court already ruled in 1977 that having to wait for six or even more years for a place to study medicine before being enrolled was unconstitutional. Today, students often have to wait for the equivalent of 15 semesters before being able to enrol for medicine courses that are supposed to take twelve semesters. In 1999, waiting time was still at four semesters.

Now judges at Gelsenkirchen Administrative Court have decided to bring the issue of entry restrictions based on numerus clausus before the Federal Constitutional Court on various grounds.

First, they criticise that there are no quotas for the individual states, which they say implies unequal treatment because Abitur degrees differ from state to state in terms of how achievement levels are assessed.

Second, waiting time in the present procedure refers to the year that applicants received their Abitur, which, the judges point out, means that an Abitur holder deciding to study medicine later on in life can “jump the queue”.

Finally, the Gelsenkirchen judges argue that the Abitur itself is given too much significance, especially since it is usually also considered as the key factor when universities decide on applicants themselves, because this saves them time with individual assessments of their own.

“We need physicians who are not only highly capable of learning but are also good in terms of their social skills,” says Frank Ulrich Montgomery, president of the German Medical Association and vice-chairman of the World Medical Association.

Montgomery believes that in addition to the Abitur mark, other criteria ought to be considered, such as psychosocial components, social commitment and professional experience. He proposes introducing an assessment centre which could focus more on individual applicants and their abilities and attitudes.

A ruling by the Federal Constitutional Court would also affect other subjects with entry restrictions, such as pharmacy, dental medicine and veterinary medicine. However, it could take several months for the court to decide on the matter.

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