Shortage in Styria

Hospitals: unfilled doctors’ posts tripled

Symbolic image

(Bild: Christian Jauschowetz)

Many part-time employees, the approaching wave of retirements and a multi-million euro scholarship program as a pipe-dream: Styria is struggling with the issue of a shortage of doctors. A new Court of Audit report now shows: Kages was unable to say how many doctors dropped out of training and why. The number of unfilled posts has also tripled - in just four years. 

There are more and more doctors, but fewer and fewer are working in Kages hospitals and with health insurance contracts. This is nothing new, and yet an almost 160-page audit report published on Tuesday by the State Court of Audit clearly illustrates the problem.

According to the report, a third of Kages' specialist doctors belong to the "baby boomer" generation, which is approaching retirement. The result: between 2018 and 2022, the occupancy rate of doctor posts fell from 97% to 92%. Unfilled posts have tripled!

In four hospitals, more than ten percent of vacancies could not even be filled:

Staffing levels in Kages hospitals in 2022 (rounded)

• LKH Rottenmann-Bad Aussee: 71 %
• LKH Murtal: 85 %
• LKH Hartberg: 89 %
• LKH Hochsteiermark: 89 %

LKH Graz Süd-West has the best staffing ratio at 99.5 percent, followed by LKH Feldbach-Fürstenfeld with 97 percent.

Non-transparent part-time work
According to the report, almost a third of doctors work part-time: 741 part-time staff compared to 1663 full-time doctors. Of the part-time employees, 551 are women, i.e. almost three quarters, and 190 are men. During the audit period, the proportion of part-time employees rose from 28 to 31 percent.

The State Court of Audit found that all evaluations of part-time medical staff left open information about the background to the respective reduction in the level of employment.

Landesrechnungshof Steiermark (2024): Prüfbericht Ärztinnenausbildung/Besetzung von Ausbildungsposten in der KAGes, Seite 127

Why is that? This is the problem that the Court of Audit criticizes: Kages does not survey the motives for which doctors reduce hours. Whether because of childcare, caring for relatives, for leisure reasons or because they run a lucrative private practice in addition to their work at the hospital. This has been permitted since 2015.

"Due to the large number of vacant posts within the Kages, the LRH considers these secondary occupations to be extremely critical," it says. 

Excerpt from page 129 of the audit report

(Bild: Screenshot/LRH)

In addition, the number of doctors leaving (i.e. resigning) increased by 28% from 2020 to 2022. The increase is even more noticeable among specialists: 45 percent more left Kages hospitals in 2022, namely 97 people.

Another point of criticism is that "Kages was unable to provide precise information on basic training completed, hospital rotations in general practitioner training and specialist training completed. The LRH recommends that specific monitoring be carried out here".

Scholarship program continues to occupy politicians
The nine million euro scholarship program of the province of Styria in cooperation with the Sigmund Freud Private University of Vienna also continues to be a topic of discussion. 60 students, 20 per year from 2022/23, were to receive financial support during their six-year studies and then be tied to a Kages house for ten years (or to a doctor's office after their rotation and specialist training). 

"It is incomprehensible to the LRH why the training offensive of the Province of Styria was originally not carried out with a local institution, such as the Medical University of Graz, but with a private university in Vienna," it says.

According to the report, Kages also has no say in the selection of scholarship holders, only the SFU. The LRH therefore recommends "specifying selection criteria in the present cooperation with the Sigmund Freud Private University of Vienna and at least negotiating a right of objection for selected scholarship holders".

Expensive specialists
25,000 euros per year or 150,000 euros in total costs the province of Styria one place. The program will not produce fully trained female specialists until 2034 at the earliest. Of the ten years of commitment to Styria after graduation, seven fall within the training period. As specialists, the scholarship holders are only bound for three years. These are "relatively high costs", according to the Court of Audit.

Kornhäusl: "We are working on it"
In a reaction to the ACA report, ÖVP Health Minister Karlheinz Kornhäusl told the "Krone" newspaper: "The report confirms what I know and what I've been talking about anyway. I don't want to sugarcoat anything. We try to improve the healthcare system every day."

There are now more people joining the Kages than leaving, both doctors and nursing staff. Regarding the regulation of secondary employment, Kornhäusl says: "The Chamber, Central Works Council and Kages negotiated this years ago. A ban could lead to the colleague resigning completely."

Regional Health Councillor Karlheinz Kornhäusl (ÖVP)

(Bild: Christian Jauschowetz)

Rotations and specialist training are "not a rigid system, and that's a good thing". Many start with general practitioner training and then switch to a specialist position when it becomes available. However, Kages knows where which positions are available.

FPÖ criticizes Kages management
The Freedom Party took up the criticism of Kages and the provincial government. "Overall, the audit report paints a far from competent picture of the Kages management," says health spokesman Marco Triller.

The Greens also take the same line: "The fact that there is no central evidence of training facilities, vacant and filled training positions and posts within Kages shows that we are flying blind when it comes to training and personnel planning," says health spokesperson Georg Schwarzl.

The KPÖ is certain that the shortage of doctors is "home-made": "While hospitals are being closed, expensive private clinics and elective doctors' surgeries are flourishing." Neos demand a full-time bonus for doctors.