Munich clinic boss shows extreme excess of beds in Germany
In an interview with the Abendzeitung, the head of Munich’s municipal hospitals, Axel Fischer, said that in future 20 percent of patients should go home immediately after treatment. For this reason, hundreds of hospital beds are to be reduced in Munich.
Abendzeitung interview with Dr. Axel Fischer (54). Since 2014 he has been Managing Director of the Munich Clinic, which has locations in Thalkirchner Straße, Bogenhausen, Harlaching, Neuperlach and Schwabing.
Abendzeitung: Mr. Fischer, if you needed knee surgery, which clinic would you go to?
AXEL FISCHER: Difficult question. Of course I would have it done by us. But I have a few options in our clinics.
Be able Do you understand that many would rather go to a private clinic for something like this?
As a patient, you often don’t have the medical insights. Maybe I would make a different decision there – because the houses are nicer elsewhere or the food is better. But when it comes to medical quality, I would always come to us.
Hospital beds cannot be occupied because there is a lack of staff
Most recently, around 500 beds could not be occupied in the city hospitals because so many staff were missing.
That’s still in the order of magnitude.
The mayor says: Not occupying the beds costs so much that he could give every nurse up to 1000 euros more. Is he right?
I see it similarly, I would also like to pay every nurse more. In fact, the fixed costs incurred in a clinic are just as high, regardless of whether there are 20 or 40 patients on the ward.
Despite this, the bonus to the nurses promised by the mayor was not paid.
To explain, there are areas like pediatric intensive care where the shortage is greater than others. We thought we would give the people there a little more money, also as an incentive to continue their education. The works council is more likely to have money for everyone. But if we distribute the sum among everyone, it will fizzle out. Not everything is possible under collective bargaining law either. We need to get together again.
200 to 300 nurses are currently missing – and the situation will only get worse
How much staff is missing?
For a stable situation we would need 200 to 300 nurses. The situation will worsen in the coming years as baby boomers retire. In Germany there will be a gap of 25 to 30 percent of the nursing staff.
What problems does this cause? Do you have to turn patients away?
We manage to treat the emergencies, but in the current wave of infections we often have to postpone operations such as knee surgery, which we can plan. We are still in a pandemic. As long as we have isolation measures and compulsory testing, we are not in a normal state.
Are more nurses from abroad the solution?
Otherwise we won’t make it. But that alone is not enough. As employers, we also have to do our homework.
Which?
We are open 24 hours a day, seven days a week. But in the generation that is now entering the workforce, many no longer want to work like this. So we have to ask ourselves how can we still make it all around the clock to be there, for example with more flexible working time models, with more childcare or caring for relatives.
Munich clinic boss: “The be-all and end-all for us is living space”
What would you like from the city?
The be-all and end-all for us is living space. We have a subscription right for 1,000 apartments of the city, but they are full. We can only reoccupy 35 to 40 apartments each year. We would certainly need three times as much. The apartments that will be built in Schwabing by 2025 are a first step.
In 2022, the Munich clinic made a loss of 36 million. In addition, there are expensive renovations to the clinics and high energy costs. How bad are the finances?
We’ll get out at about that loss. What worries me more is what will happen in the next few years. Because revenue is stagnating because more and more cases are being treated on an outpatient basis. At the same time, the costs are increasing immensely. We are planning energy costs of 42 million euros instead of 16.
The Munich Clinic has taken on 141 million euros in debt. Can she repay this money temporarily?
We had three years corona, we have an energy crisis, demographic change – we certainly can’t pay the money back in three or four years. But in eight to ten years we want to be able to stand on our own two feet.
The Bogenhausen Clinic is the main problem. It is to be renovated during ongoing operation. Wasn’t it foreseeable that this would be difficult?
In 2014 it was not foreseeable how difficult it would be. You only see that when you start. Of course, one is always wiser afterwards.
It is said that a completely new building is to be built. Is that correct?
The extension is expected to be completed in 2024. We will rehabilitate other parts of the company. And we are currently discussing other ideas such as living space with those responsible.
“There are definitely 20 to 30 percent too many beds throughout Germany”
Are there too many hospitals in Munich?
You have to look at the number of beds. The fact is: throughout Germany there are certainly 20 to 30 percent too many beds. Others say that in Germany we treat 50 percent more cases in hospital than the rest Europe, and in some cases the supply is even better there. If we had 300, 400, 500 fewer hospitals, we would still have the same quality. And because we operate so many beds, the need for nursing staff is also great.
How many beds would have to be cut in Munich?
Our target concept is currently designed for almost 2,500 beds. Today we operate between 2,000 and 2,300 beds. The population is getting older. But there is immense pressure from politics and medicine towards outpatient care. In the future, up to 20 percent more patients will go home directly after treatment. I believe that we will then need about 2,000 beds in the Munich Clinic in addition to the increased outpatient treatment.
Fischer: “The sticking point is the staff, not the beds”
Will it then still need five city clinics?
During Corona it was good that there were more beds in Germany.
We did not survive the pandemic because we had more beds, but because we reacted earlier and because we treated the severe cases in highly specialized centers. The sticking point is the staff, not the beds.
Will it then still need five city clinics?
It takes all urban locations but in a different configuration. As managing director, I would never suggest selling the site – and as far as I know, the city doesn’t want that either. But the best example is the maternity clinic in Neuperlach. I will continue to advocate concentrating them in one location. Because it will be, in ten years, to have enough staff for two difficult locations.
So you don’t understand the petition of the midwives who want to keep the maternity clinic in Neuperlach?
I can understand every single midwife who has been providing good medicine in Neuperlach for years and who does not want to change. But as CEO I would not sign the petition. In Harlaching we now have 2,400 births, in Neuperlach 1,000 to 1,300 a year. We even want to expand to 4,000. So far, no high-risk pregnancies can be made in Neuperlach – they are transferred to Harlaching. In Harlaching, the children’s intensive care unit is nearby. It doesn’t make sense to me that it should be a problem to drive eight kilometers further for a birth.
A new medical concept is currently being worked on. Many worry that jobs will be cut.
Nothing is broken down in maintenance. On the contrary: there is already a gap of 300 nurses that we would love to fill immediately. But we have to shift and relocate within the locations because the legislator will require this with the new reform: And because we can operate more beds with stable teams. If departments are also merged, I may not need every function 1:1. Of course, however, nobody will be fired, but there would probably be fewer new hires. It’s a process that takes several years. I don’t have any job cuts either.
“We are in a storm and need to change course”
Who is working on the medical concept?
After the first corona wave in mid-2020, a team of doctors, nurses and people from the administration began to think about where the Munich Clinic should go in 2030. Only in the last few weeks have we brought in a consultation. You also need this to obtain external data.
How expensive were the consultants?
Less than 200,000, otherwise we would have to advertise it across Europe.
You recently announced your retirement from management. Shortly before the new medical concept is adopted. Why now?
It’s never the right time to leave when you enjoyed doing something. It was a process. It’s also up to the family. I have two children, ages 10 and 13, who I barely noticed. And I just want to do something new again.
And was?
That’s not ready for a decision yet. I’ll definitely stay in healthcare.
Some say: the captain is abandoning the sinking ship.
The Munich Clinic will never go under.
“I made mistakes. You’re always smarter afterwards”
Your successor will have a hard time if he has to implement a concept that he didn’t come up with.
When I came, the Munich Clinic was a tanker that had gotten stuck somewhere in a total bank. And we solved that with large subsidiaries. Now we’re in a storm and need to change course. We can’t wait. Nevertheless, everyone who comes WILL be able to create within the framework of what is possible.
What would you do differently?
I definitely made mistakes. But you’re always wiser afterwards. Perhaps one mistake was that I took some things too personally.
What feeling are you leaving with?
When it’s over, I’ll be highly emotional. I was always there 24/7 for the past nine years. But I will certainly come back at some point – but then as a patient.
This article was written by Christina Hertel