T here is general discontent at German university hospitals, as the DFG hears repeatedly

in letters from young medical re-searchers. In these letters, they jus-tify their motivation for leaving thecountry, or not wanting to return toGermany. For instance, one youngneuroscientist accepted a four-yearposition in England, which allowshim 80 percent of his time for re-search, provides a grant for consum-ables and, on top of that, gives himindependence (see quote 1). Thisimplies what we evidently lack herein Germany:• Long-term appointments leadingto tenure track, in other words an al-ternative to the W3 professorships atuniversity hospitals.• A limit on the clinical workloadfor talented young medical re-searchers.• Recognition of time spent doingresearch to obtain further qualifica-tions.• Secure core support and fundingfor research.• Early independence for re-searchers, including when it comesto third-party funding.

A recently compiled study of doc-tors’ working hours at university

hospitals for internal medicineshowed that, with an average of 10hours per day being spent doingclinical work, most of the researchis done at weekends, as is empha-sised by the second quote. Medicalresearchers are evidently a “threat-ened species,” most commonlysighted at weekends.

The third quote concludes byhighlighting what is probably themost serious problem: The lack ofrecognition of the immense work-load, the motivation and the scien-tific curiosity displayed by youngmedical researchers that frequentlyexists among managers and theconsequences of an excessively hi-erarchical structure. Medicine as ascience and as an art needs a hier-archy of experience, but this doesnot necessarily apply to researchand the commitment of young peo-ple ought to be respected. It is pre-cisely those with experience whoshould invest time in the training,supervision and support of theiryoung colleagues as well as theirstudents. The attempts by politi-cians to discriminate betweenyoung doctors at university hospi-tals depending upon whether theyare currently involved in research

or caring for the sick, to the disad-vantage of those conducting re-search, is further clear evidence of alack of appreciation for these re-searchers.

But are these anecdotes repre-sentative? Of course not. There area lot of university hospitals wherethe young staff receive a great dealof support, are released to do re-search as a matter of course, andwhere research can therefore beconducted successfully. Yet even atthese hospitals, the opportunity toprovide long-term career prospects,to limit the clinical workload to alevel comparable with that in othercountries, and to implement perfor-mance related in-house funding, isinadequate. The latter, in otherwords, the dedicated use of thefunding provided by the federalstates for teaching and research asdistinct from the revenue generatedby medical care provision, has beenpointed out time and again by theDFG’s Senate Commission on Clin-ical Research. It is pleasing to seethat this concept is being put intopractice at some university hospi-tals, but even where this is happen-ing, appropriate structures are notin place to enable the full range of

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Prof. Dr. Jürgen Schölmerich

Is Medicine at German Universities

as Bad as it is Painted?

Clinical research should receive more respect for the dedication shown by young researchers, more

long-term career opportunities and more transparency of funding allocation

Commentary

clinical research. Basic researchand disease-related research aremuch more successful. There areparticular problems when it comesto patient-related and outcome re-search, since clinical researchmethods and methods of perform-ing epidemiological studies arerarely taught and hence such stud-ies are seldom carried out correctly.

What can be done aboutthis? Any improvementneeds to be based on a

clear and transparent, performance-related allocation of funding. Ofcourse, any university hospital ormedical faculty is obliged to offerthe whole spectrum of medicalteaching. To enable this, funds needto be made available to each institu-tion from the state contributions, ac-cording to teaching load, in additionto the funding for provision of med-ical care. There have to be focusedareas of research – which impliesthat there also have to be areas withless activity. This, in turn, needs tobe reflected in an appropriate distri-bution of funding provided for re-search from the state contributions.This funding also needs to actuallyreach the individual researchers,which means that the funding allo-cation needs to be individually per-formance related. If the DFG’s moveto full overhead funding of researchprojects is successful, then a signifi-cant simplification of the fundingsituation for clinical researchers is tobe anticipated.

Only on the basis of a clear sepa-ration of funds given for research orreceived for patient care is it possi-ble to differentiate between thetime doctors spend doing researchand the time spent providing med-ical care, and to secure the former.This also makes it possible to pro-vide longer-term career prospectsfor young researchers by creatingthe necessary tenure track posts forthose with particular promise. Atthe same time, it is essential to en-sure that doctors conducting re-search do not end up worse off thanthose who are solely involved inproviding medical care. This iswhere the ministers of education inthe federal states are called upon, to

make this clear to the wage negotia-tors.

Both the hospitals and the re-search funding bodies need to in-vest in training for patient-orientedresearch. Instruments such as anacademy of excellence, based onthe example of the DFG’s WorkingGroup on Medical Technology, areconceivable and would probably behelpful. At the same time, the facul-ties need to realise that, when eval-uating this kind of clinical research,a distinction needs to be drawn be-tween basic research and disease-related research. Of course, perfor-mance can also be measured interms of publications and possiblyalso on the basis of third party fund-ing. But the processes here are gen-erally longer and more drawn-out.Studies which do not receive fund-ing from industry are particularlycumbersome for the researchers in-volved and generally also yieldfewer publications in any giventime period. In this respect, it is im-portant to ensure that this is under-stood and does not have a negativeimpact on decisions that affect re-searchers’ careers.

The most important thing, how-ever, will be to ensure that the moti-vation and curiosity which youngmedical researchers have are notsuppressed through a lack of recog-nition (including in financial terms)or through treatment that may be in-terpreted as disrespect, as is evidentin the third quote. The age of the di-nosaurs has inhibited the develop-ment of the mammals for a long timeand it is doubtlessly pleasant to be amedical dinosaur. Now seems to bethe time to allow the next genera-tion to develop unhindered, how-ever, and if this is allowed to takeplace, then there is cause for opti-mism for the future of universityhospitals and clinical research inGermany.

Prof. Dr. Jürgen Schölmerich

Jürgen Schölmerich is Director of the Depart-ment for Internal Medicine 1, University ofRegensburg, and Vice President of the DFG.

1. “... I’m also looking forward toreturning to Europe next year. Ithasn’t been easy to decide on thenext step to take, but I have nowaccepted a four-year post as a Cli-nical Research Fellow in Manches-ter, with very few clinical obliga-tions (one day a week), no teachingduties, funding for consumablesand a great deal of independence(with personal third party fundingetc.).”

2. “... There is practically no rese-arch done, or it is only done by bio-logists, research scientists and as-sistant medical technicians employ-ed especially to do research. That’sprobably a good thing too, as beinggranted time to conduct a researchproject would be illusory in anycase, and the weekends are alreadyspent dictating medical reports. ... Iconsider myself above such a sys-

tem, which is so perverted that anycartoonist would refuse to caricatu-re it because it is simply too grotes-que. I could have reached this pro-fessional, social and personal lowpoint with far less trouble. Neithermy first class degree, nor my fel-lowship from the Studienstiftung(German National Merit Founda-tion), nor my PhD, which I defendedwith “magna cum laude”, nor myresearch visits abroad, nor the factthat I also passed all of the Ameri-can State Examinations would havebeen necessary. ... I will thereforebe accepting a second three-yearcontract in the USA to continue mywork.”

3. “There are just three days a yearprovided for job-related training.For every additional day spent onfurther training, we have to drawfrom our annual leave. For thethree-day course on ultrasound,which was held here in our own hos-pital by our own senior physician,the hospital charges its interns al-most €500. It goes without saying,that these three days are deductedfrom our leave.”

Excerpts from letters to the DFG

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german research 1/2007