"Nobody can take us away": Bregenz family seeks family doctor for grandmother in need of care

"Our family doctor was Dr. Kiene. He retired last year," Maria explains. Although he had recently been a private practitioner, that didn't matter to them: "We paid and were always seen right away." Neither of them had time to wait for hours, as they both worked. They briefly visited Dr. Makovec afterward, but this practice, too, has since closed "until further notice" due to illness. The sobering reality: "Now he's gone, too. No one will take us."

The couple's focus isn't on their own situation: "It's not really about us right now, but about my mother-in-law," says Maria. Hannes' mother suffers from dementia, suffered a stroke, and is cared for around the clock by a 24-hour nurse. She lives on the first floor and can no longer manage the stairs on her own. "That means an ambulance would have to be called for every little thing," the couple explains.

In total, they visited five practices, both by phone and in person – including through their mother's 24-hour nurse. The Bregenz residents also inquired at the new group practice in Vorkloster. "No one will take them. They won't even fill out a medical device form for diapers." Maria reports that she went to the ÖGK (Austrian Health Insurance Association) in Dornbirn specifically to get the form – but no doctor signed it. The couple also contacted practices in Lauterach and Wolfurt – without success: "If you're from Bregenz, they say, 'No, we don't take them.'"

Although prescriptions are issued electronically, Hannes criticizes: "No doctor looks at them, no one examines them. They simply write the prescription – regardless of whether they need it or not." The current medication list is still from Dr. Kiene. Whether the dosage is still correct is questionable. In his opinion, his mother should be examined thoroughly by a doctor again: "Especially with her diabetes, blood work, and everything else."

The couple sought help from 1450: "They told me the Austrian Medical Association (ÖGK) wasn't responsible for this either. I should contact the Medical Association," Maria summarizes the conversation. She would have liked a circular about the doctor's retirement. The Medical Association cannot dictate to doctors which patients they see, they were told. In the end, the ÖGK, along with an understanding of the situation, gave her a list of general practitioners in Bregenz. "This is all a Medical Association problem," the Bregenz resident is certain. The ÖGK recommended the following solution: "It's best for her to take an ambulance to the hospital for every little thing now. Even for medical aids."

The elderly lady once had to be taken to the hospital because she was complaining of knee pain. "Then we simply arranged an ambulance and sent her to the hospital." There, the treatment was friendly and problem-free – but it's not a permanent solution. "They always say we should relieve the burden on hospitals," Maria notes.

The couple's demand is clear: vacant practices – like those of Dr. Kiene and Dr. Brugger on Schendlingerstrasse – must be filled again. "It's insane that these doctors aren't being filled," emphasizes Hannes. "There are many patients who no longer have a family doctor." They don't want to accept the current situation: "Everyone has the right to a family doctor; they have to get this under control somehow," Maria explains. "It's important to me that my mother-in-law now has a doctor nearby."

The Medical Association told VOL.AT that it is not responsible for ensuring statutory health insurance coverage. It states: "It is not the Medical Association, but the health insurance provider (ÖGK) that has the legal mandate [...] to ensure statutory health insurance coverage." The number of approved and thus fundable statutory health insurance positions is the responsibility of the ÖGK, according to Dr. Alexandra Rümmele-Waibel in a written statement. The number of practicing general practitioners is therefore also the responsibility of the ÖGK, according to the chairwoman of the council of practicing physicians.

"The workload for Vorarlberg's statutory health insurance physicians has increased massively," Rümmele-Waibel explains. Statutory health insurance physicians feel this increased pressure and patient demand daily in their practices. "Sometimes we are told that a single statutory health insurance physician – especially now during the holiday season, when doctors sometimes cover for each other – has to care for up to 200 patients a day," she explains. Nevertheless, they always try to ensure the best possible patient care. "Every now and then, however, they are so busy that they can no longer accept new patients – and the time for any home visits is also decreasing accordingly," the doctor explains.

"Dr. Peter Kiene's cashier position has been filled since February 2020, and his successor is Dr. Yousef Abu Roumyeh," explains Rümmele-Waibel. All other cashier positions in Bregenz are also currently filled.

"For years, the Medical Association has been pointing out this development to the federal government and the Austrian Society of Statutory Health Insurance (ÖGK) and demanding more statutory health insurance positions to meet the growing demand," said Rümmele-Waibel. She points out that the ÖGK has estimated a deficit of €900 million for the current year: "The social insurance system does not have sufficient financial resources to improve the range of statutory health insurance physicians. Our demands for a strengthening of the outpatient sector and an expansion of the general practitioner system are therefore being ignored by the federal government and the ÖGK for financial reasons.

The Medical Association refers to a 2023 physician demand study commissioned by the Medical Association, the state, and the Austrian Society of Health (ÖGK): "Just to maintain the status quo of medical care in 2023, an additional 135 physicians would have to be recruited (and financed) for Vorarlberg in both the intramural and extramural sectors by 2030. Where the money for this would come from is currently a mystery to us," explains Rümmele-Waibel.

According to the ÖGK staffing plan, all necessary and approved general practitioner offices for the Bregenz district are currently staffed, she explains. "We have long pointed out that the staffing plan cannot cover current needs, but new health insurance positions are currently not being approved by the social insurance system," the doctor said in response to a VOL.AT inquiry. She concluded by emphasizing: "Politics – beginning with the health insurance reform under Chancellor Sebastian Kurz and most recently with the health care reform launched under Social Affairs Minister Johannes Rauch – has increasingly pushed the Medical Association out of the relevant areas of responsibility."

In response to a VOL.AT inquiry, the ÖGK also emphasized that primary care in Bregenz is formally covered: "All general practice positions in Bregenz are currently filled." In addition, there has been a new "plus 100% position" with Dr. ^Scheffknecht since December 2024. Since October 2024, there has been an "extended job sharing" with Dr. Baldessari and Dr. Topic of 70 percent, and since July 2022, there has also been an "extended job sharing with 30 percent." "Thus, with 14 positions in Bregenz, we are currently above the staffing plan, which provides for 12 positions for general practice in Bregenz," the health insurance fund stated.

Dr. Kiene continued to practice as a contract physician until the end of September 2019 and later as a private physician. "His position was filled by Dr. Abu Roumyen Yousef in February 2020," the ÖGK emphasizes.

Regarding the specific situation of the Bregenz resident, it states: "In principle, there is the possibility of a contracted doctor carrying out sick visits if the patient cannot be expected to visit the doctor's office due to their condition." However, there are certain criteria for this obligation – such as the population size. As a contact point if no doctor's office is accepting new patients, the ÖGK refers to the 1450 hotline: "For health complaints, our telephone health hotline is available 24 hours a day, seven days a week at 1450."

The health insurance fund rejects criticism of the planning of the care offering and refers to legal regulations: "It is legally stipulated that the number and geographical distribution of contracted physicians or contracted group practices are regulated in comprehensive contracts, taking into account the regional health structure plans (RSG)." The goal is to ensure "adequate medical care for the insured, taking into account other healthcare structures, local conditions, and demographic factors." The number and geographical distribution of contracted positions are determined in the staffing plan "in agreement between the state medical association and the health insurance provider."