MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

The German Heilpraktiker has been the subject of several of my posts. Some claim that it is an example of a well-established and well-regulated profession. Others insist that it is a menace endangering public health in Germany.

Who is right?

One answer might be found by looking at the training the German Heilpraktiker receives.

In Germany, non-medical practitioners (NMPs; or ‘Heilpraktiker’) offer a broad range of so-called alternative medicine (SCAM) methods. The aim of this investigation was to characterize schools for NMPs in Germany in terms of basic (medical) training and advanced education.

The researchers found 165 schools for NMPs in a systematic web-based search. As the medical board examination NMPs must take before building a practice exclusively tests their knowledge in conventional medicine, schools hardly include training in SCAM methods. Only a few schools offered education in SCAM methods in their NMP training. Although NMP associations framed requirements for NMP education, 83.0% (137/165) of schools did not meet these requirements.

The authors concluded that patients and physicians should be aware of the lack of training and consequent risks, such as harm to the body, delay of necessary treatment, and interaction with conventional drugs. Disestablishing the profession of NMPs might be a reasonable step.

Other interesting facts disclosed by this investigation include the following:

  • There is no mandatory training for NMPs. Some attend schools but many do not and prefer to learn exclusively from books.
  • The training programs of the NMP schools comprise an average of 7.4 hours per week of classroom teaching for an average of 27.1 months.
  • Course participants thus complete an average of ~600 hours of training. (A degree in medicine takes an average of 12.9 semesters. With a weekly working time of 38.9 hours, this amounts to ~15,000 hours of training excluding internships etc.)
  • Three-quarters of all NMP schools do not offer any practical teaching units.
  • If training programs do contain practical instruction, it is usually limited to individual weekend workshops in which the measurement of vital data, physical examinations, and injections and infusions are practiced.
  • The exam that NMPs have to pass consists of a written test with sixty multiple-choice questions and a 30 to 60-minute interview on case studies.
  • The examination covers professional and legal anatomical and physiological basics, methods of anamnesis and diagnosis, the significance of basic laboratory values as well as practice hygiene and disinfection.
  • Not included are competence in pharmacology, pathophysiology, biochemistry, microbiology, human genetics and immunology.
  • The average 600 hours of training of an NMP is thus ~5% of that of a medical student.
  • If an NMP fails the exam, she can repeat it as often as she needs to pass.
  • The day after the exam, an NMP can open her own practice and is allowed (with only very few exceptions) to do most of what proper doctors do.

So are NMPs a danger to public health in Germany?

I let you answer this question yourself.

 

8 Responses to Is the German ‘Heilpraktiker’ well-trained and educated?

  • When Germans drive a €80000 BMW, they only let experienced mechatronics engineer in their specialist workshop carry out maintenance or repairs.

    When they have health problems, however, they do not go to a doctor with several years of study and specialist training, but to a quack/Heilpraktiker who has acquired banal health knowledge in weekend courses and his free time and who proudly points to worthless paper certificates on the office wall.

    Long head shake.

    • RPGNo1

      “When they have health problems, however, they do not go to a doctor with several years of study and specialist training”

      I can’t speak to how German patients access care from German MD’s.
      In the USA, more education largely amounts to more indoctrination from the AMA and pharma industry., neither of which practice good medicine, or what’s best for the patient.
      Those that discovered this have made their decisions about CONmed, and have moved on.
      Case closed.

      • you are as ill-informed as ever:
        neither the AMA nor the pharma industry is about practicing medicine

      • Those that discovered this have made their decisions about CONmed, and have moved on.

        i.e. they jumped from the frying-pan into the fire – from an imperfect reality, to good sales pitches, friendliness and smiles; with a belief in their own sagacity in doing so.

    • When Germans drive a €80000 BMW, they only let experienced mechatronics engineer in their specialist workshop carry out maintenance or repairs.

      Germans with a €80000 BMW have plenty of money to pay for repairs to be done by someone else.
      Lots of people try to do their own mechanical work, electrical work, plumbing, etc. People whose job it is to do these things become familiar with botched work done by the owner.
      But there is still maybe a difference between people’s attitudes about taking care of their possessions and their attitude about taking care of their body.
      People underestimate how complicated their body is, much more complicated than any inanimate possession. And bodies often don’t give a person quick feedback when they aren’t taking care of it right.
      People are emotionally involved with what happens to their body, much more so than with their things.
      People’s bodies have a placebo effect that misleads them. Cars, plumbing etc. don’t.
      I find that working on a computer program gives a sense of how easy it is to be wrong, and how important it is to not make assumptions about what’s going on.

  • I still find it amazing that these people are not only allowed to ‘play doctor’, diagnosing and treating patients with almost no medical training, but that they themselves think that they are actually capable to provide medical care. And to think that many quacks out there are even worse: from what I see, more than half of all homeopaths and other quacks start out with no relevant(*) medical training whatsoever.

    Even though I must have spent thousands of hours on self-study and gathering knowledge through my work (biomedical electronics engineering), and probably know way more about medicine than all those people, I wouldn’t dream of actually treating people or even giving medical advice other than “ask your doctor” (and oh: “Don’t Drink Bleach”).

    *: Studying the fairy tales of Hahnemann and diluting plain water has of course no medical relevance, other than learning about placebo effects.

    • In order to work as a Heilpraktiker in Germany, you only need the following requirements:

      – a minimum age of 25 years,
      – a secondary school leaving certificate (“Hauptschulabschluss”),
      – health suitability,
      – a medical certificate or a certificate of good conduct from the police
      – passing the Heilpraktiker examination (Multiple-choice test and a 30 to 60 min oral part)

  • No. They aren’t.
    They are only educated in making money.
    And in nothing else.

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