Importance of collective knowledge of general practitioners in East and West Germany in the transformation of the outpatient healthcare system

• Applicant: Dr. Hariet Kirschner
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Empirical Social Research
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 570886227

The outpatient healthcare system is currently undergoing a process of transformation, in which family physicians, as members of the medical profession, are significantly involved. The current transformation is taking place at structural and functional levels, but also at a role- and identity-specific level. Structural changes are occurring due to the increasing shortage of skilled workers as a result of demographic changes and generational shifts in preferences. Likewise, requirements regarding the perception of the professional role, the fulfillment of the demands of advancing digitalization, and adaptation to the consequences of climate change are changing. Economic and political constraints are also impacting administrative and bureaucratic processes as well as medical care. The necessary adjustments made by general practitioners are relevant at the action and attitude levels and depend significantly on their current knowledge and belief patterns. Knowledge, in turn, is strongly influenced by experiences from their professional careers and personal lives. Due to the German-German division from 1949 to 1989 and the different structures of the healthcare systems in the GDR and FRG, East and West German general practitioners have different backgrounds. East German general practitioners also have experience of the political transformation in the outpatient healthcare sector around 1989. Against this background, the aim of this research project is to survey the previously unexplored field of currently existing collective knowledge and, related to this, the professional identity of practicing general practitioners in the German healthcare system and to examine its implications for the current transformation processes in the healthcare system. To collect collective knowledge, a comparative analysis of heterogeneous groups using a qualitative research design is therefore used. Within three work packages, narrative-biographical interviews are being conducted with three birth cohorts of general practitioners (1945/50s, 1970s, 1990s) in three eastern and two western German federal states. The cases are also contrasted according to structurally strong vs. structurally weak areas, gender, region, and key categories emerging from the analysis process. The survey distinguishes between three comparison groups (East German, West German, and internally migrated general practitioners). In a fourth work package, area-specific economic, socio-legal, and sociopolitical factors are being recorded and evaluated. The results of these work packages provide a central basis for future, understanding-based management of challenges in the outpatient healthcare system. These will be discussed with stakeholders in the outpatient healthcare system in a fifth work package.

• DFG Programme: Research Grants