German doctors’ helpers oil the cogs of the private ophthalmic practice

By Stefanie Petrou-Binder MD
in Germany

The tasks of ‘Arzthelferins’, or doctors’ helpers, in ensuring an efficient office administration, good patient care and effective use of complicated ophthalmological instruments make them an indispensable part of the German ophthalmological system.
The Arzthelferin apprenticeship lasts for two years and is offered at specialised institutes called ‘Berufsschulen’ or professional schools.

A high-school diploma is not required, but candidates do need to have completed school up until the 10th grade (‘Mittlere Reife’). The work/study programme is moderately challenging and relatively easy to come by.
During the two years of schooling for this predominantly female profession, ophthalmic apprentices alternately attend classes and train on the job in a private ophthalmic practice, which under German law requires that they be supervised by a certified Arzthelferin.

While the more experienced, certified Arzthelferin is required to teach the new apprentice the ins and outs of administrative tasks and office organisation, the eye doctor himself is called upon to instruct in matters of instrument use and minor surgical assistance.

The apprentice receives signatures from her employer for each concept mastered and concludes her apprenticeship with a final exam.
The theoretical part of the education that the ophthalmological Arzthelferin receives, however, does not specifically target ophthalmology.
All Arzthelferins have the same basic schooling. The specialised on the job training alone prepares them for the responsibilities of working in and managing different types of specialised medical offices.
The curriculum involves courses in first-aid and basic anatomy, physiology and surgery. She may apply this knowledge for minor surgical assistance (pterygium, chelation, xanthelasma, cysts). The Arzthelferin also takes courses in typing and commonly used office computer programmes.

The Arzthelferin is not trained, however, to assist the surgeon in larger, more complicated surgeries, such as cataract surgery, Lasik or posterior segment surgery.
Nurses with specialised surgical training usually fill these positions. In some cases, the ambitious Arzthelferin can learn operating room skills and may assist at the doctor’s request.

The theoretical education emphasises a good understanding of the German health care system as well. The large numbers of private and state-run health insurance programmes have become pivotal to patient care and require an in-depth understanding, as do their ever-changing policies, codes, point systems and budgets.
The Arzthelferin has a multifaceted set of responsibilities which include office administration, patient care and the use of complicated ophthalmological instruments.

The first thing she gains on the job, nevertheless, is a keen intuition of patients’ needs.
As with any other business, it is often the impression that is made at the front desk that counts most. In Germany, patients often seek the advice of the office personnel before reaching the doctor’s door. It is therefore an important part of the Arzthelferin’s job to make the patient feel at ease and help explain what has to be done.

In an ‘appointment only’ office system, it is her job to discern between emergencies and impatient patients wanting immediate appointments. She must balance appointments evenly, so that patients do not lose patience and leave disgruntled.
After admitting a patient, the experienced Arzthelferin will often know, according to the complaints or needs of the patient, which standard or special examinations must be carried out, such as taking automatic refractometer, mesometer (nyktometer) and automatic non-contact tonometer measurements and measuring the refractive strength of patients’ glasses.

If the doctor wishes, she may give mydriatic eye drops, take automatic perimeter readings and conduct Schirmer tests. The ophthalmologist is then prepared with the information he needs to conduct his own set of tests.
They are also called on to teach patients the proper application of contact lenses and eye drops. The eye doctor himself, however, does the actual calculation for the strength of glasses or contact lenses.

The Arzthelferin types official letters, patient reports, prescriptions and sick notices for school and work. She prepares private and non-private invoices and oversees the accounting. She also restocks the office supplies.
At the end of the day, the Arzthelferin is responsible for carefully sterilising the machinery and providing for the general good upkeep of the office.

Some physicians have elected to hire young apprentices who cost them less than the more experienced help, which is available in large numbers. This has been hard on some older, more experienced ophthalmological Arzthelferins. The tightening purse strings have therefore also yielded increased unemployment in the health care personnel sector.
The result of of this has been worse health-care service and perhaps the realisation that to pay the price of socialised health care, the patient must endure crowded waiting rooms with long waiting periods, young, frantic apprentices and Arzthelferins with less time to spend on friendly explanations.

Like all other German employees, nonetheless, Arzthelferins receive an alluring 13-month salary in winter and spending money in summer worth half a month’s salary.
They enjoy 20 to 30 days of paid vacation per year, depending on how many years they have put in, and often receive bonuses for the extra effort. For the most part, ophthalmologists have been tenacious about keeping their knowledgeable and reliable employees on the payroll. They remain the only trained office help available to eye doctors, without which their practices would really suffer.