German doctors’ helpers oil the cogs of
the private ophthalmic practice
Stefanie Petrou-Binder MD
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
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
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
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
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
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
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
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
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.