The figure of the doctor has been an awkward one. In a market society, the privilege and alienation of years of specialised training produces a certain monopoly that allows doctors to climb up the social ladder. In some cases the social ladder consists in managerial functions, e.g. within the hospital hierarchy, in other cases it expresses itself in becoming a small employer, e.g. as co-owners of clinics or medical enterprises. When pushed by revolutionary working class movements, many doctors sided with the old regime, while others became ardent allies of the cause. You can find more thoughts on the figure of the doctor in this book review.
In this sense the material class position of doctors is often arbitrary, which makes the struggle around political positions even more important. One association that takes this political struggle seriously is the Vdää* – Verein Demokratischer Aerzt*innen (Association of Democratic Doctors) from Germany. Although new organisations, such as MedAct, have recently emerged, there is no real equivalent in the UK. We therefore spoke to some members of the association and summarised its history and development.
The association recently released a substantial booklet about the threat of militarisation of the health sector. We have previously translated an article by one of their members on the issue. The association is a progressive force amongst the professional group of doctors, who, at least in Germany, tend to be both conservative and more interested in private business opportunities.
The current organisation
Currently Vdää has 900 members, out of a total of about 350,000 registered doctors in Germany. The organisation has local chapters and it works closely with organisations of critical medical students, amongst other towns in Berlin and Cologne. Similar to many groups, the problem is to maintain momentum after people leave university, as work and family obligations take up a lot of capacity. The Vdää has a steering committee of 40 people. Despite the fact that also in Germany there are many international doctors employed in the health system, most members of the Vdää are ‘local’ doctors. Many international doctors come to Germany primarily for educational purposes, an exception are doctors from Syria, but they tend to be sent into small towns where most of the doctors don’t wants to work.
The origins
The association Vdää was founded in November 1986 in Frankfurt, at a meeting of around 150 doctors who wanted to form a left slate in the election of the official and conservative doctors’ associations, the doctors chambers of the federal states (Landesärztekammern) and the Deutsche Ärztetage. The criticism of the traditional doctors’ association was that they were too closely involved with the right-wing parties, the Ministry of Defence and with both the pharmaceutical and medical equipment industry. The internal structure of the official doctors associations was deemed as undemocratic and it never dealt with the problematic role that doctors’ associations played during the Nazi regime. The Vdää* saw itself close to the historic ‘Association of Socialist Doctors’ of the Weimar Republic, but due to the contemporary Cold War witch hunts avoided the term socialism. At the time even the trade unions were dominated by anti-communist social democrats. Nevertheless, the association’s understanding of ‘democracy’ referred to a process of social and economic democratisation which goes beyond parliamentary democracy.
A critique of capitalist damage to health
In the 1980s the association took up the work of ‘sociology of health’, meaning, they looked into the day-to-day and class-specific reasons why people become ill. These debates were led openly on the so-called ‘Gesundheitstage’ (health convention), which attracted thousands of people and were an alternative to the official Ärztetage. The debate evolved around the contemporary issues of smog and the risks of nuclear power, in particular after the accident in Chernobyl. They helped coining the term Umweltmedizin (‘environmental medicine’), which tried to analyse the connection between illness and industrial pollution. They also participated in the critique of research into genetic modification. They organised a campaign for the boycott of the pharmaceutical companies Sandoz and Ciba Geigy after the disastrous pollution of the river Rhein following an industrial accident in November 1986. They put a focus on the question of women’s health and reproductive rights.
International solidarity
The association works with other progressive doctors’ associations around the globe. In the 1980s they supported doctors’ associations in South Africa (National Medical and Dental Association – NAMDA) that struggled against the Apartheid system and called for an exclusion of racist official medical associations. More recently they participated in health conferences in Greece that discussed the impact of EU-enforced austerity measures on the local health system.
Doctors of today
Early on, Vdää spoke for a general system of primary care for all, which would employ doctors as wage workers, rather than the predominant system of GP surgeries that are run as small enterprises. They notice that currently, most medical students would rather be employed than becoming small entrepreneurs, which is a shift from the traditional aspirations of doctors in Germany. They also see more support by doctors for strikes of other hospital workers, at least in symbolic terms. This has become an apparent change since the 2015 struggle at the Charité in Berlin, Europe’s biggest university hospital. This shift might also be due to the fact that doctors, too, became victims of the ‘flat rate per case’ hospital DRG system. Politicians and hospital managers had tried to integrate doctors in the management of the DRG system, which was successful for some. But most of the hospital doctors were becoming disillusioned with the system. Currently they see that due to a lack of workforce it becomes possible that doctors change jobs more often and there are more opportunities for further education. Overall though, research and scientific work are still very disjointed, there is less ‘practical research’ work done by doctors themselves, compared to some decades ago. Research happens more and more within medical industries (‘lab science’).
Resistance against reforms and austerity measures
The association criticises the stark division between hospital and community care and the dominance by pharma and tech-companies. In Germany, we see payments for individual treatments on one side (individualisation) and the power of health insurances on the other (bureaucracy), there seems to be no space for alternatives. Currently, there are experiments with cooperatively managed polyclinics in Berlin, Hamburg and Frankfurt which Vdää members are involved with. The organisation also criticises the current structure of doctors’ training, with an unfruitful separation of theoretical and practical elements. There is not enough patient engagement and engagement with their social conditions. The association has published a thorough analysis and critique of the ‘flat-rate per case system’ / DRG system and of the wider health reform. They talk about the difficulties to agree on a common position, for example about the state lock-down strategy during Covid, which the association might perhaps have supported too uncritically. They are part of the alliance ‘Krankenhaus statt Fabrik’, which support local disputes of health workers.
