Jan. 20 (Bloomberg) -- Christoph Heinrich, an anesthetist making 25,000 euros ($30,295) a year in the northern German town of Jever, works two weeks each month at a private hospital in Britain to supplement his income.

``I was making less than a skilled tradesman,'' Heinrich, 51, said in a telephone interview from Berlin as he joined a march against government plans to curb public-health costs. ``I couldn't do it anymore.''

Heinrich was among the 20,000 people who protested this week in Germany against pay and working conditions, the biggest public show of unity by the medical profession since World War II. More than half of Germany's doctors closed their practices on Jan. 18, according to the NAV-Virchow-Bund, a group of self- employed doctors that organized the event.

The six-week-old government of Chancellor Angela Merkel, 51, plans to cut 14 billion euros of health costs in the three years ending in 2007. Germany needs to reduce public spending to meet European Union budget deficit limits, after having exceeded them for four years.

``Nobody can dispute the fact that the social-welfare system in Germany of the past is no longer financially sustainable,'' Hans-Juergen Hoffmann, director of the Psephos Institut, an independent research firm in Berlin, said in a Jan. 19 interview. ``I don't believe this will spark a wave of protests, but it shows how much health policy and health reforms are affecting people. This is a reality check.''

More Paperwork

Health Minister Ulla Schmidt is introducing price caps on prescription medicines and treatments, increased use of cheaper generic drugs, and a bigger payments by patients as the country's aging population threatens to overwhelm the health- care system. Schmidt, who was health minister under Chancellor Gerhard Schroeder, retained the post after Merkel took office.

Health spending eats up around 230 billion euros, or about 11 percent of annual German gross domestic product, according to the Federal Statistics Office in Wiesbaden. That compares with 6 percent in the U.K. and 16 percent in the U.S.

The reforms will only add to the paperwork that already takes up 20 percent of a doctor's workday, said Klaus Greppmeir, a spokesman for the Cologne-based NAV-Virchow-Bund, in a Jan. 17 telephone interview. They will also force doctors to dip into their own pockets to cover their operating costs, he said.

In an interview with Deutschlandradio today, Health Minister Schmidt promised more transparency in the fee system, and said it's possible to cut 70 percent of the red tape.

Going Bust

Doctors are also protesting against health insurers, whom they accuse of mismanaging funds.

German doctors are compensated by health insurers based on a fee scale. Around 30 percent of the fees sought are not reimbursed because of disagreements over how insurers and doctors interpret the fee scale. Health insurers owe doctors 7.9 billion euros for services rendered in 2004, Greppmeir said.

``My professional existence is on the line,'' said Christa Schmaler, 55, a neurologist and psychologist with a practice in Gruben, near the Polish border. ``My savings will allow me to continue one more year.''

Schmaler has asked her landlord to lower the rent. She also canceled her life and pension policies.

German doctors earn about 15 percent less than their counterparts in the U.K. and about 40 percent less than U.S. doctors, who earn an average of $138,000 a year, according to the Organization for Economic Cooperation and Development. Doctors in the Netherlands, Switzerland, Denmark and the U.K. top the European scale. German general practitioners earn more than their counterparts in France, Sweden and Belgium.

Less Likely

More than 90 doctors filed for personal bankruptcy between January and September last year, according to the Chamber of Physicians in the state of Brandenburg. It estimates that as many as 125 doctors went out of business, an increase from 86 the year before.

Even at that rate, doctors are 10 times less likely to go bankrupt than any other profession, according to data from Creditreform, a Neuss, Germany-based European credit reporting company. There are 96,000 medical practices in Germany, according to the KBV, Kassenaerztliche Bundesvereinigung.

``I can well understand some of the doctors' grievances, but not some of the hyperbole of the functionaries,'' Health Minister Schmidt told reporters at a press conference in Berlin Jan. 18. ``The numbers show that one can't generally talk of a malaise,'' Schmidt said.

General practitioners in Germany grossed an average 202,000 euros last year from state-insured patients, plus as much as 33 percent from privately insured patients, Schmidt said. The average net income stood at 84,000 euros, she said.

Emigration

``We are so deeply frustrated we are thinking about emigrating,'' said Christel Robotham, 53, who runs a specialist cardiology practice with her English husband Charles, 58, in the south-west German town of Neustadt, near Mannheim.

She estimates the practice generates about half the income it did 10 or 15 years ago because of a drop in the amount paid by health insurers for state patients. Robotham now uses money generated from t private patients to subsidize the treatment of those in the state health system.

``We are the last fig leaf the population has that everything is well in Germany,'' Robotham said. ``This is the end of the post-war model of social welfare. When doctors quit, the population will realize that Germany has run itself down.''

Marburger Bund, Germany's biggest doctors' association, estimates that between 6,000 and 12,000 German doctors have emigrated, most of them working in the U.K. and Sweden.

Heinrich says he makes 70,000 pounds ($122,878) a year for working two weeks per month in the U.K.

``A doctor's practice is a business,'' Heinrich said.

To contact the reporters on this story: Angela Cullen in Frankfurt at acullen8@bloomberg.net Eva von Schaper in Frankfurt at evonschaper@bloomberg.net

Last Updated: January 20, 2006 03:25 EST