How Can Americans Avoid Double Medical Billing?

Acquisition of two medical specialist titles: more effort, more competence

The acquisition of several medical specialist titles requires a high degree of perseverance and willingness to learn. From a medical point of view, this usually results in more diagnostic and therapeutic options, but not necessarily in a fee increase.

Neurologist and psychiatrist, nuclear medicine and radiologist, general surgeon and visceral surgeon, specialist in internal medicine and cardiologist as well as specialist in internal medicine - the medical advanced training regulations offer a number of possible combinations of two or more specialist titles.


For Dr. med. Viviane Sterzer, for example, already knew during her medical studies that she wanted to hold both the title of neurologist and psychiatrist. Three years ago, by chance, the now 28-year-old came across an offer from the Lower Saxony Agaplesion Diakonieklinikum Rotenburg to continue her education in both subjects within eight years.

The model project, in which the continuing education assistants rotate between the subjects at the turn of the year according to a precisely defined plan, was jointly launched in 2015 by the chief physicians for psychiatry and neurology, Prof. Dr. med. Carsten Konrad and Prof. Dr. med. Reinhard Kiefer, from the baptism. "The annual change and the close interlinking of the curricula should make it easier for doctors to balance between specialization and broad specialist knowledge and ensure that they stay up-to-date in the other discipline," says Konrad.

Prerequisites for acquiring both titles within eight years are a high level of motivation and willingness to learn, perseverance and good self-organization. The precisely timed course of the program as well as continuous agreements between the two clinic directors are intended to prevent unplanned delays from occurring, unlike the classic acquisition of both titles in a row. There is also no need to change jobs and living environment.

Technical breadth

In principle, however, the following applies to having several specialist medical titles: this expands the diagnostic and therapeutic spectrum, opens up new and better career opportunities and, with the appropriate qualifications, also opens up additional billing options.

But it is also clear that the acquisition of a double specialist - regardless of whether it takes place in the traditional way or as in the Rotenburg model - is associated with significantly more effort, starting with the time and content requirements in the context of further training to the further training requirements for both titles on bureaucratic matters such as applying for permits from the statutory health insurance associations in the area of ​​quality assurance.

Weighing Possibilities

In addition, practicing a medical activity in two (sub) areas increases the risk of recourse and the expense of having to provide a substitute in the event of illness or vacation.

Nevertheless, keeping two specialist titles is often medically very useful in the sense of a holistic view and treatment from a single source, especially for patients with more complex symptoms. "The assessment of the extent to which this makes sense or is worthwhile for the doctor is ultimately always an individual assessment of all the pros and cons," says Miriam Mauss, deputy managing director of the external relations management division of the North Rhine Association of Statutory Health Insurance Physicians.

Most often, several specialist degrees are earned in the fields of internal medicine and surgery. "In the case of specialist training courses in one area, the basic training, in whole or in part, can be credited," says Sabine Schindler-Marlow, head of the communications department at the North Rhine Medical Association. It depends on which specialist is sought second. If, for example, someone has a specialist in general medicine and would also like to acquire a specialist in occupational medicine, 30 months of internal medicine and general medicine will be counted towards occupational medicine from their first specialist training, so that only 30 months of occupational medicine then have to be completed.

The situation is similar within the field of internal medicine. Here, too, a specialist in internal medicine and cardiology can be credited for a maximum of 30 months if, for example, the second aim is to become a specialist in internal medicine.

The North Rhine Medical Association recommends that you always acquire a specialist in internal medicine first, as this requires 72 months of further training and can therefore be taken into account for up to 36 months if you acquire another title.

In individual cases it is also possible, when changing subject, to have financially funded training courses credited to another specialist training course.

From a licensing point of view, it is again the case that there is no longer a double license. "A doctor who acquires two specialist titles can accept half the license for each specialist title, but not more than one full care contract in total," says Karl Roth, spokesman for KV Hessen. In which cases this makes sense depends on the billing options that are then available to the doctor. This has to be considered individually, explains Roth. "Having two specialist titles does not always result in a fee increase."

Type of double admission

Basically, it is important to clarify: Is it a subject-related "double license", for example a specialist in internal medicine plus a specialist in internal medicine and gastroenterology, or is it a real "double license", which is made up of two partial approvals, such as the combination neck Nose and throat doctor and phoniatrist. In addition, it is crucial for billing whether the areas are exercised at one location or within a practice or at different locations and practices.

Important rules for dual specialists

If a second specialist title is acquired, the established further training period can be shortened in individual cases according to the applicable further training regulations, if further training periods to be completed have already been completed within the framework of another specialist further training. The remaining further training time may be reduced by a maximum of half the minimum duration of further specialist training.

The rules of the extended evaluation standard provide for a doctor who is licensed to provide medical contract medical care with several specialist titles that the doctor can bill from the corresponding specialist groups / chapters. Depending on the combination of titles, there are very different effects on the billing options and fee system.

Furthermore, the following applies: Only one basic or insured flat rate per quarter can be billed per patient, analogous to the predominant treatment of the patient. Depending on the combination of subject areas, the evaluation of the quarterly flat rate can look extremely different.

Combined residency

Agaplesion Diakonieklinikum Rotenburg GmbH, Elise-Averdieck-Str. 17, 27356 Rotenburg

Written applications for the eight-year combined further education in neurology and psychiatry / psychotherapy should be sent to:

  • Prof. Dr. med. Reinhard Kiefer, Neurological Clinic and
  • Prof. Dr. med. Carsten Konrad, Clinic for Psychiatry and Psychotherapy or
  • via the online application portal of the Diakonieklinikum Rotenburg: