gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Dr. med. – obsolete? A cross sectional survey to investigate the perception and acceptance of the German medical degree

research article medicine

  • Xenia Heun - University Medicine Rostock, Institute for Immunology, Rostock, Germany
  • Christian Eisenlöffel - University Medicine Leipzig, Division for Neuropathology, Leipzig, Germany
  • Bastian Barann - University Medicine Rostock, Institute for Molecular Biology and Medical BiochemistryRostock, Germany
  • corresponding author Brigitte Müller-Hilke - University Medicine Rostock, Institute for Immunology, Rostock, Germany

GMS Z Med Ausbild 2014;31(3):Doc30

doi: 10.3205/zma000922, urn:nbn:de:0183-zma0009228

This is the English version of the article.
The German version can be found at:

Received: May 23, 2013
Revised: March 18, 2014
Accepted: May 6, 2014
Published: August 15, 2014

© 2014 Heun et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Purpose: To obtain the German Medical Degree “” candidates are required to write a scientific thesis which is usually accomplished during Medical school education. This extra work load for the students amongst a lack of standardization and an M.D. awarded upon graduation in other European and Anglo-Saxon countries leads repeatedly to criticism of the German system. However, a systematic survey on the perception and acceptance of the German doctoral thesis among those affected is overdue.

Methods: Using an online questionnaire, medical students as well as licensed doctors were asked for the status of their medical degree, their motivation, personal benefit, time and effort, scientific output, its meaningfulness and alternatives concerning their thesis. Patients were asked, how important they value their general practitioner’s title “Dr. med.”. The resulting data were evaluated performing basic statistic analyses.

Results and Conclusions: The title “Dr. med.“ does not seem to be obsolete, but there is room for improvement. The scientific output is good and only a mere 15.1% of the candidates do not publish their results at all. Moreover, while at an early stage motivation, appreciation and recognition of personal benefits from the medical degree are considered as independent aspects, they merge to a general view at later stages. The current practice is considered most meaningful by the ones who have already finished their thesis. However, there are discrepancies between the expected and the actual length as well as the type of the thesis indicating that mentoring and educational advertising need improvement. As for the patients, their educational level seems to correlate with the significance attributed to the title “Dr. med.” held by their physician.

Keywords: Dissertation, Dr. med., medical degree, questionnaire


The rate of dissertations among medical graduates lies in the range of 60-65% and is above the average of most other subjects [1], [2]. While students in other subjects generally begin their dissertation upon graduation and require at least three years of scientific research, German medical students usually begin their thesis during their studies. This circumstance leads to a recurring discussion about a lack of quality among experts [3], [4] as well as the feuilletons of leading German newspapers write about e.g. “Junk title Dr. med.” [5], [6]. The science council supports the idea to bestow the title “Medical Doctor” (MD) with the licensing (approbation) and to reserve the scientific dissertation following graduation to those interested in an academic career [7]. The “Medizinische Fakultätentag” (Medical Faculty Association) disapproves of a professional doctorate because they consider the scientist an indispensable role for tomorrows doctors. No other academical profession transfers scientific progress and knowledge faster into practice than medicine. Therefore, every doctor needs to learn how new findings are gained, which methods are used and how the quality of scientific publications can be assessed [8]. In addition, two recent publications show that the German medical dissertation is better than its reputation [9], [10]. Depending on whether the data were collected via online survey or voluntary disclosure, 52% and 62% respectively of the doctoral candidates publish their results in scientific journals and 25% even publish as first author. Moreover, it seems unrealistic to expect a 3-years scientific dissertation following no less than six years of medical school and between 4 and 7 years of advanced training, before a young doctor can chose between a career as a scientist or a practitioner.

In the current discussion the acceptance of the medical dissertation among medical students and physicians as well as the personally gained benefits resulting from a thesis are neglected. To date, no study or survey sufficiently examined the stance of patients on doctors with or without the title “Dr. med.”. The present study uses a cross sectional inquiry and evaluates the self-assessed motivation for starting a medical dissertation and the expected and personally gained benefits from those directly concerned. Furthermore, the motivation and satisfaction was determined according to the kind of topic (statistical, clinical or experimental). A “statistical” topic applies to a retrospective data collection, “clinical” means a prospective data examination and “experimental” means collecting data experimentally in a laboratory and its subsequent interpretation. We assumed that the attitude is different in each stage, therefore this survey randomly included students before starting their dissertation, students currently working on their dissertation and students refusing a dissertation as well as licensed physicians. Additionally, patients of general practitioners were interviewed as an external observer for their attitude toward physicians holding the title “Dr. med.” and those without, respectively.


The idea for developing the questionnaire originated at a congress of the federal representation of the medical students (Bundesvertretung der Medizinstudierenden) in November 2010 in Muenster. The questions were developed including focus groups and literary sources, e.g. Kock et al. [11] and Weihrauch et al. [12], [13].

The questionnaire used consists of five major topics. The first asks about personal data such as age, sex, state of education and state of dissertation. The second inquires about the motivation for doing a dissertation. The next topic includes questions about the type of dissertation, the time frame and effort, restrictions and publications. For those currently working on their thesis or already finished there are two more questions, one concerning their overall satisfaction with the thesis and another one concerning a possible increase in their research interests. Topic 4 analyzes the personally gained benefits and topic 5 the meaningfulness or appreciation of alternative procedures to obtain the title “Dr. med.”.

The topics 1 and 3 could be answered by ordinal and nominal scales and the topics 2, 4 and 5 were answered by ordinal scales. The ordinal scales had 4 options from “correct” to “not correct”. The topics 2-4 were written in different tenses in order to ask the same questions to students before starting and students during their thesis, as well as doctors after finishing their medical thesis. The first topic was identical for each respondent. After that the items could be answered either in subjunctive or future tense (before starting thesis), in present tense (currently working on thesis) or in imperfect or perfect (already finished). If the respondent chose “no interest/no thesis” the questionnaire switched directly to topic 5.

The questionnaire was developed with the help of EvaSys, a software for automated surveys. The resulting link including a password was sent to the medical students of Greifswald using the e-mail distribution list of the student association and to the medical students of Rostock using the e-mail distribution list of the Dean’s office. Regarding data protection laws, the physicians of the University of Rostock were contacted through the heads of the respective departments. The doctors of the municipal clinic in Rostock received their questionnaire on paper. All respondents had four weeks to complete the questions.

The questionnaire for the patients consists of five questions regarding age, sex, educational background and knowledge of as well as importance of the title “Dr. med.” of their attending general practitioner. Four doctor’s offices – two holding the title “Dr. med.“ and the other two without – were chosen for the survey. The patients were personally addressed in the waiting room to fill out the questionnaire and to put it into a box to preserve anonymity.

The agreement of the local ethical review committee was obtained before starting the study (A 2012-0009).


Descriptive statistics were employed to calculate the response rates of the cohort, the frequencies of the type of thesis, the duration of thesis and the publication of results. The means of data following Gaussian distribution were compared by t-test, and the rank sum of data not following Gaussian distribution was compared by Mann-Whitney U test in order to determine the significance levels of differences between the groups. The differences in patients' behavior toward selecting the physician were calculated by using the Fisher’s exact test.

Correlative structures were analyzed to examine possible changes in motivation and attitude toward the medical dissertation depending on the different levels of education. Therefore three scales were defined: motivation and appreciation (topics 2 and 5), personally gained benefits (topic 4) and a scale combining both (topics 2, 4 and 5). The reliability of these scales was determined by Cronbach’s alpha for the three different levels of education. Values >0.65 were considered reliable. To analyze the motivation and satisfaction in relation to the type of thesis, the two groups „currently working on thesis“ and „already finished the thesis“ were evaluated via analysis of variance (ANOVA). Topic 5 was analyzed by calculating the means and subsequent analysis of variance.

IBM SPSS Statistics 20 and Microsoft Office Excel 2003 were used for calculating the statistics.


Response rates

In the present study 631 questionnaires were evaluated. The combined response rate for the students from Rostock and Greifswald was 30.6%. The response of the doctors could not be calculated due to our data protection policy. Table 1 [Tab. 1] describes age and gender distribution of the cohort as well as the current semester and years of working experience, respectively. The high amount of women showing no interest in a dissertation is conspicuous. As expected, the licensed physicians who already finished their thesis are considerably older than the students.

Expectation and experience differ depending on the state of the dissertation

Comparing the responses of students and doctors before, during and after finishing their dissertation, there are significant and interesting differences. One difference concerns the topic of the thesis. While upfront, 19.6% of the respondents favor a statistical topic, 54.1% prefer a clinic topic and 26.3% an experimental one, in reality the majority (40.7%) conduct an experimental thesis, 34.1% a statistical and only 25.3% a clinical one. This discrepancy is even more pronounced for the group already finished: only 10.0% worked on a statistical topic, 20.0% on a clinical and 70.0% on an experimental one (see Table 2 [Tab. 2]).

Another difference concerns the duration of the dissertation, meaning the time from beginning until defense. On average the students before starting their dissertation expect a median of two years and the ones working on their dissertation correct their estimate to a median of three years. However, the group already finished required a median of four years for their dissertation. These differences are significant for all three groups interviewed (see Figure 1 [Fig. 1]). The questions relating to investment of time and constraints due to the dissertation show no significant differences.

The scientific output resulting from medical dissertations is better than expected

The scientific publication is a generally accepted means to measure the scientific gain of knowledge. Therefore it was asked whether the results generated during the course of the thesis will be or were published and if so, in which way. Predictably, the students before starting their dissertation can only express expectations and indeed, 71.4% state that they do not know yet. This percentage decreases during the dissertation to 52.0%. But in the end only 15.1% of the ones already finished did not publish their results at all. Compared to 67.9% having publish their results as an (at least one) article, 47.2% as an oral presentation or lecture and 37.7% as a poster (see Figure 2 [Fig. 2]). Data about a first or middle authorship do not exist. Of note, the expectations toward the publishing of one’s own results are low before starting, increase while working on the dissertation and are surpassed by the actual results in the group already finished. This observation not only counts for published articles, but for oral presentations and posters as well.

The attitude toward the medical thesis is dependent on the state of the dissertation

The correlative structures of the questionnaire were compared between the three groups surveyed. This was done in order to verify the initial hypothesis that the motivation toward and the appreciation of the medical thesis as well as the acknowledgement of a personally gained benefit depend on the particular state of education and progress of the dissertation, respectively. To that extent, we defined three scales which include the motivation and appreciation of the medical thesis (topics 2 and 5), the personally gained benefits (topic 4) and the combination of motivation, appreciation and benefits (topics 2, 4 and 5). The reliabilities for the three scales and the three groups surveyed were determined using Cronbach’s alpha. Table 3 [Tab. 3] illustrates that the third scale with the highest dimensionality features the highest Cronbach’s alpha (0.90) and therefore the highest reliability for the group of the licensed doctors. In contrast this third scale shows a Cronbach’s alpha of 0.63 – and therefore no reliability – for the students before starting a thesis.

Motivation and satisfaction are higher for those working on an experimental topic compared to those working on a statistical one

In order to evaluate the question whether the type of topic influences the motivation or satisfaction toward the dissertation, an analysis of variance was used. Small but statistically significant differences between the three groups exist regarding the satisfaction as well as the motivation (p-value 0.0008 and 0.0005). The ones working on a statistic topic are less motivated and satisfied than the ones undertaking an experimental topic (see Figure 3 [Fig. 3]).

Students who reject a medical thesis consider the current procedure of a medical dissertation less appropriate than the students who are planning to or are currently working on their thesis, or the doctors already finished with their thesis (see Table 4 [Tab. 4]). Additionally, students rejecting a thesis significantly more often consider alternative procedures like a professional doctorate (MD) more appropriate. The current procedure is regarded as the most appropriate by the ones who have already finished their thesis.

Patients with a higher educational level prefer doctors with an academic title

Finally, we analyzed patients for their attitude toward a doctoral degree of the general practitioner in relation to their level of education. Two doctor’s offices with physicians holding the title “Dr. med.” and two without were chosen and 83 patients were questioned about their age, sex, level of education and the significance they attribute to their general practitioner's title “Dr. med.”. In essence, the higher the level of the patients' education (high school diploma/university degree), the more often they choose a physician holding the title “Dr. med.” (p=0.0005, RR=0.3778, 95% CI=0.1893-0.7541). Patients whose level of education could not be categorized distinctly (vocational training, other) were not included into this calculation. Figure 4 [Fig. 4] summarizes the result of Fisher’s exact test and shows that patients with a higher level of education favor a physician holding a doctor’s degree.


Using a cross sectional survey, the present study determines the attitude of medical students and licensed physicians toward the medical dissertation and the acceptance of the current procedure. Because of the high dissertation rate among medical graduates and since the dissertation is usually accomplished while studying [1], [2], the questionnaire addresses mainly students, who also responded the most. Only 8.40% of the respondents are licensed physicians. The distribution of age and sex among the group of the students is homogeneous and balanced. In contrast, the group of the physicians is significantly older and heterogeneous which on the one hand was expected since this group includes the whole range of professional careers. On the other hand this was intended so as to represent a large spectrum of experience relating to the personally gained benefits for the further path of life. At the same time we have to assume that the physicians working at a university clinic represent a bias, since to them the dissertation will have a larger significance than for physicians not working in an academic environment.

The main result of this survey is that as of yet, the title “Dr. med.” is far from obsolete. This conclusion is based on three findings. First, the scientific output resulting from medical dissertations is respectable and much higher than previously expected by the candidates. 68% of the respondents publish their results in an article whereas only 15% of the candidates do not publish at all. Ziemann and Oestmann have recently published results from the Charité which show that 52% of the doctoral candidates between 1998 and 2008 published in PubMed-listed journals [9]. The present questionnaire does not specifically ask for the PubMed-listing which could be a reason for the discrepant results. Beyond that Pabst et al. recently showed that self-reported publications yield better results than an internet based survey [10].

The second important finding is that those concerned show a positive attitude toward the medical dissertation. The supposed hypothesis, that the motivation toward the dissertation and its appreciation as well as the acknowledgement of personally gained benefits depend on the state of the dissertation turned out to be true. Before the start of a dissertation, motivation and appreciation are considered separate entities from the acknowledgement of personally gained benefits. During the progression of the dissertation and retrospectively, the motivation and appreciation merge together with the acknowledgement of benefits to a general view. The benefits include personally gained benefits for dealing with statistics, literature and time management as well as the benefits for the completion of medical school and progression of the career in general. Of course it is possible that only those students and physicians answered our questionnaire, who have a more conservative opinion from the outset. Likewise it is conceivable that the doctors do not want to deprive the young colleagues of their experiences and therefore evaluate their dissertation more positively. However, this latter view would contradict our observation that satisfaction and motivation correlate with the type of thesis and the amount of effort invested e.g. in the course of an experimental dissertation. This connection was also shown in a study by Pfeiffer et al. [14]. In summary we cannot rule out that an actual long-term study would yield additional or different aspects.

The overwhelming refusal of the professional doctorate – as also suggested by the science council [7] – or alternative procedures by all groups was unexpected. We cannot rule out though, that the concept of a bachelor thesis is too foreign as of yet and fuels fears of a Bologna reform of the German medical school curriculum. However, our questionnaire does not lend itself to any causal research – neither for a lack of interest in a medical dissertation or for the high percentage of women in this context.

Our third most important result is the point of view of the patients. Even though here the number of cases is relatively small, the state of education seems to correlate with the importance of an academic title held by the treating general practitioner. Here as well, it is neither possible to make any statement about the motives of the patients nor if the same demand exists toward other medical specialists. Nevertheless, a medical student with the goal of becoming a doctor in his or her own practice should be aware of these possible expectations.

Whether these results from the universities of Greifswald and Rostock can be transferred nationwide or if site-specific differences exist, could be determined by future use of the present questionnaire.

Furthermore, our survey reveals that the German procedure for obtaining the title “Dr. med.” leaves occasional room for improvement. The first issue concerns the discrepancy toward the expected and the actual duration of the dissertation. Another issue is the predominant desire concerning a clinical topic, while the majority of topics worked on were experimental. We cannot name the exact reasons for these discrepancies, but we can suppose that they could be reduced by better education and clarification in advance as well as better organization and support.

Nowadays, the doctor’s role as a physician is equally important as the role as a scientist. It is required for the medical work, the training and development and for the critical assessment of new scientific findings in therapy and diagnostics. Against this background the awareness of graduated physicians that a dissertation is a worthwhile endeavor gains additional meaning and should be an incentive for the medical faculties to invest more into the support of doctoral candidates and to keep improving the quality of the medical dissertation.


The title „Dr. med.“ does not seem to be obsolete because the medical students as well as licensed physicians express a need for a scientific dissertation. Despite the recurring discussions about the quality and thereby the meaningfulness of the medical dissertation, more than 90% of the medical students in Mecklenburg-Vorpommern pursue a dissertation. Nevertheless the procedure to gain the title “Dr. med.” can be improved in some areas, e.g. education, clarification and support.

A positive attitude toward the medical dissertation develops in the course of progression. The satisfaction increases relative to the effort made and is highest when working on an experimental topic. The motivation and appreciation of physicians holding a doctorate retrospectively merge with the practical benefits in the use of statistics, specialist literature and for time management as well as the general benefits for completing medical school and for career progression. The concept of a professional doctorate is currently dismissed. The value of the title “Dr. med.“ is also reflected by the attitude of the patients, whose expectations toward their treating physician holding an academic title seem to increase relative to their own level of education.


Thanks to all medical students and physicians from Greifswald and Rostock who answered the questionnaire. Special thanks to Annett Müller from the dean’s office in Rostock, to Prof. Dr. Peter Schuff-Werner, Prof. Dr. Emil Reisinger und Dr. Wäschle of the University of Rostock and also to PD Dr. Christof Schober und Dr. Reichardt from the Klinikum Südstadt and to the general practitioners of Rostock for the possibility to realize this survey.

Competing interests

The authors declare that they have no competing interests.


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