I've never been to a doctor in Germany that doesn't have office staff (though I suspect that it would be possible). You still need someone to deal with incoming

I've never been to a doctor in Germany that doesn't have office staff (though I suspect that it would be possible). You still need someone to deal with incoming calls, organizing the file cabinet and looking through the insurance rule changes of the week. Usually this is done by people who do limited medical work on patients as well (think nurse). Having one employee per doctor is not uncommon. Doctors only send their bills once every three months and payment takes a while after that - a week would be a dream. Insurance can deny payment if they determine it wasn't medically necessary (and they do checks if they find a trend) but that comes out of the doctor's pocket. And for expensive things (like psychotherapy or dental) it needs to be preapproved by the insurance but they are are very limited in what they can deny. And good digital health records? I don't think I will live long enough to see that in Germany. The only thing that leaves your doctor's office digitally (within they are free to work with paper or computer or whatever they wish) are the procedure and a short code for the diagnosis. If you need to see a specialist, paper still gets send around. Edit: I just read the Germany chapter of that book. While it contains some (not really significant) errors and is a bit outdated (now six years old) I would still recommend that book based on this chapter.