I would 100% Do it Again: An Endocrinologist’s Experience at Landstuhl, Germany

Welcome to our latest Hippocratic Adventures Interview! Today we are very excited to have Dr. Christopher Mulla with us. Dr. Christopher Mulla is an Endocrinologist currently working at Landstuhl Regional Medical Center in Germany.   

1.Tell us your story, how did you end up practicing in Landstuhl, Germany?

I am a clinical endocrinologist and I had been working in Boston as a physician scientist. My wife who is a Maternal Fetal Medicine physician within the Air Force received orders to report Landstuhl Regional Medical Center in Germany, which is near Ramstein Air Force Base, and about 1.5 hours from Frankfurt.

Originally, I had been trying to connect with contacts at Landstuhl to see if there were any opportunities as an endocrinologist. Unfortunately, they initially did not have a civilian endocrinologist position available, but they were going to see if they could potentially create one if there was sufficient demand for consultations. To keep up my clinical skills, I volunteered as a Red Cross physician for about year and I worked for a telemedicine company. I continued to do research and publish with my prior institution.

Eventually, a civilian endocrinology position opened up and that is where I am now working.

2. Tell us about Landstuhl Regional Medical Center.

Landstuhl Regional Medical Center is the largest US government hospital located outside the US. It was heavily utilized during the Iraq and Afghanistan wars. It is coming up on it’s 70th year and it has traditionally been staffed by active duty military. Increasingly, there have been positions opening up for civilian physicians who are hired as government employees or as contractors.

Landstuhl has the feel of a community hospital but has almost every specialty, including almost every IM subspecialty, surgery, neurosurgery, plastic surgery, pain management, behavioral health, anaesthesia, OB/GYN and subspecialties, and pediatrics. It is a fully staffed hospital and clinic with an onsite pharmacy and there is a good mix of German nationals present as well. There are similar military hospitals located in Germany, Spain, Italy, and the UK.

Since it is a military hospital, the leadership, such as the chief of a division is typically staffed by military personnel though that is not always the case.

3. What is the clinical practice of endocrinology like at Landstuhl?

I spend the majority of my time in the outpatient setting though I do see patients on the inpatient wards as well.  

The population I serve skews younger than what I saw in the US. There are a lot more healthier patients in their 20’s and 30’s who get a sudden endocrine diagnosis. I typically see patients with a wide variety of diagnosis including Graves’ disease, Hashimotos, new-onset diabetes as well as established type 1, type 2, gestational and LADA diabetes, PCOS, adrenal tumors, prolactinomas, thyroid nodules, thyroid cancer, and thyrotoxicosis in pregnancy. The patient population is very diverse, and about half the population served by the hospital are women. I not only serve the military personnel, but I also see their family members. The patients have the same insurance provided by the government so there is minimal concern about if medications, procedures, or surgeries will be covered by insurance or not. 

4. What type of job opportunities are available at Landstuhl for civilians? 

There are several positions that can be filled by non active-duty civilians. These include physician positions in Psychiatry, Neurolgy, IM, Family Medicine, Endocrinology, Bariatric Surgery, and Emergency Medicine. The number of open positions are limited and they only open up once every couple years.

The standard contract is typically for 3 years, which can be extended to 5 years, and rarely to 7 or 9 years. This is because when you work for the US government and you live in Germany, you do not have to pay German taxes under the State of the Forces Agreement (SOFA). Understandably the German government does not want people to benefit from living in Germany without paying their fair share.

5. What about taxes?

When you work for the US government and you live in Germany, you do not have to pay German taxes under the State of the Forces Agreement (SOFA). Understandably the German government does not want people to benefit from living in Germany without paying their fair share. You will have to file US taxes.

6. Are you able to work under a US medical license?

Yes, you are able to practice with your US state medical license and a government funded DEA license. You do need to be credentialed by the hospital. The German medical licensing regulations are not in effect while providing patient care at the US military hospital.

7. How did you approach the job search? 

For those who may be interested in working at Landstuhl, they should check out USAjobs. The jobs are not easily attained since the positions are typically filled by someone who knows someone.  

8. How do your income/benefits at Landstuhl compare to that of a traditional Endocrinology position in the US?

The government is aware of the market rate and will offer you a low salary. You have to negotiate for what you think is fair, and depending on how badly they need you, they will be more or less willing to negotiate. I feel that I am fairly compensated but I did have to negotiate for it. In fact, I would say it is expected for you to negotiate.

9. How does malpractice insurance work in Landstuhl?

Malpractice insurance is provided and you are represented by the government.

10. What were the challenges you encountered in transitioning to Landstuhl?

The hardest thing is getting hired because the open positions are scarce. If they don’t have a position, there may not be a position available. You can always volunteer for free but that is not very financially satisfying, There are a lot of physicians, nurses, PAs who are stationed in this area with active duty spouses, and not all of them have been able to find a paid position.

11. What are some of the joys of living in Germany?

It is a fantastic place to live. We are a short train ride away from Paris. We can drive to visit castles, the Rhine, and the Alps. I’ve loved hiking and skiing in the Alps, whether they are the German or Swiss or Italian Alps. I can see why people would love living in Europe – it’s amazing! That said there are cultural differences between the US and Germany and it does take some time to adapt

12. Quick Rapid-Fire Questions

We will ask some “Rapid Fire” type questions at the end which are meant to induce short/off the top of your head type answers. These will be fun!

What is a cool place you visited after moving to Germany?

The Alps, Switzerland, being able to hike

What is a piece of advice you would give to someone who is on the fence about trying out an experience abroad?

It is never an easy decision because there are always opportunities missed by leaving. Not being close to your friends, family, and being in a different time zone is tough. If you are trying to build an academic career or a community in the US, you will miss out on those years. But living abroad in Germany, within a culture that values time with family, saving the environment, and doing good for the community, feels good. I think it is a really wholesome place to live and a great experience for kids, especially when they are young. If your kids are in late middle/school or high school the experience may be different though there are American schools on the base.  

Has this relocation and move been worth it?

This move has changed my whole life trajectory, but it has given me innumerable experiences with my family and I have made a lot of friends who are in a similar place as myself. It’s like going away to summer camp, and you get closer to those that you are stuck at summer camp with. I would 100% do it again, there were definitely some pains, but I would 100% do it again!

And with that, we wrap up another episode of discovering where your white coat can take you. Share this with your colleagues or friends and join our newsletter for the latest blogs, interviews, discounts and perks.

For those who are interested in moving to Germany, and are feeling overwhelmed with the relocation process or are struggling to navigate licensure or finding a job and want to find a way forward, sign up for our Guidance Service. A fellow physician who relocated from the US to Germany will help you through the process, step-by-step. You can sign up here!

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