Vienna’s most prominent cancer specialist, Christoph Zielinski, on precision medicine, unhappy doctors, and why social equality is the key to successful health care.

All in all, Dr. Christoph Zielinski loves his work. As the head of the Clinical Department of Oncology of the -Medical University of Vienna he sees 12 percent of all the patients who get treated in Vienna – which wasn’t hard to believe after seeing the packed waiting room in the outpatient department on the 6th floor of the Red House of Vienna’s General Hospital (AKH).

“I’m lucky to be working with such gifted people,” -Zielinski smiled. He has a warm face and a voice that underlines his style: opinionated, yet open-minded, with an irresistible chuckle. He celebrates his colleagues – from Michael Gnant in surgery or Walter Berger in fundamental science, to Ulrich Jäger, the former President of the European Society for Hematology.

The young people are also inspiring. “It’s important to remember that society looks different than it did 20 years ago, much more open and international,” Zielinski said. But he also sees a world that is closing up again. “The rise of these authoritarian regimes is a catastrophe that works against science and research.”

Even if it hadn’t come up, it would have been difficult to avoid discussing the U.S. health care system. “You can’t compare the two,” Zielinski says. “The American system is very income driven, and we have a social system.” And in Western Europe there is a correlation between how much a country spends and the survival rate of cancer patients. “In the States, spending is much higher but survival is at the level of Albania.” Essentially a small number of people are spending a lot with little positive effect on the population at large.

Zielinski is a self-ascribed communist, but his analysis – three pillars that cannot be subjected to financial constraint – transcends politics: treatment of illness;  the needs of the elderly and access to education.

“The moment one of these pillars falters, the society becomes unequal. And that creates endless problems” – from obesity, to more severe drug and alcohol abuse. “Unequal societies are sick.”

For doctors, the biggest challenge is information overload.  “In my field, it was the Cancer Genome Atlas,” defining the molecular changes present in various tumors, allowing for drugs aimed directly at these developments. That was the real game changer. “Targeted treatment” is such a new approach that most doctors have never learned how it works, explained Zielinski. But he sees it as a vital part of the treatment for patients in Vienna.

The MedUni is in fact launching a Center for Precision Medicine, a project he feels very strongly about. “My main motivator is envy,” Zielinski said. Other countries already have working facilities like this one .

He sees a lot of potential for growth in medicinal services in Vienna. “We have to define what we’re good at,” he said. “We could start with questioning the sacred cows” untouchable at certain institutions.  The MedUni today has visionary leadership, making it a good time for innovation, hes said. But it’s hard to see this happening when doctors are protesting over working conditions and inadequate salaries. “The payments to doctors from the Krankenkassen are catastrophic,” exclaims Zielinski. “It is unparalleled underpayment, which naturally leads to dissatisfaction.” His own net salary: €4,800 monthly. Doctors are also beginning to look to Germany for better pay. He wouldn’t call it a brain drain, exactly, but he does feel it in relation to Switzerland. “Vienna can’t be beautiful enough to say no to a salary of €100,000 or more.”

The other reason for the protests is the 48-hour week, precious hours, which Zielinski said are overburdened by administrative work –  “non-core tasks” of paper work and quality control. This is left to doctors, giving them too little time with the patients themselves.

“The health sector is very complex,” he said.

No kidding.


What Christoph Zielinski Wants for Austrian Health Care

Promoting specialization

“It’s important that every patient can be treated in a specialized department, where they are cared for by people with the highest competence in their area. Not just providing beds for patients.”

Establishing non-hospital centers

“Acute geriatric care for instance. We definitely will need that. Society is getting older and an older person might get a urinary tract infection and shouldn’t need to run straight to an acute-care hospital.”

Generating private-public partnerships

“For instance between the Association of Hospitals and the regional insurance providers (Gebietskrankenkassen). We have 15,000 outpatient  treatments per year. There could be a container near an U-Bahn station and people could go there to get an infusion. It would be easier for patient and for
hospital staff.”

Digitization

“In the next 3-5 years we’ll be seeing a vast change in human behavior. Not just shopping without a cashier, or that your phone becomes an ID card, but it will also affect our health. Right now, at the Haus der Barmherzigkeit we have robots drive around and bring people food.”