In recent years, the Public Health Service (PHS, in German: Oeffentlicher Gesundheitsdienst) in Germany has not been able to attract qualified young professionals in sufficient numbers [1
]. Already in 2015, the health ministers of the German federal states had warned in a joint statement that in face of the increasing—in some cases dramatic—staff shortages and at the same time constantly growing responsibilities, urgent measures were needed to secure function in the PHS [1
]. In this context, small rural health authorities in particular report difficulties in finding well-qualified professionals, including medical doctors with a specialization in public health (in German: Facharzt Oeffentliches Gesundheitswesen).
The PHS workforce in Germany is composed of multiple different professions. However, the size and composition of the PHS workforce is not assessed or recorded on a regular basis. According to a survey conducted in 2015, administrative staff accounted for 20% of the full-time equivalents, physicians accounted for 19%, followed by social pedagogues (18%), hygiene inspectors (11%), and medical assistants (10%) [3
]. Health and social science professionals accounted both for less than 1% [3
]. At the end of 2021, a survey was conducted, where the PHS staff consisted of 20% physicians, 52% other specialist staff and 28% administrative personnel [4
However, detailed information on the workforce in the PHS is only publicly available for physicians through the German Medical Association (in German: Bundesärztekammer). According to their data, the number of public health specialists has decreased by 27% over the 20-year period from 1998 to 2018 (from 1072 to 784), while the overall number of individuals with any medical specialization has increased by 52% [2
]. This trend is likely to become more pressing over the forthcoming years due to the demographics in the current public health workforce of the PHS [1
]. The German Medical Association estimates that about three out of four physicians employed in the PHS will retire in the next 10 to 15 years [6
]. Unfortunately, comparable data are not available for non-physician members of the PHW working in the PHS.
Although these challenges were long known and widely problematized [1
], they only became apparent to the broader public when the PHS reached its capacity limits during the COVID-19 pandemic and received much attention as a result [9
]. While the number of filled permanent job positions has increased during the course of the pandemic, a total of 8% of permanent job positions in the PHS remained unfilled at the end of 2021 [4
Thus, given the existing staff shortage and its likely aggravation in the future, the need to increase the perceived attractiveness of the PHS as an employer is an important and urgent challenge [2
]. In a survey of more than 13,000 medical students published in 2018, only 3.3% of the participants stated that they definitely, and 19.7% potentially, could imagine working in the PHS [10
]. In this survey, only working in the pharmacological industry and for health insurance companies was a less attractive career path [10
To overcome these issues, multiple experts and stakeholder groups pointed out perceived deficits and highlighted potential solutions, such as overcoming the salary gap, which exists between individuals with a medical degree who work in the PHS in comparison to working in health care [1
], improving the image of the PHS in the medical community and the society at large [1
], and highlighting the diverse and broad scope of activities within the PHS [11
]. Furthermore, it was repeatedly proposed to improve contact with and insights into the PHS through providing internships or more exposure to the practice of the PHS during the study [7
]. Other options for overcoming the shortage of (young) professionals include a stronger anchoring of public health-related topics in the curriculum of medical studies and other studies with potential relevance for the PHS (e.g., in the social or political sciences) [7
], and a general improvement of research opportunities and/or strengthening public health research within the PHS [7
Similar to other European countries and beyond, medical doctors take a prominent role within the current structure of the German PHS [17
]. In this context, experts and stakeholders stressed repeatedly the need to reform the PHS in order to be more accessible to young professionals without a medical degree [7
]. However, this call is in direct contrast to the statements of, for example other experts, professional medical associations and political decision makers who primarily or exclusively focus on attracting medical professionals [1
]. To increase the attractiveness overall, experts and stakeholders—including the German National Academy of Sciences in their analysis of public health in Germany—suggested that multi- and interdisciplinary approaches that recognize and integrate a variety of relevant professions should be strengthened [7
]. This would enable the PHS to fulfill its original purpose of ensuring and improving population health, and focus PHS on the underlying social determinants of health and assure health in all policies [7
Despite the described importance, no empirical research for the German context is available thus far, neither which assesses among students and young professionals the reasons for their lack of interest in working in the PHS nor the reasons of those inclined to follow such a career path. While some empirical studies from other countries exist [22
], their findings are often not directly transferable to the German context. To overcome this knowledge gap, the OeGD-Studisurvey was initiated, a comprehensive research project to analyze the interests and perceived attractiveness of the PHS in Germany as a potential employer for students and young professionals based on two national cross-sectional surveys. The logic model outlining the theoretical foundation of the project is provided in detail in the accompanying publication [29
], which also describes the quantitative analysis of the OeGD-Studisurvey and discusses key findings in the context of existing training programs in Germany.
In this publication, part II of the OeGD-Studisurvey, we focus on the qualitative data collected in the two cross-sectional surveys to identify the reasons given by respondents for why or why they do not consider the PHS as an attractive career path. Based on these responses, we aim to develop suggestions for strengthening the attractiveness of the PHS.
Among medical, 33%, and among PH&ONM students, 62% provided at least one argument for why they considered the PHS as attractive, while 72% of medical and 45% of PH&ONM students provided at least one reason for why they did not consider it as attractive. These figures are largely overlapping with the proportion of individuals who stated that they could imagine working in the PHS, as found in the quantitative analysis of the OeGD-Studisurvey [29
] and the Berufsmonitoring Medizinstudierende 2018, a large survey of medical students conducted in 2018 [10
] (with 29% and 23% of the more than 13.000 participants, respectively).
As proposed by experts and stakeholders [5
], focusing on those characteristics of the PHS regarded as positive, e.g., by emphasizing them in public awareness campaigns or by further expanding on them when reforming the PHS, could be an effective strategy in increasing the attractiveness of the PHS among young professionals.
However, a high number of individuals provided at least one reason for why they did not consider the PHS as attractive, and the finding that around one in three participants who could imagine working in the PHS provided at least one reason for why they did not consider it attractive should give rise to concern. This aligns with statements by young professionals who would like to work in public health, but emphasize the need for reform in the PHS to become an attractive option for young professionals [13
]. If a sustainable recruitment and retention of young professionals in the public health workforce in Germany is to be achieved, the concerns raised should be taken seriously.
While several themes were brought up by the participants, they considered the PHS as (not) attractive for different reasons. Therefore, the attempts to increase the attractiveness of the PHS will likely need to reflect his heterogeneity and a one-size-fits-all solution will probably not be able to achieve the intended impact. This may include messages targeted and tailored to specific groups as well as addressing different targets of reform of the PHS. Due to the heterogeneity in reasons provided within this survey, the messaging to attract young professionals with and without a medical degree would need to be different as well.
|Key finding 1. Some individuals are simply not interested—trying to convince everyone is likely not the most efficient use of limited resources|
Around one in five participants explicitly stated that they were categorically not interested in working in the PHS, for example, they had a different career path in mind. This argument was often provided in conjunction with the intention to work in the curative health care sector, and was by far the most prominent aspect among medical students for considering the PHS as unattractive. This was reflected in the quantitative analysis of the OeGD-Studisurvey [29
] as well as in the Berufsmonitoring Medizinstudierende 2018 [10
] where more than nine out of ten medical students stated that their primary career focus lay on working in hospitals or in private medical practice.
The attractiveness of a job, i.e., how satisfied an individual (expects) to be in an occupation is affected by many different factors, such as interest in the tasks to be performed, the amount of pay, or the perceived significance of the tasks [33
]. According to Locke’s Range of Affect Theory, (expected) job dissatisfaction results from a job not providing or not being expected to provide a job facet valued by a person, while (expected) job satisfaction arises when those expectations are met [33
]. The theory furthermore states that individuals value facets of work differently — leading to differences in (expected) job (dis-)satisfaction within the same occupation [33
]. Thus, if a person clearly and categorically rules out an interest in working in the PHS, this could be due to the facets of work provided within the PHS that do not match that person’s values and preferences, or because other occupations are known or expected to better match those expectations.
Therefore, in light of limited resources available and constraints on the political capital needed for reform, the following should be considered: convincing individuals who categorically rule out working in the PHS will likely require much more resources and more fundamental institutional changes, as would overcoming the barriers perceived by those who already regard the PHS as attractive to some extent.
|Key finding 2. Overcoming a lack of knowledge about the importance of the PHS|
One prominent theme was statements from participants (both medical and PH&ONM students) who stated to know little about the PHS. These statements match findings for example from the Berufsmonitoring Medizinstudierende 2018, where only 4.5% of all surveyed medical students considered themselves well informed about occupation and working conditions within the PHS [10
]. We are not aware of similar surveys among PH&ONM students.
In light of Locke’s Range of Affect Theory [33
], overcoming these gaps of knowledge may increase the perceived attractiveness of the PHS through increasing expected job satisfaction: Not being aware that facets of work valued by an individual may match with the facets of work provided in an occupation within the PHS could impede individuals in engaging in a career path within the PHS.
Increasing exposure to the PHS by anchoring PHS-related topics into the curriculum and through practical insights is among the approaches most often discussed and proposed to enhance the attractiveness of the PHS, although often with a focus on medical students [7
]. To date, several measures were already taken in this regard addressing medical students. For example, since the amendment of the medical licensing regulations for medical (in German: Approbationsordnung für Ärzte) was introduced in 2021, medical students now have the opportunity to complete a term of their obligatory medical electives (in German: Famulatur) and the final practical year (in German: Praktisches Jahr) within the PHS [34
]. This is in line with other findings in our study, as statements about a lack of knowledge were often combined with suggestions to increase the presence of PHS-related topics in the curriculum or suggestions to allow for opportunities to gain insight into the PHS (e.g., through internships). The quantitative analysis of the OeGD-Studisurvey reported similar findings, where two out of three participants could imagine gaining some form of insight into the PHS during their studies [29
Our findings indicate that more presence of the PHS during the course of study could help to overcome the lack of knowledge, which seems to be a barrier for medical as well as for non-medical students to get to know the PHS.
|Key finding 3. Without structural reforms within the PHS, increasing exposure to the PHS will likely not have a major impact on the perceived attractiveness of the PHS|
However, our analysis indicates that increasing exposure to the PHS by itself is unlikely to be sufficient: When comparing the self-reported reasons provided by participants with and without previous experience in the PHS, both groups brought up similar reasons for not considering the PHS as attractive, even in the same order of importance. Furthermore, several participants explicitly referred to their experience in the PHS and stated that this did not lead them to consider the PHS as more attractive, but rather had the opposite effect. The quantitative analysis of the OeGD-Studisurvey showed similar findings: participants with and without experience had the same perception of the PHS across all but one thematic domain, such as the proportion of participants who considered the work in the PHS as not very challenging or demanding, as having little impact on population health, as being outdated and not innovative, or that working in the PHS was attractive for those people who are looking for a relaxed job [29
The similarity in the perception of the PHS among participants with and without practical insights and experience indicates that the reasons brought forward by the students may at least partially be based on structural issues (i.e., reflecting real-world conditions), rather than them solely being unjustified (i.e., not true) negative prejudices. Hence, a one-sided focus on attempting to change the public image of the PHS (e.g., through large-scale image campaigns) or trying to increase exposure to the PHS (e.g., through electives or practical inside during studies) will likely not lead to a sustainable retention of young professionals, unless it is accompanied by structural reforms of the underlying issues — as those outlined in the following key findings.
|Key finding 4. Emphasizing a good work-life balance in the PHS may increase the attractiveness of the PHS, but affirming existing negative stereotypes needs to be avoided|
The most prominent themes among medical students for considering the PHS as attractive were good work-life balance and attractive working hours associated with it (51% of medical students), which was also — although to a lesser extent — provided as a reason by roughly one in ten PH&ONM students. This positive image might be a valuable resource in attracting students and young professionals and could be utilized, for example, by emphasizing it in public awareness campaigns. In particular, emphasizing the perception of the PHS offering an overall good work-life balance, family friendliness, predictable working hours, and lack of shift work and less stressful working conditions compared to working in a hospital could be a helpful approach. This is also supported by the quantitative findings of the OeGD-Studisurvey, which found that good work-life balance was rated as most important among all work-related factors [29
Therefore, the association of the PHS with comparatively good work-life balance and family friendliness could be helpful employer branding. However, in pursuing such a strategy, careful messaging is important: For one, this kind of messaging could play into and further emphasize existing stereotypes of the PHS being the ideal workplace for individuals seeking a job with low workload and is not attractive to individuals with goals and ambitions, a perception affirmed by three out of four medical students and every second PH&ONM student in the quantitative analysis of this survey [29
]. Unintentionally reaffirming such stereotypes could reduce the attractiveness of the PHS, for example, among career-oriented individuals or those striving for high public health impact. Second, if not carefully worded, campaigns embracing primarily the message of a good work-life balance in the PHS could be perceived as alienating by those individuals who experienced a high workload in stressful environments in particular during the COVID-19-pandemic [27
]. This may lead to the perception that their sacrifices were neither seen nor acknowledged. Due to its local anchoring, the public health service and, above all, the local health authorities are responsible for the prompt implementation of complex measures in times of crises. This requires enormous efforts and appropriate competencies to adapt to the new requirements within a short time. These challenges cannot be overshadowed by “simple” family-friendly employability branding.
|Key finding 5. Emphasize and further strengthen the focus on population health, health promotion, and social determinants of health|
The focus of the PHS on population health, health promotion, or social determinants of health (SDH) was a prominent reason for considering the PHS as attractive, as was the reason of having impact, with these two themes often linked by the participants. This is reflected in the quantitative analysis of the OeGD-Studisurvey, where individuals who associate the PHS with low impact were less likely to be interested in the PHS [29
We believe these findings are helpful to be interpreted in light of the Job Characteristics Model [35
], a theory on job satisfaction with strong empirical foundation [36
]. The model postulates that five key job characteristics influence critical psychological states that can directly affect work outcomes. According to the model, the key job characteristics skill variety (variety in tasks and skills needed to complete them), task identity (being involved in the entire process of a workpiece with a visible outcome, rather than only part of the work), and task significance (associating a sense of meaning with the task, such as having a tangible, positive effect) influence the critical psychological state of meaningfulness of the work. The job characteristic of autonomy can influence the experience of responsibility of outcomes, and the job characteristic of feedback mechanisms can influence one’s knowledge of the results. Together, all three critical psychological states then can lead to a number of potential outcomes, including (expected) job satisfaction [35
A job characteristic of particular significance in this context is task significance, which refers to the sense of meaning associated with the task, such as having a tangible, positive effect on the world and other people. While having impact and making a difference was a prominent reason among participants considering the PHS as attractive, for others, the lack thereof was a reason why they considered the PHS unattractive. This may be in part due to participants overestimating the impact of medical approaches and innovations regarding its beneficial impact on health (i.e., a significant task), while underestimating the impact of non-pharmacological public health measures or addressing SDH, a prevalent misconception that we found among the participants within the quantitative analysis of the OeGD-Studisurvey [29
] and which was also already found in the past [40
]. A limited focus on the importance of public health and related themes during the medical studies (e.g., of SDHs [15
]) may contribute to this issue. Hence, improving knowledge of the importance and the impact of public health action may increase the perceived attractiveness of the PHS by increasing the expected task significance and the expected meaningfulness of the work resulting from it.
In this context and given the prominence of wanting to focus on population health, health promotion, or social determinants of health (SDH) as a reason for considering the PHS as attractive, emphasizing these aspects and putting them in the center of public health awareness campaigns can be a successful strategy.
Focusing on this might be of particular importance, as health promotion and disease prevention (including a focus on vulnerable and marginalized individuals or addressing SDHs) were not consistently associated with the PHS. Within the survey, one out of four medical students and two out of three PH&ONM students expressed an interest in behavioral and primordial prevention (in German: Verhältnisprävention). However, out of those, roughly one in four did not consider this as a key function of the German PHS. Experts and stakeholders have criticized an insufficient focus in the PHS on these topics [41
] and have emphasized the need to strengthen health promotion and disease prevention activities in Germany [13
] and beyond [44
]. Thus, our findings indicate that doing so could increase the perceived attractiveness of the PHS among young professionals.
|Key finding 6. Reform bureaucratic structures and expansion of digitalization, but also empowerment of young professionals to act within the established administrative structures|
The most prominent reason for not considering the PHS as attractive among PH&ONM (37%) and to a lesser extent among medical students (25%) was that the PHS was regarded as too bureaucratic. This was often linked to the reasons of the PHS being regarded as outdated, not innovative or in need of modernization as well as that working within the PHS would not allow for creative freedoms. In this context, participants criticized both an overburden of administrative tasks as well as the adverse consequences resulting from them (e.g., slow decision making and action, limited creative freedoms). These reasons were repeatedly provided alongside with statements characterizing the occupation in the PHS as monotonous and boring. This was also seen in the quantitative analysis of the OeGD-Studisurvey, with nine out of ten participants considering the PHS as bureaucratic, and with less than one in five characterizing it as modern or innovative [29
]. These perceptions were shared by both individuals with and without experience within the PHS [29
]. Furthermore, similar findings have been reported on the satisfaction of the PHS in other countries [28
Again, our findings are well reflected in the Job Characteristics Model [35
], where a lack of core job dimensions is captured under what participants refer to or relate with bureaucracy: low skill variety (with working in the PHS is perceived as a monotonous office job in a public administration), low task significance (with extensive rules and regulations limiting swift and effective public health action), low autonomy (with hierarchical structures and regulation limiting the experience of responsibility for the outcome of the work), missing feedback and low task identify (with the compartmentalization of the work limiting the awareness about the results of the work).
Thus, a reform of the PHS toward a more modern public administration in which the core job dimensions are reflected seems to be necessary to increase attractiveness: streamlining overburdened administrative procedures, overhauling inefficient processes, expanding digitalization, and automating processes may considerably reduce the bureaucratic tasks considered as unattractive by students and young professionals. Expanding creative freedoms and an increasing responsiveness of the PHS (i.e., be more responsive to the needs of the community it serves) could also increase its attractiveness [45
However, the PHS is part of the public administration and will always be bureaucratic to some extent, even after streamlining, digitalizing, or automating processes. Despite their negative image, bureaucracies themselves are not essentially problematic: in their ideal form, they were characterized as the most rational form of governance by the sociologist Max Weber, as they allow for predictability, consistency and protection from corruption [46
]. Therefore, while the need for reform and modernization of overburdening bureaucracy within the PHS remains, both medical and PH&ONM students could benefit from more exposure to and training in public administration and sociology: First, this could raise awareness and appreciation of this rational form of governance. Second, the knowledge that the PHS always acts on behalf of the state and is therefore politically legitimized can contribute to a higher appreciation. Third, these skills could enable and empower young professionals to work within the system of public administration to implement change and improve health.
|Key finding 7. The salary gap needs addressing—but handled with care|
In our survey, roughly one in ten participants provided a low salary as a reason for not considering the PHS as attractive. These findings are in line with what we found in the quantitative analysis of the OeGD-Studisurvey, where receiving a high salary was regarded as important, but not among the top priorities for future working life among the participants [29
]. This reason was less prominent than its importance in the public discourse suggested [1
], with some experts also criticizing an overemphasis on the salary of PHS employees with medical degrees [41
]. However, it needs to be kept in mind that the survey participants were students, whose lifestyle and salary expectations might change over time, including the importance attributed to the salary when making career choices. For example, other international studies have found dissatisfaction with the salary as a reason for employee dissatisfaction or intention to leave [25
Regarding this reason, we believe Adams’ equity theory [47
] provides a valuable frame of reference: it postulates that individuals expect compensation (e.g., salary, promotion, or recognition) that is fair in relation to what they are contributing (e.g., educational background, prior experience, or high job performance) as well as fair in relation to the compensation of their peers (i.e., their balance of what they contribute and receive). If the (expected) compensation is not perceived as in balance with their contribution (i.e., fair), this reduces their motivation and job satisfaction [47
For example, in the OeGD-Studisurvey, medical students expressed that one of the reasons they did not regard the PHS as attractive was that their input, in the form of having a medical degree and an acquired a medical specialty, was not compensated fairly by the salary they would receive working in the PHS, in particular when compared to what their peers—physicians working in the health care sector—receive for the same input.
The problem of the existing salary gap between physicians in the PHS and in the health care sector needs to be addressed, if the PHS is to become more attractive to medical professionals. However, in light of other reasons for not considering the PHS an attractive employer, raising the salary without addressing other concerns is likely not the solution. Furthermore, this issue should be handled with care: reducing the salary gap between physicians within and outside of the PHS would lead to a further increase in the salary gap between medical and non-medical professionals within the PHS, which could spark social tensions. It may even reduce the attractiveness of the PHS among non-medical professionals, if this creates the perception that they and their work (i.e., their contribution) are not adequately valued and acknowledged, especially when compared to the input-output balance of medical professionals in the PHS [27
|Key finding 8. PH students perceive a lack of access to and acknowledgement in the PHS|
A final reason for not considering the PHS attractive, primarily among PH&ONM students, was that individuals without a medical degree would not receive adequate acknowledgement within the PHS or—despite interest—that the PHS would not provide adequate job opportunities for them.
This stands in contradiction to the high levels of interest in the PHS among PH&ONM students, found in both this analysis and the quantitative analysis of the OeGD Studisurvey [29
]: Not only were considerably more PH&ONM students interested in working in the PHS as a career path, they were also more often interested in becoming a public health specialist (in German: Facharzt Öffentliches Gesundheitswesen), if Germany would implement something similar to the United Kingdom model [48
], resulting in opening the public health specialist program to both individuals with and without a medical degree. However, simply opening up the residency training in public health to professional groups other than medical is not easily possible in Germany due to its strong medical tradition. Consideration should therefore be given to the extent to which career and qualification paths can be created for non-medical professionals that enable them to obtain certification analogous to the public health specialist in Germany (albeit in a different form). The academies for public health, as well as the chairs for PHS currently being planned at several universities in Germany [49
], are likely to be important actors in order to ensure new and, above all, interdisciplinary training structures in the future.
Thus, our findings are consistent with the discourse led by experts and stakeholders calling for a reform of the PHS in Germany to create more open and flexible structures for young professionals without a medical degree [7
]. Furthermore, they are in line with Adams’ equity theory [47
]: if PH&ONM students believe that their qualification and training, their competences and knowledge, or their motivation will not receive fair compensation (e.g., in the form of acknowledgement), this may reduce the perceived attractiveness of the PHS and their motivation to seek a career within it. The findings also fit with the general discourse on strengthening the public health workforce in Germany, which largely focuses on medical professionals [1
], although is not a discussion unique to Germany [45
Individuals with a medical degree are essential for some core tasks within the PHS in Germany. However, currently, the potential of young professionals with high levels of interest to work for the PHS seems not to be adequately utilized. Strengthening the role of PH&ONM students within the PHS, reflecting on which skills and competencies are essential for which task as well as expanding the collaboration between disciplines and the appreciation for the expertise of every discipline contributing to the work of the PHS are likely crucial to sustainably strengthen the PH workforce in Germany.
5. Strengths and Limitations
Our study has several strengths and limitations. First, despite a comprehensive recruitment strategy, our sample is not a randomly selected sample. However, we found that the population of medical students in our survey, in particular in wave 1, was comparable to a large survey of more than 13,000 German medical students conducted in 2018 [10
], for example regarding interest in working in the PHS or the interest in medical specializations. Unfortunately, we are not aware of such a document for PH&ONM students. It cannot be ruled out that through self-selection, individuals with interest in the PHS are overrepresented. However, due to our qualitative approach employed and due to conducting the analysis of reasons for considering and for not considering the PHS attractive separately, our main concern is representation rather than representativeness. In this regard, which we believe to have achieved, we found a saturation regarding both codes and meaning despite the heterogeneity of our sample.
Second, our analysis is based on the analysis of written responses to a survey. This approach does not allow one to further inquire to clarify ambiguous responses or explore complex topics in depth (e.g., understandings of bureaucracy). Here, additional research employing focus groups or key-informant interviews should be conducted.
Third, the population questioned in this survey comprises students, whose perception and attitudes might change in the early phase of the professional career. For example, medical students may overestimate the administrative work in the PHS and underestimate the administrative work in a clinical setting or change their attitudes toward the importance of salary. Here, conducting additional research among professionals in early stages of their career within and outside of the PHS might provide valuable insights.
Fourth, our survey was conducted before and in the early phases of the COVID-19 pandemic. During the pandemic, the PHS in Germany has received high levels of media, political, and public attention. This has likely raised awareness about the PHS among young professionals and may have sharpened their perception of it, both in a favorable or less favorable way. Additional research—for example in the form of a third wave of the OeGD Studisurvey—might be a solution.
Fifth, in order not to overwhelm the participants, we did not differentiate between the PHS on a local and on the federal or national level. As by far, most individuals working in the PHS are working on the local level, we believe this is the dominating frame of reference of the participants. This should be addressed in future publications.
Sixth, while we regard the qualitative approach in this publication to be a particular strength, further expanding on these findings through additional quantitative analysis (e.g., cluster and factor analyses) would provide additional insights. While this is beyond the scope of this publication, we aim to close this gap in an upcoming analysis.
However, despite these limitations, this survey—to the best of our knowledge—is the most comprehensive empirical study on the topic of young professional perceived attractiveness of the PHS in Germany conducted thus far. The overall lack of empirical evidence on the topic further emphasizes its importance. The qualitative approach utilized on responses by more than a thousand individuals allowed for an in-depth exploration of the diverse reasons for why the PHS was (not) considered attractive. Furthermore, the quantitative analysis of the qualitative data allowed for an estimation of the relative importance of these reasons. The approach of the OeGD-Studisurvey allowed us to interlink both qualitative and quantitative findings in a mixed-method approach.