Carrie King,Technology Reporter
Doctolib is one of the great success stories of the French startup world.
Founded in 2013 by Stanislas Niox-Chateau and three co-founders, the software company primarily assists healthcare providers with administrative tasks such as booking and managing appointments.
Instead of contacting the clinic directly, patients can use Doctolib to check availability and book appointments online.
In a world where everything is booked online, this may seem like a simple innovation, but in the time-consuming, data-sensitive and bureaucratic world of healthcare, any software that can certainly simplify complexity and save time is a welcome change.
Doctolib is free for patients; doctors pay 139 euros ($151, £120) per month for the core product, with a range of add-ons and upgrades available, as well as separate packages for hospitals and other healthcare professionals such as physiotherapists.
Already doing well before the pandemic hit, Doctribe has benefited from the rapid growth of telemedicine and has made a name for itself in France after partnering with the French government to speed up the rollout of COVID-19 vaccines.
office It says it covers almost everything It represents around 10% of France's population and was valued at around £5 billion in its last funding round in March 2022.
But repeating that success in other markets has proven difficult.
Doctolib launched in Germany in 2016, but has only recently started to gain traction after eight years in the German market.
Of the 900,000 healthcare providers and 80 million patients registered to use Doctolib, Germans account for 200,000 healthcare providers and 19 million patients.
Adapting from France's centralized system to Germany's federalism was only the first of many obstacles that would test the platform's flexibility.
” [one] “Entering the German market,” says Nikolai Kolev, Managing Director of Doctolib Germany.
Each of Germany's 16 federal states is a different market and companies have had to adapt.
But the complexities that make it initially difficult to start a business in Germany protect existing companies and make it difficult for new competitors to pose a significant threat.
The existing closed system of clinics also poses a major barrier to entry, says Dr. Carol von Wildhagen, a physician and health venture partner at Munich-based Caesar VC who previously led the German arm of Scandinavian telemedicine provider Platform24.
“Companies that manufacture and sell a large number of products [practice management systems] “It's very difficult to connect third-party software to the physician practice software because physicians build them like fortresses, which makes it very difficult to provide value to the physician,” she says.
“I understand the concern from the large traditional clinical information systems companies. Their systems are old, have an outdated look and feel, are not user-friendly and may quickly be overtaken and replaced by cloud-based alternatives that prioritize user experience.”
“I think home field advantage will always play a big role in the European startup scene,” says Liam Buger Azoulay, who founded the French bilingual startup blog Rude Baguette in 2011 and is now co-founder of Waypoint AI.
“I can't stress enough that Germans love buying from German companies, and it's the same in almost every country,” Buger-Azoulay said.
Perhaps part of the reason for this reluctance towards non-German companies, and the reluctance to embrace digitalisation more generally, lies in the belief that only domestic companies can understand Germany's demands for a high level of data security.
Doctolib’s 2022 acquisition of French data encryption startup Tanker may be a gesture intended to appease those who care about data security.
But Kolev doesn't believe data security is the real reason Germany's system is slow to change.
“If we really want to move the industry forward, it has to be based on the best security and privacy available. So I don't think the issue in the German healthcare market is data privacy. I think it's more a fax machine issue.”
He's not kidding: 82% of German companies still use fax machines on a regular basis, according to a 2023 survey by German digital advocacy group Bitkom. Faxes are often the go-to method for sharing medical information.
Driving digitalisation has long been on the German government's agenda: the German National Association of Statutory Health Insurance Doctors estimates that healthcare organisations spend around 61 days a year just on paperwork.
Doctolib relies on the shift from paperwork to digital services.
“[Outdated tech is] “This is not an insurmountable problem, it's just a barrier to adoption,” Booger-Azoulay said.
“With the tailwind and market backing from France, I think they can put money into solving the problem for a long time. They don't need to be efficient. They can run losses in the German market for 10 years just to get past the fax machine wall.”
It's easy to see why Doctolib is willing to invest heavily to make its German operations a success: as Boogar-Azoulay points out, the market opportunity is “enormous.”
With Germany's population of 84 million people aging and a growing shortage of doctors, widespread optimization is badly needed to ease the strain on the health care system and restore Germany's reputation for efficiency.
According to the most recent statistics available, Germany will spend €495 billion on healthcare in 2023, roughly 13% of total GDP. Germans visit the doctor around 9.6 times a year, significantly more frequently than people in most other European countries.
In 2022, German primary care doctors saw an average of 254 patients per week, compared with around 114 in France and 110 in the UK.
Lessons learned from its expansion into Germany are evident in how Doctolib approached the Italian market in 2021. Although the number of users in Italy is still small, Doctolib acquired Italian competitor Dottori.it to gain an initial foothold in the market.
What about crossing the Channel?
“The UK is certainly an interesting country. But having said that, Germany, France and Italy alone account for 55% of the European healthcare market. So if you can secure a good position there, your rent will already be halved,” Kolev says.