ask-shifting from doctors to members of various non-medical specialized professions is routine practice in the Anglo-Saxon countries and Scandinavia (1, 2). In Germany only narrowly defined medical tasks (MT) are delegated, mostly to Qualified Medical Practice Assistants (MPA) (eBox) (3,4). Although the concept of redistributing certain medical activities has existed since 1975 (5), the requirements, as well as the services eligible for delegation, were first defined in 2013 (6). The prerequisite of delegating tasks is supervision by the physician who has the authority to issue instructions. She or he has the duty of selection, instruction, and supervision (5) and retains full responsibility.The reallocation of MT to MPA is considered a practicable strategy to counteract the consequences of demographic change and shortage of physicians, especially in rural areas. The aim is to create structures that make it possible to maintain the quality of care and simultaneously alleviate doctors' workload (2,7,8).In recent years in Germany, various training models have been used to qualify MPA to take over tasks eligible for delegation and equip them to carry out specific tasks (7, 9). In evaluating these projects the perspectives of the participating physicians, MPA, and patients on the delegation have been studied (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Altogether the results show that delegation was broadly acceptable to all participants (15,18,19). Almost nothing is known, however, about attitudes in the general population, independently of previous experience.For Germany, the results of two survey studies are currently available: Höppner's purely descriptive study on the basis of a representative population survey carried out in 2007 shows that about half of the participants were prepared to consult an MPA instead of a physician for minor illnesses (e.g., colds, gastrointestinal problems, or headache) (20). Data from a nationwide survey of members of the National Association of Statutory Health Insurance Physicians (KBV, Kassenärztliche Bundesvereinigung) in 2017 indicate a greater readiness to be treated by an MPA for minor illnesses than for chronic disorders (21).

Background Germany is one of the countries most affected by demographic change. Meaning the shift towards the population being older is growing. At the same time, the number of doctors is declining. In order to ensure adequate care in Germany, the delegation of medical services to specially trained medical practice assistants (MPAs) is currently discussed. The aim of this study was to assess the attitudes of the German population towards medical delegation. Methods The analysis was based on a population survey of 6.105 German-speaking residents aged 18 years and over. Associations between respondents’ attitudes towards the delegation and social determinants (age, gender, education, employment status, region, self-rated health) were assessed using standardised questionnaires. Bi- and multivariate (logistic regression) analyses were performed. Results In case of a chronic disease half of the German-speaking population (51. 8%) would accept getting treated by a MPA. More older participants (65 years and above) than younger participants (18 to 34 years old) (OR: 1,64; KI [1,24-2,18]), more lower than higher educated participants (OR: 1,20; KI [1,04-1,39]) and more non-German than German participants (OR: 1,61; KI [1,24-2,10]) are significantly more likely to not accept medical delegation in case of a chronic disease. Discussion: In the debate on delegation models the present results should be taken into account in order to be able to address relevant target-groups. Further qualitative studies that investigate the reasons for the critical view on delegation are recommended. Key messages Approximately 50% of the German-speaking study population would accept treatment by a MPA for chronic disease. Especially older study participants, lower educated people and non-German participants would not accept medical delegation in case of a chronic disease.