- Author, Carrie King
- Role, Technology journalist
- Report of Berlin
Doctolib is one of the great successes of the French start-up scene.
Founded in 2013 by Stanislas Niox-Chateau and his three co-founders, the software publisher supports healthcare providers in their administrative tasks, including making and managing appointments.
Rather than having to contact practices directly, patients can use Doctolib to check availability and book medical appointments online.
In a world where we book everything online, this may seem like a simple innovation, but in the slow, data-sensitive and bureaucratic healthcare industry, any software that can reliably simplify complexity and free up time is a game-changer welcome.
Doctolib is free for patients. Doctors pay a monthly subscription of €139 ($151; £120) to use the base product, with various add-ons and upgrades available. There are also separate packages for hospitals and other practitioners like physiotherapists.
Already in good health by the time the pandemic hit, Doctolib benefited from the sudden rise of telemedicine, and its partnership with the French government to facilitate the Covid-19 vaccine rollout made the company a household name well known in France.
The company claims to cover almost the entire French population and was valued at around £5 billion in its latest funding round in March 2022.
But repeating this success in other markets has proven difficult.
Doctolib expanded into Germany in 2016, but after eight years in the German market, the company has only recently started to gain traction.
Of the 900,000 healthcare providers and 80 million patients registered with Doctolib, the Germans represent 200,000 providers and 19 million patients.
Adapting the French centralized system to the German federal configuration was only the first of many obstacles that tested the flexibility of the platform.
“There is not a single entry into the German market,” says Nikolay Kolev, Managing Director of Doctolib Germany.
Each of Germany’s 16 Länder represented a different market to which the company had to adapt.
However, the complications that initially make it difficult to start up in Germany also protect established businesses and make it difficult for new competitors to pose a significant threat.
Dr. Carol von Wildhagen, a physician and healthcare partner at Munich-based Caesar VC who previously headed the German branch of Platform24, a Scandinavian telemedicine provider, says existing closed systems in medical practices are also a major barrier to entry.
“Companies that make and sell lots and lots of practice management systems build them like fortresses. This makes it very difficult to connect third-party software to a medical practice’s software. So it’s very difficult to provide value to the doctor,” she says.
“I can understand how the large incumbents who traditionally produce practice information systems would be worried…they might be quickly overwhelmed because their systems are old, look old, look old, aren’t very user friendly and could be replaced by something cloud-based and focused on user experience.
Image source, RAISE Summit
“I think home advantage still plays a big role in the European startup scene,” says Liam Boogar-Azoulay, founder of the French bilingual blog Rude Baguette in 2011 and now co-founder of Waypoint AI.
“Germans like to buy from German companies and I think that cannot be overstated. It’s the same thing in almost all countries,” explains Mr. Boogar-Azoulay.
This reluctance towards non-German companies and this hesitation to embrace digitalization more generally may be partly explained by the belief that only a local company will understand the German desire for high levels of data security.
Doctolib’s 2022 acquisition of French data encryption startup Tanker could be a move to reassure minds concerned about data security.
But Mr Kolev doesn’t think data security is really the reason why the German system has been slow to evolve.
“The best security and privacy available should be our baseline if we truly want to move this industry forward. So I don’t think data privacy is the problem in the German healthcare market. I think it’s more the fax machines.
He’s not joking. A 2023 study by German digital advocacy group Bitkom found that 82% of German companies still use fax machines regularly. In many cases, faxing is the preferred method for sharing medical information.
Increasing digitalization has long been on the German state agenda. The German National Association of Statutory Health Insurance Physicians estimates that healthcare practices spend around 61 days per year on paperwork alone.
Doctolib is banking on the transition from paperwork to digital.
“(Outdated technology is) not a problem that cannot be overcome. It’s just a barrier to adoption,” says Boogar-Azoulay.
“I think just having the French tailwind and having this market behind them, they will be able to invest money to solve the problem for a long time. It doesn’t have to be effective. They can lose money on the German market for 10 years just to overcome the fax barrier.”
And it’s easy to understand why Doctolib is willing to invest a lot to make its business in Germany work. As Mr. Boogar-Azoulay points out, the market opportunity is “insane.”
As Germany’s population of 84 million continues to age and the shortage of doctors grows, the healthcare system is in dire need of widespread optimization to ease pressure and restore Germany’s reputation for efficiency.
The most recent available statistics show that Germany spent €495 billion on health in 2023, or around 13% of its total GDP. Germans visit the doctor around 9.6 times a year, which is significantly more often than most other Europeans.
In 2022, German primary care doctors saw an average of 254 patients per week, compared to 114 for their French counterparts and 110 for British doctors.
Lessons learned from its expansion into Germany can be seen in the way Doctolib approached the Italian market in 2021. Although the number of Italian users is still low, Doctolib acquired its Italian competitor Dottori.it to gain an initial foothold in the market.
What if you crossed the Channel?
“The UK is certainly an interesting country. That said, Germany, France and Italy alone represent 55% of the European healthcare market. So if you’re in a good position there, that’s already half the rent,” says Kolev.