Anne-Marie Brunerie has tried everything, but nothing works. On December 31, this assistant in charge of organizing health services at the town hall of Naves, in Corrèze (2,390 inhabitants), will see the last general practitioner in her town close the door of her office for good. After more than forty years of service, Dr. Chaumeil will retire… And no one has yet come forward to replace him. “However, it was not for lack of trying,” sighs the sixty-year-old, who continues to desperately seek a possible substitute.
By partnering with several neighboring municipalities, the deputy first proposed to the regional health agency (ARS) to create a multidisciplinary medical center, which never saw the light of day for lack of available professionals. Anne-Marie Brunerie then posted informative banners at the entrance to all the surrounding towns, intended for doctors passing by by car, then distributed leaflets to several faculties of medicine, sent a direct mail to the inhabitants of 350 towns, organized a welcome day to present the region to young students at the end of their course, and even created a Facebook group on the subject. Search results? Nothing, except two young doctors who still say they are “in hesitation”. “Waiting for their response, believers will put a candle in the church, and the others cross their fingers,” says the chosen one.
At 66, Dr. Jean-Marie Chaumeil, too, wants to believe it. “I feel a little guilty to leave: there are patients I’ve known for decades, who have almost become friends. I feel like I’m letting them down,” he says, estimating his patient base. to more than 2,000 people. Last doctor for the 2,400 inhabitants of Naves, he also receives patients from nearby towns or even from Tulle, the largest town in the area. “It’s overflowing: every day, I receive one or two calls from people without a doctor. I’m one of the few to help out, only for pathologies that can be treated quickly. Otherwise, I have to refuse.” On average, Dr. Chaumeil sees around thirty patients a day: in the morning by appointment, in the afternoon for home visits, and in the evening for free consultations. Not to mention the administrative work, “heavier than ever”. His days, started early in the morning, often run until 10 p.m. “And that’s the problem,” he admits. “Young doctors want a family life, working 40 hours a week. Not 70, like I do.”
While a Senate report published in March 2022 recalled that 30% of the French population lives in a medical desert, that 11% of patients over the age of 17 have no attending physician and that 1.6 million French people give up medical care each year , the case of Dr. Chaumeil is far from unique. On June 7, the National Council of the Order of Physicians (Cnom) regretted, on the occasion of the publication of its annual atlas of medical demography, a “fragile situation, with many uncertainties”, and a “widening of territorial inequalities in access to care”. The map of the variation in the density of general practitioners between 2010 and 2023 leaves no room for doubt: the number of general practitioners has only decreased along the famous “diagonal of the void”, from the Meuse to the Landes, just like in Normandy or in the Mediterranean basin. Only a few areas, particularly in Brittany, Auvergne-Rhône-Alpes, overseas territories or on the Atlantic coast show a positive development.
“Permanent Stress”
“In my area, some patients can travel tens of kilometers to see a doctor, with waiting times ranging from two weeks to three weeks. For me, this is incomprehensible”, breathes Dr. Alain Berche, general practitioner in Chaumont-en-Vexin (3,217 inhabitants), in Oise. At 77, this former firefighter officially retired several years ago. “But I can’t really hang up,” he admits, laughing. More than forty years after graduating, the man reformed in general medicine, then practiced for a few years as a substitute general practitioner. Shocked by the number of “abandoned” patients encountered in the countryside he has become accustomed to criss-crossing, the doctor decided last December to reopen a medical practice at home, three half-days a week. Like more than 20,000 practitioners in 2023 according to the Cnom, he thus combines employment and retirement. “I invested 10,000 euros in my medical equipment and various software. I tried to convince the surrounding mayors to come together to invest in a cabinet, but I was told that it would cost too much”, regrets- he.
Since then, patients “jostle at the gate”, at the rate of around thirty visits per morning and 800 people registered in six months, to which are added dozens of emails and calls weekly for possible appointments. . And for good reason: in addition to Dr. Berche’s office, which is open on Mondays, Tuesdays and Thursday mornings, only one other general practitioner – 62 years old – still practices in Chaumont-en-Vexin. The two “last of the Mohicans”. “Forty years ago, there were eight of us. The patients I see are all or almost all in a situation of medical wandering, for sometimes very serious pathologies”, he recalls. On this morning in June, a young woman with unattended psychological problems, a breast cancer patient and a man with serious prostate problems presented themselves. “Recently, I even detected undiagnosed multiple sclerosis! This is where we are, in France, in 2023”, storms Dr Berche.
In the town of Reilly (121 inhabitants), four kilometers from Chaumont-en-Vexin, Claudine is one of those “forgotten” inhabitants, sailing between the attending doctors of different towns to get an appointment quickly. “Fortunately Dr. Berche is there, since my 76-year-old referring doctor is less and less available”, testifies this octogenarian, who suffers from heart and respiratory problems. Aware “that it is better not to fall ill on a Friday evening”, nor to wait too long before joining a general practitioner in her region, she evokes “permanent stress” at the idea of not being able to be taken care of in case serious problem. “Especially since for specialist doctors, it’s the same story. My pulmonologist could not offer me an appointment before February 2024.”
“I felt a real disappointment”
From Montagny, in the Loire, Dr. René Caravano shares the same concerns about his 3,000 patients. “Who will monitor their cardiovascular problems, their diabetes, their pregnancies, their chronic pathologies? Everyone wonders how they will do when I’m gone,” says the last GP of this town of 1,100 inhabitants. The 64-year-old doctor has decided to retire next year, as has his closest colleague, who practices seven kilometers away and turned 65 this year. “The third, who also works ten minutes away by car and is 62 years old, risks leaving sooner than expected after our departure. It will no longer be a medical desert, but an abyss,” he says.
For the past few months, Dr. Caravano has nevertheless wanted to slow down, exhausted by his eleven-hour days, during which he could have up to 70 appointments of ten minutes each. “Sometimes people come in for plantar warts or eczema, because they don’t have anyone else to go to. And sometimes you’re diagnosed with a serious heart condition, cancer or depression. That takes you forty-five minutes and makes you late, but you have to be there for them.” This crazy pace, which has nothing to do with the “25 patients” that Dr. Caravano visited by car at the start of his career, is not without consequences for his health. The general practitioner has been sleeping badly for several years now, with sleepless nights and intense days of appointments. “I would have been fine until I was 67, but I have six children and thirteen grandchildren… I would like to take advantage of that.”
To find a successor, he has tried to welcome interns at the end of their medical studies, to present to them the “special” links which unite him with the patient “that we are familiar with and that we follow all the life “, to remind them of the advantages of the rural environment. “But when they saw the pace it was, none wanted to stay. I felt a real disappointment.” While waiting for retirement, the doctor still hopes that the public authorities will become aware of the complexity of his situation, and will help him to keep the medical practice open. “The mayors should create a collective, bang their fists on the table, open a dialogue with the administration or the ARS… The health of our patients is at stake”, he believes.