The ad went around medical offices in no time. Texted, between two consultations, stethoscope around the neck, mask under the nose. A jolt. “Did you see about Olivier Véran?” Another: “It’s huge, did you know?” Again: “Scary”. It’s official, since this Tuesday: the former Minister of Health, Olivier Véran, is abandoning neurology. No more consultations at the public hospital, at the Grenoble University Hospital, where he worked before entering politics. Having become a simple deputy again after the reshuffle, the “Mr. Covid” of the executive will devote himself, instead, to aesthetic medicine, these ever more popular beauty injections. He will train at the Clinique des Champs-Elysées, and at the university.
The former first doctor of France, at war against medical deserts when he was in office, who is deserting care while the system is falling apart? The news provoked the ire of the medical community, especially since its discipline is not immune to the shortage of personnel. “Wait, it must be a fake news“, stumbles an elected official from the order of doctors.
A real siphon
France only had three neurologists per 100,000 inhabitants in 2023, according to the Atlas of Medical Demography. As in many other specialties, the battalions are becoming thinner, and the waiting rooms are filling up: “The average appointment time is six months, and the needs are only increasing, as we live more and more for a long time”, specifies Farid Yekhlef, president of the National Union of Neurologists.
Olivier Véran, however, is not an exception: before him, many other doctors have deserted, to plump up lips or fill in wrinkles. A real siphon, which has become one of the main concerns of the health authorities, like the order of doctors: “We talk about aesthetic medicine at every session. So if even the ministers get into it…”, s annoys Dr. Christophe Tafani, president of the Loiret order of doctors.
Within the medical community, many see the choice of Olivier Véran as a signal against the grain. For years, the departmental councils of the order have been warning about the drain represented by this practice, born on the job, in the 1990s. In the Loiret, the new caregiver installations can be counted on the fingers of one hand. The last ? An “aesthetic”, complains Christophe Tafani. “In Orléans, half of the general practitioners no longer do general medicine, it has become a scarecrow. And those who remain, who says they don’t fill in wrinkles to make ends meet?”
The alerts are multiplying
There is no register of aesthetic doctors. But, according to our information, the National Council of the order estimates at least 9,000 the number of doctors who devote themselves to this practice in France. A figure which would actually be underestimated: “More and more doctors are offering it, in addition to, or instead of, part of their activity, without us knowing it, because declaring it is not obligatory “, explains Dr Jean-François Delahaye, responsible for these subjects at the National Council of the order.
At around 300 euros per injection, this medical sector, one of the only ones where VAT is applied, is much more profitable than treatment. “A neurology consultation at the hospital costs around fifty euros; 26.50 euros in general medicine in Paris. The care does not pay, and it is more restrictive. It is difficult to blame those who stop. The fact remains that it is a real problem”, argues Jean-Jacques Avrane, president of the Departmental Council of the Order of Paris. Especially since there is no shortage of demand, especially in large cities.
A phenomenon accentuated by a total absence of regulation. Currently, any doctor can return their coat. “As it is not a medical specialty, but only a set of procedures, there is no quota, unlike cosmetic surgery for example,” explains Dr. Adel Louafi, president of the National Union of Reconstructive Plastic Surgery. and aesthetics. And if Olivier Véran decided to train, nothing forced him to do so: he could, as it was, not do it.
Emergency physicians, radiologists, psychiatrists
A chasm: while only dermatologists and certain surgeons study this practice during their studies, a vast majority of injectors are in reality general practitioners, according to the order. Then come all kinds of specialties, although they are often far removed from facial anatomy. “There are a lot of emergency doctors, anesthesiologists, radiologists, psychiatrists,” continues Dr Delahaye.
On Doctolib, the examples are legion. Like this rheumatologist, in Issy-les-Moulineaux, who poses in her office on the appointment booking platform. In addition to treating joints, she also offers purely aesthetic injections. Or peeling, this treatment which removes dead skin. Even vulvovaginal radiofrequency, used to improve the appearance of the genital tract, a segment that is growing.
An angiologist in the 5th arrondissement of Paris, who treats facial imperfections in addition to the arterial problems for which she was originally trained. An ophthalmologist from the 7th arrondissement, a gynecologist in the 17th, an anesthesiologist in the 16th, another in the 8th, a phlebologist… And, more intriguing, the European Pediatric Center, a health center in the 15th. One of his GPs recently took up touch-ups, on top of everything else.
The rush of young graduates
Jean-Philippe Platel, president of the Order of the North, also did his little research: “In Lille, in dermatology care, everything is complete. In aesthetics, I find for tomorrow”, reports the caregiver, dismayed. In tense areas of his department, it regularly happens that doctors defect, announcing that they are making beauty their priority. Enough to increase the burden on professionals who try to resist medical deserts. “Who will take care of the real patients? Those who have serious or chronic pathologies?” asks the specialist.
A few months ago, a figure particularly worried the order. The Paris Departmental Council estimated that 80% of young doctors who settle in the capital after their studies wanted to pursue aesthetics. Nothing was published because it was a back-of-the-envelope calculation. The fact remains that he left his mark. “If this is only an estimate, it seemed incredible to us, and particularly worrying,” continues Dr. Delahaye.
Beyond reducing the workforce, the phenomenon poses significant medical problems, identified by the order. Some careerists don’t train, thinking that a few needle sticks in the forehead can’t cause a problem. Injected in the wrong places, aesthetic products can nevertheless paralyze the face or necrotize it. Others adopt a commercial practice (advertising, canvassing, discounts, etc.), although it is formally prohibited. And some don’t do more than that. Difficult to tolerate, given the medical crisis.
The order has been working on dikes for several months. In the pipeline: the ban on practicing aesthetic medicine before three years of medical practice. Enough to nip in the bud the rush of young graduates, who do not even try the science that they have studied for around ten years, at the expense of the taxpayer. To this would be added the creation of a university diploma, compulsory for practicing. The project should be completed in the coming months. It could contain bloodletting, by limiting the number of doctors authorized to access this diploma. With these provisions, a neurologist well known to the French who would like to get started could thus find his training refused.
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