In a newly built housing estate on the heights of Sarlat (Dordogne), a funny choreography is played every evening. In the entrance of the apartment, on the right, several bags filled to the brim piled up waiting to be grabbed. It’s 6 p.m. Neither one nor two, Jennifer jumps off the sofa laughing, puts on her coat, slips her cell phone into her purse and runs as best she can towards the elevator. Her husband, hilarious, also plays the game. But they both know that soon the smiles will give way to panic. Because the young woman of 29 years is pregnant for more than 8 months. Problem: the birth rooms of the Jean-Leclerc hospital center in Sarlat have been closed since March 29 due to a lack of staff. “We’re going to have to take the car and drive an hour to reach Périgueux. That leaves time to have a problem…”, breathes Jennifer.
Like her, around twenty future mothers from Sarlat or its surroundings had to resign themselves to giving birth in Périgueux, Bergerac or Brive, forcing them to travel more than 50 kilometers. The maternity hospital in the city should reopen its doors “on May 2 at the latest”, announced the Regional Health Agency (ARS) of New Aquitaine, but its closure is symptomatic of the crisis that the public hospital is currently going through. Two weeks after the application of the “Rist law” which caps the price of temporary doctors – at 1,390 euros for 24-hour care – the closures of emergency and maternity services are indeed increasing. in small public institutions. The ministry admits to making a “daily update” with the ARS to identify sites and/or hospital departments in difficulty. At this stage, a dozen would have been identified. But the National Union of Hospital Replacement Physicians (SNMRH) has drawn up a list of “more than 70 closed services” using feedback from its members.
In fact, looking at the local press, the pressure does not seem to fall. Emergencies, maternity wards, pediatric services… Interim doctors held the services at arm’s length in almost a third of French establishments. From Sarlat to Bastia (Haute-Corse), from Sedan (Ardennes) to Feurs (Loire) via Aubenas (Ardèche), Epinal (Vosges) or even Bourges (Cher), the dysfunctions seem to extend to all of France. At the Grenoble University Hospital, as one might fear, a tragedy recently occurred. A 91-year-old man died on Wednesday April 12 after spending three days waiting for a geriatric hospital bed, the establishment confirmed to L’Express. Worse, his family could not be present by his side “in view of the high activity of the emergency department”, soberly comments the management in a press release. The death of this nonagenarian is not an isolated case, it is the third sudden death that has occurred in the emergency room of Grenoble, for four months, while the medical prognosis did not indicate any particular urgency. “50% of emergency physician positions have been vacant for more than a year and a half. Since April 3, we have deplored the disengagement of a large majority of temporary emergency physicians who no longer wish to come and practice,” continues the CHU.
If the evil strikes first the small establishments, Ile-de-France is not spared. The emergencies of the Foch hospital, in Suresnes, for example, were closed on the Easter weekend, as were those of the Sainte-Camille hospital in Bry-sur-Marne (Val-de-Marne).
“Compensation drift”
At the origin of the standoff led by the government, the desire to control the prices of these doctors who come to compensate for the lack of hospitals. Minister François Braun still considered last week this measure “totally essential” to “put a stop” to “the drift in remuneration”. Faced with increasing feedback from the field, the government does not intend to let go of the temporary workers, Prime Minister Elisabeth Borne again recalling at the beginning of the month her objective of “cleaning up unfair practices” vis-à-vis other doctors hospitable. Some of the temporary workers, who refuse to be called “mercenaries”, have brandished the threat of slowing down, to remind us that the system cannot function without them.
In Sarlat, for example, the maternity unit was running with 70% temporary workers, hence the difficulties encountered in recent weeks. The ARS and the establishments find themselves faced with a dilemma: how to attract temporary doctors to remain in post, with a duty rate lower by at least 20 to 30% than what they have been receiving so far? The response can take several forms, including the establishment of other types of contracts, for different working hours but with amounts that can sometimes be higher. At the risk of giving the impression of circumventing the law, even if the ministry argues that the use of this type of contract is “regulatory”. In the Dordogne, in particular, the press echoed sums of up to 1,800 euros gross per custody. The boss of the ARS of Nouvelle-Aquitaine responds to the World that this “reconciliation or comparison does not really hold”, his region facing many “disturbances”. “The proposed contracts, known as ‘pattern 2’, are provided with the authorization of the ARS, for territories in tension and/or specialties in tension”, explains Benoît Elleboode.
At this stage, it has authorized all establishments under its responsibility to use it. Without this, according to his calculations, eight emergency services and six maternities would have had to close. For Eric Réboli, this is “a first stroke of the penknife in the Rist law”. Especially since beyond these ‘reason 2’ contracts, the emergency doctor points out, in certain departments, the circumvention of the Rist law by other means: overtime, fictitious on-call payments… “In fact, the question would be whether only one replacement is currently paid at the Rist rate in France”, questions, provocatively, the spokesperson for the SNMRH.
The showdown continues
On the employers’ side, the French Hospital Federation (FHF), although in favor of the reform, is concerned to see the problem become encysted. “Tensions will undoubtedly manifest themselves during the periods of leave”, predicted Vincent Roques, the chief of staff of its president Arnaud Robinet, during a press conference last Friday. To avoid the worst in May and during the summer, many incumbent doctors agreed not to take certain leaves, others agreed to move to territories “in tension”, but these patches could not be enough. The cabinet of François Braun, if he wants to be optimistic by ensuring that everything is “under control”, recognizes that “the complicated situation will not last only in April. It will also be difficult in May and June”.
The Ministry of Health ensures that temporary doctors are now classified into three categories: those who remain temporary, those who have joined hospital teams, those who have remained temporary, and those who have left the profession. Without knowing, for the time being, what proportion for each of them. Either way, the standoff continues.