The Head of State will advance on a path lined with brambles. He is eagerly awaited during his wishes to caregivers, this Friday, January 6, in a hospital in Essonne. Will Emmanuel Macron’s “very concrete” announcements live up to the promised “refoundation” of a “breathless” health system? “The President of the Republic will give a course to caregivers”, to allow them to “find meaning in their profession” and facilitate “access to care” for the French, according to the Elysée. He will unveil “very concrete measures, with precise and close review clauses to ensure their execution”, added the presidency, without detailing the content.
The early and particularly virulent bronchiolitis epidemic shed harsh light on the lack of pediatricians in hospitals and in the city. “In the spring, will there be someone left to care for the children?” Asked in December some 10,000 caregivers gathered within the Pediatrics collective. On October 21, 4,000 caregivers denounced “a glaring deterioration in the care provided to children” which puts them “daily in danger” in a letter to the President of the Republic.
“Currently, eight departments have a density of less than one pediatrician per 100,000 inhabitants”, noted thegeneral inspection of social affairs (PDF) in a 2020 report. A UFC-Que Choisir study, published Tuesday, November 8, notes that a quarter of children under 10 live without a pediatrician within a 45-minute drive. In addition to working conditions, this disaffection with paediatrics is explained by the lack of recognition of the specialty and the lack of attraction it arouses among students.
Dermatologists, gynecologists, psychiatry…
To respond to this “historic” crisis, the executive promised “paediatrics and child health meetings” for the spring, by setting up a steering committee but without specifying the date of this meeting in impatient professionals. Assizes, psychiatry has already known in September 2021, with the key to the creation of 800 nursing positions in medico-psychological centers (CMP). An announcement deemed largely insufficient, while the shortage of doctors and nurses today affects five out of six hospitals, according to the unions of a “dilapidated” mental health sector. The government claims to be “fully aware” of the difficulties of psychiatry. Discussions should take place at the start of 2023 with a view to presenting a new “scale plan”.
In general, France is experiencing a lack of specialist doctors, given the increase in the French population and its needs. In addition, there are geographical disparities with regions that are better endowed because they are more attractive, such as Île-de-France or Provence-Alpes-Côte-d’Azur. Among the specialties in crisis, there is dermatology. Indeed, it can be complicated to get an appointment with one of the 4,000 dermatologists based in France. On average, it takes two months to get an appointment, but it can take longer in other areas. In question: many retirements and job openings in dribs and drabs.
And this problem is not isolated. In a study released in early November, UFC-Que Choisir indicates that a quarter of women and a quarter of children live in a medical, gynecological desert and a pediatric medical desert. Between 2007 and 2020, France lost 52.5% of its medical gynecologists. The latter provide follow-up throughout the life of women, unlike their obstetrical colleagues, who are dedicated to pregnancy. Another telling figure: today in France there are three medical gynecologists for every 100,000 women of consulting age. It should be noted that the average age of specialists, who remain in place, is 51, and varies greatly depending on the territory.
Access to a general practitioner is also very complicated: 15 million French people would be affected. To carry out this study, UFC-Que Choisir relied on two criteria: the geographical distance of the doctors, accessible within a 45-minute drive, and the current rates. Among the recommendations of the association: that it is no longer possible for doctors to settle in over-supplied areas, with the exception of doctors practicing Social Security tariffs. Added to this is the abolition of public aid for doctors who do not respect the Social Security tariff.
Other specialists also find themselves in tension, like ophthalmologists. According to a study revealed by France Blue, in July 2021, “29% of ophthalmology practices were not taking new patients in 2020”, a sign of a significant lack of professionals in certain territories. Also according to the study, the density of private ophthalmologists in the territory was 7.4 per 100,000 inhabitants and 8.7 for all of these professionals. In addition, there are regional disparities that persist. To mitigate them, the national union of ophthalmologists of France (SNOF) proposes to prioritize aid for the installation of health insurance to ophthalmologists who choose to practice in under-resourced territories.