The seven unions of liberal doctors, the representatives of young doctors, but also the Order, interns, the National College of General Practitioners, SOS doctors and even two organizations of hospital workers (Hospital Practitioner Action) and the Amuf (association of emergency physicians of France): the mobilization of doctors promises to be massive this Tuesday, February 14. “Such a movement is historic. It must be said that we are facing an accumulation of attacks against our profession”, recalls Dr. Agnès Giannotti, the president of MG France, the first union of general practitioners.
Faced with a declining medical population and the needs of the population in constant progression, the government, the Health Insurance but also the parliamentarians are advancing a series of measures intended to strengthen the attractiveness of the profession, and to free up time for care. But these proposals are far from meeting the expectations of doctors. Quite the contrary even, since it is a question, for many of them, of increasing the constraints on the liberals. However, these are today, and for the next ten years, in a position of strength.
Caregivers are lacking everywhere, and many “attending doctors”, pillars of our healthcare system, threaten to throw in the towel if they do not manage to be heard. In the arm wrestling that has begun, it is above all the patients who have the most to lose. Remuneration, installation, work with paramedics, medical assistants, administrative tasks… L’Express reviews the issues that annoy.
Remuneration: an increase or nothing
At the beginning of the year, the Health Insurance proposed to increase the basic consultation fee by 1.5 euros, which would increase for a general practitioner from 25 to 26.5 euros. “An affront” to doctors. The negotiations opened at the beginning of November between their unions and the Social Security to redefine the conditions of exercise of the liberals had gone well so far: the two parties had managed to agree on the principle of the creation of four “levels”. tariffs, supposed to better reflect the reality of the work of our family physicians. The collective “Doctors for tomorrow” had certainly launched a protest movement at the end of last year, demanding that the consultation immediately increase to 50 euros. However, this request was not accepted by the main unions involved in the negotiations, who considered it “unrealistic”. These organizations had therefore not called for following the mobilization initiated by the collective.
But the discussions stopped dead when the representatives of the National Health Insurance Fund (Cnam) presented their tariff proposals… “We have been saying from the start that if we do not obtain a revaluation of the consultation to 30 euros, without counterparts, we will not sign. For the moment, we are far from it”, warns Dr Giannetti, of MG France. Different levels of consultations, better paid, would be created, but accompanied by conditions of activity. Listed in a “territorial commitment contract”, they consist, for example, in accepting more patients, participating in on-call duty or opening the practice on Saturday mornings, or even in joining a “CPTS”, a territorial professional health community, which aims to organize collaborations between caregivers at the level of a territory.
“The different levels of remuneration would replace the long or complex pediatric consultations for which we were already receiving a supplement. But as it stands, the territorial commitment contract requires us to work more to have access to these rates”, regrets Dr Michaël Rochoy, general practitioner in Pas-de-Calais. Physicians would remain free to join or not. But without membership, no increases…
Task sharing: the fear of no longer being at the center of care
This is the other major subject of discontent among doctors: the desire of the public authorities to promote “direct access” for patients to professions for which a prior medical prescription was essential. The subject is at the heart of the bill brought by Renaissance MP Stéphanie Rist. Its objective: to relieve the doctors of certain acts to free up their time, and to widen the offer of accessible care for the patients. Thus, patients would no longer need to go through their general practitioner to see a physiotherapist, a speech therapist or an advanced practice nurse.
If the majority of doctors already collaborate with the paramedical professionals installed around them, many fear, with this reform, to no longer be at the center of the patient’s care pathway. The National Council of the College of Physicians sees “risks of loss of opportunity” and, unprecedentedly, will participate in the event for this reason. However, it had previously paved the way for the development of activity sharing between caregivers. But not to the point of accepting that the doctor loses a small part of the follow-up of his patients: “Every patient has the right to see a doctor if he is sick. Only coordination by the doctor is able to guarantee patients the accessibility, quality and safety of their care pathway”, he insists today.
In the meantime, the Senate modified the text in a direction more favorable to doctors during its first examination in committee. “However, we fear a step backwards when it is read this Tuesday in public session, or later in a joint joint committee”, warns Dr Giannotti.
Administrative tasks: relief that is too… light
To save time for their patients, physicians would like to get rid of non-medical tasks first. Some of them had listed, in a forum published by L’Express, these useless and time-consuming activities: certificates of absence for sick children, medical prescriptions for transport or medical beds, certificates for insurers or for sports clubs … These doctors saw in these multiple requests, which mobilize consultation time, the result of a generalized lack of confidence (insurers, employers, health insurance).
They hoped that the tensions over access to care would be an opportunity to entrust these missions to others, or even to abolish them altogether. “Unfortunately, we were not heard. The ministry announced measures supposedly going in this direction, but in reality, out of our seven proposals, only one was retained”, sighs Dr Rochoy, originally of the appeal published on January 5. Something to annoy caregivers a little more…
Supervision of installation rules: a first victory
The bill brought by the emergency physician and Horizons deputy Thomas Mesnier, represented an additional subject of annoyance for the medical profession. It was a question of regulating the installation of the liberals, by subjecting it to an agreement of the Regional Health Agency in charge of the territory where a doctor wished to open a practice. Thomas Mesnier was beaten during partial legislative elections, but his text had been taken over by Frédéric Valletoux.
What annoy the liberals a little more because this newcomer to the National Assembly was also the former president of the Hospital Federation of France. As such, he regularly criticized the city doctors, too little inclined according to him to participate in the management of unscheduled care and thus to lighten the task of the emergency services. Faced with the mobilization which promises to be very strong, Frédéric Valletoux finally preferred to withdraw the text. But this could only represent a short-lived victory for the liberal unions: the deputy has indeed announced that he will be working on a new “health and territories” bill with the government…