For several years, the difficulties of access to care have been at the heart of the concerns of the French population. While the problem exacerbates, the temptation is becoming greater and greater to give in to the demagogic measures highlighted by certain policies. This is why we, medical students, internal and doctors, want to recall that there is no simplistic solution to a complex problem.
Current difficulties have a multifactorial origin. Medical demography remains strongly impacted by the numerus clausus Established in the 1970s, and having reached its climax in the 1990s, drastically limiting the number of trained doctors and therefore the supply of care. The population growth of the population, associated with its aging and an increase in chronic pathologies, has increased health needs tenfold. The conclusion of this equation is simple: the supply of medical care is today insufficient to deal with the demand for care, especially in ambulatory medicine, due to the marked decrease in the liberal exercise.
“” “The collapse of the liberal exercise will result in the overflow of the hospital»
Despite these data, the attacks on liberal medicine are multiplying. However, the health system is based on two legs: city medicine, mostly liberal, focused on the first and second appeal, and the hospital, whose expertise is turned to the second or even third appeal. The collapse of the liberal exercise will be the result of the overflow of the hospital, unable to meet all of the population’s care requests. It is therefore urgent to support these two additional exercises fairly, requiring support measures more than the addition of additional constraints.
Simplistic measures, the effectiveness of which is not proven
In this context, simplistic measures are often sold as a miracle solution. They find more and more echo despite the lack of proven efficiency and the repeated alerts of the profession regarding the perverse effects they would generate.
In recent years, a transpartisan working group on access to care, led by deputy Guillaume Garot, strives to put the concept of regulation on the scene. This measurement amounts to prohibiting the installation of additional doctors in areas not classified as undersea by regional health agencies, in the hope that these installations will refer to the under-to-do territories.
This idea has already been the subject of several bills, the next will be examined by The National Assembly on March 31. If the regulation model may seem attractive, it focuses on the question of distribution, ignoring the context of liberal medical demography at half mast. This is why it is illusory to think that the under-to-do areas (covering 87 % of the territory) are the fruit of over-dated areas, in which too many doctors would exercise! Prohibiting installations in certain territories, without any guarantee that they are referring elsewhere, only amounts to slowing down the increase in the supply of care.
Among nurses, installation regulation was implemented in 2012. If this measure made it possible to limit the installations in over-dated areas, the impact is to be nuanced, prohibited installations having not reported on the under-to-do areas, but more on intermediate areas. All this in a very particular context of high increase in the number of liberal nurses in activity and particularly important territorial inequalities. Note that, despite this regulation, the distribution of general practitioners remains more homogeneous than that observed for Other health professionsthat 98 % of the population has access to a general practitioner less than 10 minutes And for the most part to a specialist doctor less than 20 minutesand that the overall accessibility to nurses is finally down.
The German model, integrating a similar measurement, also demonstrates the ineffectiveness of this solution. The 2016 Senate information report on the organization and financing of city medicine in Germany explains that “if the selective agreement prevents the establishment of new doctors in dense areas, it cannot impose it in under-dense areas. We note, in fact, a leak of doctors to other forms of exercise, or An establishment on the border of the dense areas. “
This proposal therefore did not show effectiveness because it is distributing a shortage cannot solve a quantitative problem. What elected official would be ready to ban the installation of new doctors on her territory today? Medical deserts are everywhere, including in major cities. The question of regulation is more of an unsuccessful attempt to satisfy electoral expectations rather than the search for a lasting and efficient response to the needs of the territories. This is why we call political decision -makers to the greatest vigilance in the face of these ineffective and dangerous measures.
A new burden on doctors, whose mental health is already precarious
Building a response to the challenge of access to care requires acting with and not against doctors today and tomorrow. Above all, we want to act in confidence, to build measures to improve working conditions, the main lever to improve attractiveness and arouse more facilities. We will oppose these sloppy coercive measures, known for their ineffectiveness.
Weigh the weight of the current situation of our health system on the last guarantors of city medicine or on future generations of doctors, while their mental health is already precariouswould be a serious mistake. It would expose to many risks, including that of delaying the increase in medical demography by altering the attractiveness of the doctor’s profession, and would undoubtedly amount to bringing the first appeal exercise, depriving the population of essential local care.
* Authors: Bastien Bailleul, president of Isnar-Img (National Autonomous Intersyndicale Representative of General Medicine Interns); Raphaël Dachicourt, president of Reagjir (Autonomous grouping of youth generalists installed and replacements); Killian L’Helgouarc’h, president of theIsni (National Intersyndicale of Interns); Lucas Poittevin, president of theAnemf (National Association of French Medicine Students).
* Signator: Agnès Giannotti, president of MG France ; Franck Devulder, President CSMF ; Luc Duquesnel, president CSMF-Generalists ; Patricia Lefebure, president Fmf ; Sophie Bauer, president SML ; Jérôme Marty, president UFML-S ; Anna Bactor, president Young doctors ; Moktaria Alikada, president Doctors for tomorrow ; Paul Facpé, president CMG ; Olivier Saint-Lary, president Cnge ; Philippe Serayet, president Snemg ; François Arnault, president Cnom ; Gilles Noël, vice-president Association of Rural Mayors of France.