The tension does not seem to fall. More than three weeks after the implementation of the Rist law, which caps the price of temporary doctors at 1,390 euros gross for a 24-hour call, the closures of certain services are increasing in hospitals, everywhere on the territory. . Deprived of these reinforcements, sometimes expensively paid but essential to their proper functioning, dozens of establishments had no choice but to completely or partially close their emergency services, already affected for a long time by a shortage of professionals. and strong tensions in the sector. In Feurs, in the Loire, more than 2,000 people demonstrated on April 22 against the total closure of the city’s emergency service, affected by the departure of “half of the 10 temporary doctors” who worked there and who did not would not accept, according to the director of the establishment, “the cap on their remuneration imposed by the Rist law”. Same discontent in Vittel, in the Vosges, where several hundred people demonstrated on April 15 against the closure of the emergency service of the hospital center (CH) at night and on weekends until the beginning of May, for lack of emergency doctors. available.
According to the National Union of Hospital Replacement Doctors (SNMRH), “more than 70 services” are currently closed for lack of doctors. An assertion denied by the Ministry of Health, which affirms for its part that there is no “dry closure”, and that “solutions have been put in place everywhere”, in particular via “medical regulation”. Widely relayed by the local press, the examples are however numerous: on April 13, the emergencies of Sainte-Foy-la-Grande (Gironde) closed their doors for ten days “due to an unresolved lack of medical personnel” , while the emergency service of the CH du Center-Bretagne, in Noyal-Pontivy (Morbihan), has indicated that it will be closing its doors at night since April 18 and until the beginning of May.
Same restrictions in Manosque, in the Alpes-de-Haute-Provence, from May 1 to 6, for “lack of staff” or at the CH d’Ardèche-Méridionale, in Aubenas, forced, “after having sought all possible alternatives “, to adapt its organization in the face of the shortage of personnel, by limiting access to its emergencies during the day and by closing its doors at night since April 3. In Nevers (Nièvre), the mayor found a solution as spectacular as it was costly: at the end of January, an airlift was set up between his city and Dijon. Eight doctors boarded a plane for a 35-minute flight. Destination: Nevers hospital. Cost of the operation, 5,200 euros, once a week at least, hopes the town hall.
Highlighted in recent weeks, the shortage of professionals in the hospital is far from unprecedented. To avoid the famous recourse to temporary workers or the outright closure of their services, many establishments are trying to attract doctors or nursing staff by all means. At the CH d’Ardèche-Méridionale, the management thus took the lead in 2020, by acquiring a property of 240 square meters “with swimming pool and wooded exterior”, located near the hospital center and in which several thousand euros of work allowed the creation of seven rooms, all equipped with bathrooms. Project cost ? 600,000 euros, financed by the hospital with the help of subsidies from the regional council and communities of neighboring municipalities, with the aim of offering young practitioners a “quality and more pleasant welcome”. The promise of such accommodation would allow them, according to the CH, to “reduce the logistical and financial constraints linked to the search for accommodation”, while “strengthening the feeling of community and dynamism among the interns of the hospital. “… Objective, to encourage doctors to settle permanently in Ardèche. Inaugurated in September 2022, the “house of interns” has already welcomed 14 young doctors in the region.
“We are trying to break this vicious circle”
But if the return of the interns on this initiative was “unanimously positive”, according to the hospital center, none of the doctors recently accommodated has for the moment remained in post at the Aubenas hospital. “The second team of seven interns has not yet completed their internship”, specifies the establishment to L’Express, recalling also that the construction of this house also aims to “strengthen the reputation of the hospital and attract attention of healthcare professionals who are looking for employers committed to their well-being”. A long-term bet, therefore, on which the establishment is not the only one to bet. At the specialist hospital center (CHS) in psychiatry in Saint-Rémy-et-Nord-Franche-Comté, in Haute-Saône, seven apartments have also been made available to interns or young doctors in psychiatry who would like to join the establishment, at the within a villa completely renovated and inaugurated at the beginning of summer 2022.
For an investment of 400,000 euros, the Bourgogne-Franche-Comté Hospital Association (AHBFC), which manages this private non-profit hospital, welcomes a house “almost always full” since its creation, which “facilitates the return of interns” to this isolated territory, located more than an hour by car from the Faculty of Medicine of Besançon. “Psychiatry is not always the first choice of interns, and we are in a rural environment which is not necessarily attractive to young people. We are having difficulty recruiting, and those who remain are exhausted. We are trying to break this vicious circle”, comments the AHBFC, which ensures that “some interns” remained in post within the establishment following their internship. To recruit sustainably, the association is not limited to the handful of apartments offered to young doctors: an installation bonus is also paid to caregivers, ranging from 4,000 euros net for caregivers to 5,000 euros for nurses, and up to 15,000 euros for doctors… In exchange for recruitment on a full-time permanent contract and a commitment for at least two years. As in other establishments, certain retention techniques have also been put in place: every three years, the staff receives a seniority bonus, which can amount to “up to 1,500 euros net”.
“We support these innovative projects which try to attract young doctors, but they cannot be the only response to current tensions, analyzes Yaël Thomas, president of the National Association of Medical Students of France (ANEMF). decent boarding facilities in all hospitals in France, clean gowns when we arrive in the establishments, respect for the rights of interns and a decent welcome when you come to the hospital, this would already be a big step forward for attract and retain interns”, he lists. “Sometimes the devil is in the details,” adds Pierre Schwob Tellier, member of the Collectif inter-urgences. “Some doctors just don’t want to engage in medical deserts that the state seems to have abandoned, where you have nothing left, where you know the strain on the hospital is immense…Even if the establishment offers a swimming pool or bonuses for its staff.”
For Olivier Milleron, spokesperson for the Inter-hospital Collective, these “local attractiveness policies” would even lead to unequal treatment on the territory and competition “which is not desirable” between hospitals – the best-endowed establishments having more resources to attract their future physicians. “Everyone tries to get away with it as best they can… But, by dint of considering the hospital as a market, we create a loss of meaning among caregivers, resentment and anger. And this only worsens the recruitment issues.
“We are not resolving the entire situation”
Despite the cautious reception of certain professionals, communities and hospitals are increasing the number of seduction operations with doctors and nursing staff. At the Saint-Lô hospital center, in the Manche department, an allowance of 700 euros per month has been paid since the start of the school year in September 2022 to nurses in the last year of study via the “nursing student engagement contract” system, subject to a commitment on their part to remain at the hospital for the next eighteen months. In Nantes, the CHU will soon be experimenting in one of its units with a four-day week for nurses, nursing assistants and hospital workers. And, at the Montpellier University Hospital, the human resources department has been offering since the beginning of March the payment of a co-optation bonus to each employee who will help in the recruitment of a state-certified nurse (IDE), specialized or not.
Concretely, the establishment – which has set itself the objective of recruiting 400 nurses for 2023 – will pay a bonus of 600 euros gross to any agent of the establishment who, between March 1 and June 30, 2023, manages to convince a nurse to join their teams. Provided, of course, that the candidate is actually hired, that he has not himself submitted a curriculum vitae to the CHU and that he does not terminate his contract during his trial period of four months . “This specific measure is causing a lot of talk, but it is only a small part of our overall attractiveness plan, wishes to specify Judith Le Page, director of human resources and training at the CHU. We are also working on remuneration, the improvement of working conditions and hours, communication plans to make these professions known, and on in-house training.”
At the Montpellier University Hospital, each nursing assistant wishing to begin nursing training and each IDE wishing to specialize sees their training fully financed by the establishment. “For the moment, we are at the very beginning of the process: we are waiting for these initiatives to bear fruit. But between the Covid crisis, professional retraining and the number of vacant positions everywhere in France, we are still in a scissor effect. There is real tension in the nursing profession,” admits Judith Le Page.
“In response to this tension, we see all sorts of initiatives springing up everywhere… The local bonuses paid to staff respond to part of the problem, but are far from resolving the entire situation, deciphers Thierry Amouroux for his part. , spokesperson for the SNPI nurses’ union What we deeply regret is that most of the time, nothing is proposed on the aspect of working conditions: the number of patients per nurse does not change, the sequence of acts and techniques of care on ever more patients is still heavy and frustrating”, he regrets. A necessary reflection, while no less than 60,000 nursing positions are currently vacant in the territory according to the union.