In terms of medical desert, Dr. Julien Cottet, President-in-Office of the Council of the Department of Physicians, that Eure-et-Loir is the worst ward in France. Here are the reasons that, according to him, explain this situation.
1. A training deficit.
“According to the conclusions of a report by the Department of Research, Studies, Evaluation and Statistics (DREES), support for the installation and construction of nursing homes does not in itself work,” he explains.
“And why does it not work? Because there are training deficits. When there are no trained interns, you can set up all the health centers you want.”
“The numerus clausus was 130 for the region when I finished my studies in Tours ten years ago,” continues Dr. Cottet. “Today it is 300. Do you see more doctors? Where are they ? We make people believe that by increasing the training capacity we will get out of it, but it is a lure ”.
“People are made to believe that nursing homes work, but it has been twenty years since nursing homes have sprung up in all corners of the ward, and it does not work. For a moment, one has to have the honesty to say: we have screwed up, it does not work. The system needs to be revised.
Dr. Julien Cottet
2. Freedom of installation.
Dr. Cottet continues: “Of course we need to increase the number of doctors, but the problem is not to train more in Orléans or Tours. The problem is that from the age of six they can leave to take their internship elsewhere. Even those who are in practice in the Center region, when their studies are finished, they enjoy the freedom of installation.And many go.We could of course regulate them if there were too many of them.But there, what will you regulate when there are no doctors enough? “
3. The enchantment of the profession as a general practitioner.
People do not know, but after their nine years of study, future doctors are not forced to make general medicine. “There are 70% who want to do something else,” notes Dr. Cottet. “When you train a cardiologist, he does cardiology. The same for a rheumatologist. However, when training a general practitioner, he does not necessarily do general medicine. He can go to work in the hospital, in occupational medicine, in social security, in nursing homes … And then, if he passes an extra diploma after his nine years of study, he may not be a general practitioner. That’s my case. I did a three-year capacity in allergology … So when we say that we train 80 interns in the department, it greatly distorts the statistics ”.
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“As for why a majority of trainees do not stay in general medicine? It’s a national debate,” adds Dr. Cottet. that they do not want to do this job. In fact, general medicine is experiencing an identity crisis, but no one dares say it. This profession no longer pleases, it is no longer the general medicine from before. We lost gynecology, small emergencies, etc.
“On the other hand, we do a lot of paperwork: transport coupons, ALDs, etc. Administrative all day long. I am a concrete example of this: If I changed direction, it was because I did not have fun with my job ”.
Dr. Julien Cottet
4. Installation aids.
“It’s the bleeding in Chartres because of the cartography,” Dr. Cottet. “Especially since we have seen the appearance of aids for installation. This means that if you settle here, you will receive € 50,000. Already now I can not see why € 50,000 is needed to settle. A GP who settles down costs € 5,000. Doctors are lured with money that they do not need to set up shop. And these aids, we have divided them. The Ministry of Health said they would go where there are fewer GPs. We said to ourselves that under these conditions the whole department would go in red. So no. They calculated by noting all the general practitioners, including those in the hospitals … Result: we end up with a Chartres district, which reportedly has a surplus of doctors. The Ministry tells you that there is no problem in Chartre’s agglomeration while it’s creating a medical desert … “.
“You realize that there are even doctors who go to get help elsewhere … It’s a scandal”
Dr. Julien Cottet
“On the other hand, we do a lot of paperwork: transport coupons, ALDs, etc. Administrative all day long. I am a concrete example of this: If I changed direction, it was because I did not have fun with my job ”. This is one of the reasons why I wrote a manifesto, which was unanimously adopted by the city of Chartres. It includes in particular a charter on non-competition between municipalities ”.
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“And then, philosophically speaking, for twenty years you have had interns who told you that rural areas are complicated,” adds Dr. Cottet. “All government services are deserted. There is no more post office, there is no more nursery, college … Why would the doctors go? They want public services, things for their children. If you look at a map of Eure-et- Loir, you see something incredible: where there are most public services, economic activity and cultural activity, that is where there are fewer doctors when that is where they want to work ”.