would it be high time to go from carrot to keeping up with the doctors?

Is our landscape, our suburbs doomed to lack doctors? Even money is not enough to convince GPs to settle in medical deserts. It is a document noted by AFP, which sounds the alarm. And the result is particularly discouraging.

We are in 2022 and 10 million French people still live in an area where access to care is lacking. What’s worse, the differences in life expectancy are getting worse: Rural residents live on average 2 years less than in urban areas. These are figures from the Association of Rural Mayors.

France is unable to green its medical deserts. Even money does not matter. For 5 years we have financially helped doctors set up. Up to 50,000 euros to put your suitcases and treat entire villages. In 5 years, barely more than 400 doctors a year have requested this installation help. All in all, the All Incentives panel attracted less than 5,000 healthcare professionals with an average age of 49.

Health insurance recognizes this itself: despite spent 32 million in 2020 alone, to combat medical deserts, inequality in access to GPs has increased.

An old evil

This is a terrible and old realization of failure. Already in the years 1860-1880, the statistics of the Ministry of the Interior show a worrying shortage of doctors. At that time, almost 30,000 cities in France were without a doctor. If we’re still there 150 years later, it’s mainly because of the ravages numerus clausus, this limitation on the number of doctors. It has just been removed and we will see the effects in 10 years.

others reforms going in the right direction: creating teams, groups to better monitor patients, freeing doctors from paperwork and simple actions by putting medical assistants and nurses into advanced practice. The municipalities also do a lot: construction and lending of cupboards, facilities for installation, even offers of employment in salaried work, sometimes at a gold price. Even doctors in medical deserts make an effort. More than 8,000 retired doctors, some over the age of 70, continue to practice according to the order of the doctors. We try checks, cancellation of contributions, we explain that it is necessary to implement support for spouses, the Internet network, to make rural areas attractive. Safe. All this is positive, but the numbers show it: it is not enough.

An unbearable “loss of chance” for patients

Here is the horrible phrase from a doctor from Lot-et-Garonne: “When a patient comes to see me with a bitch, I already know he is out of luck”. What a scandal still to die today of lack of care.

There is still a solution that we still have not solved to try: go from carrot to stick. From the incentive to the obligation, even temporary, for medical students: 6 months or 1 year of activity in rural areas. Why not practice in liberal cabinets rather than in the hospital? Why not a few quarters of an hour during a career, the time when the situation improves and that the number of doctors gradually expands. Is it really a terrible solution? Would it really be likely to detest generalist calls?

Of course, this solution does not appeal to doctors who talk about a false good idea, nor to health insurance, nor to the Ministry of Health, which prefers to enter into dialogue about new levers, e.g. new wage increases. The elected representatives are looking for compromises so as not to rob anyone, and we see again and again that we look each other in the eyes in the hope that it will pass. It’s awful for the patients, and desperate for the doctors in the desert areas, alone, overwhelmed, taking care of ever older patients without a compensation for the holidays.

Limit efficiency

As surprising as it may seem, those who ask for more restraint are rare. UNSA wants “more coercive measures”. PS recently tried a bill, rejected by the majority, at a time when 11% of the French population has no declared attending physician, where the whole chain of hospitals and emergencies crackles, all the more so in an area with a lack of resources … the worst thing is that it has now been proven: a touch of limitation can really improve things.

This is the example of midwives and nurses which have both aids to settle in medical deserts and constraints. In areas that are already well-equipped, these occupations have to wait for a place to become vacant. Health insurance has taken stock of these measures: Territorial inequalities are declining for midwives and nurses. This is proof that medical deserts are not inevitable, as long as you dare to ask, a little louderfor GPs to set up there.

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