By Writes Meaux
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The problem has persisted for decades. Marne et Gondoire, like the entire department, lacks health personnel. Having an attending physician, the gateway to the care process, is a challenge.
The question plagues many municipalities: how do you get young doctors to settle in their homes? When each of them is competing for incentives, providing premises, housing, financial assistance, is this really the right approach? To find out, we interviewed young doctors. What are their expectations?
“It’s hard to say: the doctors will,” begins Cam-Anh Khau, general practitioner in Chanteloup-en-Brie. Installed in the city since 2015, she is also a teacher at the University of Paris 13.
“For me, they must have the freedom to choose their installation location, to choose to be self-employed or salaried, to work in a group or alone… There are as many wishes as there are doctors. »
The race for the caduceus
Not enough to help the municipalities to be able to attract young people. “I’m not sure that’s the right question to ask. There aren’t enough doctors. By doing individual initiatives, cities are competing with each other. It’s wrong to think that there are doctors waiting for the best opportunity or areas where there are too many doctors. It doesn’t exist. France is a medical desert,” she continues.
An observation shared by Nicolas Groëll, general practitioner at the Maison de santé in Thorigny-sur-Marne:
Obviously, the benefits come into play. But everyone does: How high will the bidding go?
It would therefore be better, according to them, to bring together and harmonize policies at the different levels: municipal, departmental and regional. Awaiting the effects of the abolition of numerus clausus… within ten years.
Doctors, but above all people
For these two generalists, far more human aspects must be taken into account. Francis Abramovici, retired general practitioner from Lagny-sur-Marne, general secretary of the College of General Medicine, sees this clearly.
“Young people no longer want to work before 9 p.m., also on Saturdays. They want to enjoy their family life, they see if their spouse will be able to find a job, if there is a school nearby…”.
“Young graduates settle in locations they know”, supports Nicolas Groëll. Reality illustrates this: young graduates settle where they were educated, near their school or their place of practice.
But in general medicine, practice in a practice comes very late. “I was lucky enough to be able to do two internships, today there is only one. However, this allows you to see what life is like in a liberal cabinet, to understand how it works, to pay attention to the work of the leadership,” says Cam-Anh Khau.
Bringing students to Seine-et-Marne
The installation of a CHU in Seine-et-Marne, as demanded for a long time by many elected officials, could therefore play a role without being the only answer to be given. Above all, it would be necessary to get students out of classes and hospitals to bring them to other structures and other territories.
Nicolas Groëll, internship supervisor, has just recruited a new doctor to Thorigny: his young intern. “The location of the internship is very important”, he emphasizes.
“CHUs are centers of excellence. Today we need doctors who know how to deal with societal pathologies: aging, cancer, etc.,” adds Francis Abramovici.
Rethinking the role of the attending physician
His two colleagues see this daily with consultations that last longer:
We deal with more and more complicated situations, people are not feeling well. It’s not necessarily medical, but it’s us they come to see.
Mediators, social workers, to empty the offices, it is necessary to have complementary actors.
According to these professionals, prevention, awareness raising and even prioritization work are also necessary. Despite the insufficient number of doctors, whether you have a cold or the beginning of a heart attack, everyone gets the same time.
“Many patients tell me that I should not have come. We must continue and develop prevention messages and rethink the GP model,” adds Nicolas Groëll. For him, the issuing of a health certificate or suspension of work should no longer be handled by the attending physician.
He also reminds that consultations only represent a third of a doctor’s time. There is handling of files, of practice, but also “a whole job that we don’t do in front of the patient. For polypathology, for example, you have to call colleagues. And there are all the projects that we carry out for the benefit of the territory with CPTS for example”.
A more collective work
“Jobs are changing,” notes Francis Abramovici. Reflections, now well under way, plan to rethink the distribution of competences with nurses.
Another notable change is the willingness of new health professionals to meet. On this, the municipalities with their houses, centers or health centers are right on target. However, these sometimes have difficulty filling up.
The human connection takes precedence over the structure. When we create premises, it is essential to have a relay, a supplier of doctors.
The presence of CPTS Health Links 77 is a great help in the Marne et Gondoire area: “We must allow health professionals to create connections, to exchange, we avoid burnout”, continues Dr. Abramovici.
“Getting together has many advantages,” sums up Nicolas Groëll, who settled just before the health crisis. “In a few days we opened the first consultation center dedicated to Covid. It took listening and mutual support to stay together,” he recalls.
In addition to these extraordinary situations, the group also allows doctors to support each other in a specific case or simply to take care of patients during each person’s leave.
Within CPTS, health professionals all work together to find solutions for patients who do not have attending physicians. “The question of the shortage of doctors occupies us every day, we are the first to hope to be able to remedy this problem”.
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