Adopted at first reading in the National Assembly on January 19, 2023¹ and voted following reshuffling by the Senate on February 14², the Rist bill continues to make waves. The Academy of Medicine reacted to one of its flagship proposals³, and rejected by the medical unions, on the possibility of direct access for patients to certain advanced and specialized practice nurses, physiotherapists, speech therapists, who would have a precisely framed prescription right. She ” would like to recall the place that must be reserved for the attending physician in the patient’s care pathway “, to know :

• Ensuring comprehensive health care,
• Carry out preventive actions, first medical recourse, long-term follow-up and coordination of care,
• Practice close collaboration within adequate medical and paramedical structures, possibly by transferring tasks, but keeping the general practitioner “ his place as coordinator and personal referent of the patient throughout his course of care. »

The Academy does not comment on the merits of the Rist law, but it questions its impact on the role of the general practitioner, whose profession is already subject to profound ” challenges »: technological (development of artificial intelligence and telemedicine), rapid diagnostic and therapeutic developments, posing the problem of updating knowledge, professional (teamwork) and societal (the patient is better informed). In addition, the profession is becoming more feminized, practitioners want a reduction in their working time and an increase in their remuneration, which is lower than that of most other specialists, although the general practitioner is considered to be part of it.

The Academy believes that the patient now reports the need, on the one hand, to obtain appropriate medical information, and on the other hand to benefit from informed management of his illness, including the role of a specialist. »

ER saturation depends on medical density

The tone and concerns are significantly different at the association Que Choisir, for which the main concern of patients is rather access to care⁴ (particularly emergency), which it should be remembered is the reason for the provision of the Rist law on direct access for patients to non-medical health professionals. Like the Order, the association underlines the significant territorial disparities but while the Order recalls that ” in 50 years, the number of general practitioners has been multiplied by 3 when the population has only grown by 17% “, recognizing the important place of doctors “with particular practice”, the association quotes the DREES (Direction of research, studies, evaluation and statistics) for which “ by 2030, the density of liberal doctors will drop by around 5% », because this population is aging and the replacement of the number closed by the number open is almost ineffective. Moreover, it gives the results of a unpublished econometric analysis » which shows that a « national reduction of 1% of the offer of city medicine would lead to more than 100,000 additional visits to emergencies over a year! “Where finally his indignation in front of the Emergency Patient Package, “ aberrant financial drain since it makes users assess their own state of health “, starting from ” postulate that they might perfectly consult doctors of city rather than to take part in the saturation of the urgencies. »

The association also demands to organize the permanence of care by coordinating city and hospital medicine, to increase the number of doctors in training and to pilot it ” to prioritize the specialties and regions where medical demography is the most insufficient in relation to the demand for care. She does not comment on the provision of the Rist law relating to non-physician health professionals, although she finds it ” interesting »⁵.