She needed an additional sign of the great malaise of liberal doctors, the massive refusal of their six representative unions to sign the agreement that the National Health Insurance Fund offered them brings it in a resounding and worrying way. After four months of negotiations at loggerheads, strikes and demonstrations, the profession’s niet represents a failure for the government – which supported the draft agreement – and weakens the dual system to which the French are particularly attached: the free consultation of private status doctors covered by Medicare, in other words by public money. The legal deadline for initialling the text, set for Tuesday February 28 at midnight, having been exceeded, a minimum agreement will have to be drafted by a senior official designated as arbitrator.
This situation of impasse comes at a time of multifaceted medical crisis. After the Covid-19 pandemic highlighted the weaknesses of the hospital system, the return to a more normal health situation highlights the ravages caused by medical demography at half mast for more than ten years: 11% of French people, including 657,000 chronically ill, have no attending physician, while there are fewer and fewer city practitioners to care for an aging population. Medical deserts, the result of the disastrous numerus clausus which limited access to medical studies until 2019, are spreading, while inequalities in access to care are exploding.
Choosing “regulation” rather than coercion, the government intends to tackle these evils through a system of financial incentives. A revaluation of 1.50 euro for consultations, bringing the reference rate for general practitioners to 26.50 euros, was proposed for all. But an additional increase (at least 30 euros for general practitioners) was conditional on the subscription of a “territorial commitment contract” providing for the reception of new patients, participation in hotlines and weekend guards.
Ensuring the sustainability of an irreplaceable medical network
“Insult”, “provocation”, replied the unions of liberal doctors, demanding more substantial and unconditioned increases, as well as new means to free up “medical time”. They cannot, however, overlook the fact that the minimum increase put on the table is 6% and represents an average of 7,000 euros more per year, according to Health Insurance, for GPs whose average activity income is of 89,700 euros per year. The 113,000 self-employed physicians – including 57,000 general practitioners – would, on the other hand, be less exposed to accusations of corporatism if they did not refuse the solutions put forward to relieve them, such as the delegation of tasks to “advanced practice nurses” and to some paramedics.
The reality of the dedication of liberal doctors and the heavy workload that already weighs on them is undeniable, and the government has underestimated their distress. But the public financing – by Medicare – of a private activity seems rather coherent with the idea of a balance between rights and duties. While the healthcare access crisis will take years to resolve, the status quo in the organization is hardly tenable. To signs of confidence in a worried profession must be added measures intended to ensure the accessibility of an irreplaceable medical network to all and its sustainability.