Hospitals very weakened by the interim crisis

2023-04-18 17:00:00

70 health establishments are closed, according to the Syndicate of substitutes. The Minister of Health François Braun considers that the situation is “under control” but recognizes “some weaknesses”.

By Marc Payet

Since the application of the Rist law on medical interim, on April 3, 70 services have had to close, according to the Syndicate of hospital replacement doctors.
© DENIS MEYER / Hans Lucas / Hans Lucas via AFP

Published on 04/18/2023 at 7:00 p.m.

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Lhe situation is becoming more and more problematic. Since the application of the Rist law on temporary medical work on April 3, the situation has been very tense in many places. This provision caps the remuneration of temporary workers at a maximum of 1,300 euros for 24 hours of call duty. Many of them no longer want to come to work because their overall pay has gone down. This is a major concern for the hospital, and for the patients, because these anesthesiologists, emergency doctors or psychiatrists held the services at arm’s length in almost a third of the establishments. A death of an octogenarian was recorded at the Grenoble University Hospital last Wednesday when he had been in the emergency room for three days and could not have a hospital bed in a department due to a lack of temporary medical workers.

The Ministry of Patch

For the Union of Hospital Replacement Physicians, the situation is “very serious”. Its president, Doctor Éric Reboli, has drawn up a list of “more than 70 services closed” using feedback from its members. Among the examples, he mentions “the maternity ward of Sarlat, in the Dordogne, the emergencies and the Smur line of the Vittel hospital (Vosges), restrictions on access to the emergencies at the CH of Troyes (Aube), the emergencies of nights closed at the CH de Redon (Ille-et-Vilaine), the closure of the follow-up care and rehabilitation service in Issoudun (Indre)”. In Île-de-France, certain establishments are concerned, such as the CH Foch, in Suresnes, whose emergencies were closed over the Easter weekend, and the emergencies of the Sainte-Camille hospital in Bry-sur-Marne ( Val de Marne). In Rochefort (Charente), “no anesthesia consultation is scheduled until September”. And there is “no doctor at the nursing home of the CH of Oloron-Sainte-Marie (Basque Country). Difficulties are also identified in psychiatric establishments.

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On the side of the Ministry of Health, the vision is more optimistic. “Overall, the situation is under control. The mobilization is total, but solutions are found. Our goal is that there are no breaks in support. Some situations have given rise to weaknesses, ”said the entourage of François Braun, interviewed on Tuesday. The ministry “does not validate the estimates of the Syndicate of substitute doctors, which speaks of 70 service closures. There is no mapping of this type, it changes every day,” he adds. But, when asked about its own estimates of closures, the Braun firm does not give any precise figures. However, the ministry points out: “It would be wrong to believe that the complicated situation will only last in April. The situation will also be difficult in May and June. But we will deal with every situation. To avoid the worst, many incumbent doctors have agreed not to take certain leaves, others have agreed to travel to territories “in tension”, but these patches may not be enough, especially at the time of Spring Break.

A cure worse than the disease?

When asked, Renaissance MP Stéphanie Rist told us: “Indeed, certain hospital services, which had already been in difficulty for a long time, because they are having difficulty recruiting, may currently be threatened with closure. It is not my wish. We are looking closely at the situation, with the regional health agencies, to find solutions for patients. »

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Interim medical care has developed strongly over the past few years, to the point of representing almost a third of the activity in many establishments. If some of these temporary workers have huge incomes – up to 6,000 euros a week – most have much lower earnings. The capping of their income has created holes in the already fragile schedules in many hospitals. Many players in the system – the French Hospital Federation, Health Insurance – however support this cap on the grounds that the interim is “cannibalistic” and “disorganizes the teams”, in the words of Minister François Braun. But, in the face of the current crisis, one may wonder whether the proposed remedy is not worse than the disease.

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