“These accusations, I can’t sleep anymore”: targeted by a health insurance control campaign for having prescribed “too much” work stoppages, several general practitioners are protesting to AFP against “unfair, purely statistical procedures”, ignoring their difficult conditions of practice and the delays in accessing care.
They first received “a call from Health Insurance”, sometimes presented “like a fraternal exchange”. Then a recommended “anxiety inducing”suggesting a “targeting” figures, to reduce the volume of sick leave prescribed under penalty of a fine, tell the six doctors questioned, preferring to remain anonymous.
“It affected me deeply”says Doctor B., a forty-year-old living in Brittany. “I feel infantilized, designated as the bad student, who does her job badly”while “I have been practicing for fifteen years, with passion”. “Since I sleep more, I have anxieties.”
The health insurance criticizes these practitioners for having prescribed two to four times more daily allowances (IJ) than the regional average in “similar towns”. More than a thousand doctors are targeted by the same procedure this summer.
Because the stops are in the sights of Bercy. Spending on daily allowances reached 13.5 billion euros (excluding maternity) in 2022, an average annual increase of 3.8% since 2010.
“There are people who abuse it”estimated the Minister of the Economy Bruno Le Maire in June, calling for “empower” patients, employers and physicians.
“Rope around the neck”
Professionals point to statistics “disconnected from the field”. “I have the misfortune to practice near large companies. My patient suffers from musculoskeletal disorders, from recurrent tendonitis. These people work on the assembly line, in the food industry, they have no solution”. “Who’s stopping them? Always me”sighs Doctor B.
“Last Installed” from a shared practice, Dr. L. took charge of the majority of emergencies. “That means acute pathologies, so no more stops”advances this thirty-year-old Breton, who “drive an hour daily” to work in an under-resourced area, in a “complicated territory”to “numerous accidents at work and burn-out”.
“I was asked to reduce by 15-20%. It’s impossible. The person with the gunned knee, it’s unheard of to say to him: ‘sorry, it’s the 20th of the month, I’ve reached my rate from IJ, get back to work'”he is moved. “Now, as soon as I stop a patient, I have the impression of having the noose around my neck, and of continuing to tighten”.
A colleague from the Parisian suburbs also points to medical desertification. “To have an appointment for a CT scan, an MRI, an operation, it takes months”during which “everything falls on the general practitioner”she testifies. “La Sécu tells me ‘it’s up to the psychiatrist to stop for depression’. But my patients can’t find any, or can’t pay for them!”
The long affections “must be seen by a social security medical adviser”more “they are rare, so the files drag on”et “It’s the same on the occupational medicine side”, continues the 50-year-old. Specialists and surgeons “stop patients for 15 days, then send them back to us”.
“We don’t have holy water”
“Worn down by three years of Covid-19, I work 80/90 hours a week. Being accused, watched, it hurts”she chokes.
“The system is collapsing and doctors are being told: ‘take more patients, guards, Samu regulation’, but ‘especially without prescribing IJ, with less medicine’. We don’t have holy water !”area, “flabbergasted”, a 50-year-old living in the south. After having “redo all the calculations”she also judges that “The statistics are wrong”.
“Doctors can and should” refuse the setting under objectives, hammer the unionists, including Marcel Garrigou-Grandchamp, head of the legal unit of the FMF (Federation of Doctors of France).
The Health Insurance can then impose another procedure, consisting in “have each stop validated one by one by the medical advisers of the Sécu”. “Unmanageable” on a large scale, assures the trade unionist. The FMF sometimes accompanies doctors in court. “We win” car “no patient population is really comparable” with the average.
“I refuse to censor myself, I will let the Secu take its responsibilities”, decides in Marseilles doctor M. “But looking for savings by bleeding GPs is stupid”while “nobody settles down, even in town”. “When patients end up in the hospital, they cost more.”