2023-06-14 17:48:30
The scenario feared by the government and the unions of liberal doctors did not come true. On Wednesday, the deputies rejected the idea of regulating the installation of liberal doctors in the territory.
Examining in public session a bill supported by the majority groups Horizons and Renaissance, elected officials rejected (168 against 127) amendments requiring doctors to obtain the approval of the Regional Health Agency (ARS) for to be able to open their practice.
The measure, defended in particular by the elected socialist Guillaume Garot, leader of a group of deputies from different political sides favorable to the regulation of the installation, provided that in the areas best provided with doctors, a doctor is only authorized to “place his plate” by the ARS if a practitioner of the same specialty has ceased his activity.
Failure of incentive devices
At a time when the number of general practitioners is decreasing, the device was intended to help the French to more easily obtain a medical appointment by improving the distribution of doctors on the territory. It also wanted to draw the consequences of the ineffectiveness of certain policies.
“The incentive policies that have been carried out for years, decades, have not produced the results we expected”, argued Guillaume Garot in the hemicycle. “We tell our doctors don’t go and settle where the needs are already met”.
Disappearance of liberal medicine
The measure was, however, fiercely opposed by the government. Attempts to regulate installation would only “degrade the supply of care significantly in the hours to come”, warned the Minister of Health, François Braun. They would lead to the establishment of a system “which will see the disappearance of liberal medicine, which is nevertheless one of the pillars of our health system”, he hammered.
According to the executive, with such constraints, young doctors would be dissuaded from choosing general medicine and settling in town. The risk would also be that doctors refuse to work with Social Security by opting out, even if their care is no longer reimbursed.
Better support doctors
“One less doctor in a well-endowed city center is not one more doctor in a rural town in Mayenne or Ardèche, it’s more likely two fewer doctors everywhere,” said François Braun.
Faced with French people worried about not always being able to get easy treatment, the government defends that it was ended under the previous Macron five-year term at the numerus clausus which limited the number of medical students.
Until this reform bears fruit, the executive wants to ensure that doctors are better supported to be able to take care of more patients.
medical assistants
For example, he defends the development of medical assistants, supposed to relieve doctors of many tasks. It also promotes the work of doctors in groups, within multi-professional centers and the delegation of tasks from doctors to paramedics.
However, the executive is struggling to convince the unions of liberal doctors of the merits of its policy. They denounce poor working conditions, demand an increase in their remuneration and often claim to be the scapegoats of politicians.
Hostile to the idea of delegating tasks to paramedics defended by the government and very attached to their freedom of installation, they constantly warn against any questioning of this that would come, according to them, ” break liberal medicine”.
Relations between the public authorities and doctors are all the more tense as the latter have to renegotiate the agreement that binds them to Social Security and defines their remuneration in particular. After a first failure in the spring and the use of an arbitrator, negotiations are supposed to resume.
The risk of a major social conflict
The adoption of a regulatory mechanism in the Valletoux bill risked greatly complicating the resumption of these discussions. The Minister of Health François Braun has also constantly warned against a “major social conflict” in the event of a vote regulating the installation of doctors. Unions had also put pressure by explaining that they could launch a strike from October 13th.
The deputies still have to consider a large number of amendments by Friday so that the bill can be adopted at first reading.
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