2023-06-26 11:13:56
Opinion of the Order of Physicians June 10, 2023: “It is imperative to break the vicious circle which forces fewer and fewer doctors to do more work”.
Regarding the shortage of general practitioners (9 years of training), the measure that has just been taken to increase the quotas for medical studies will provide its effects in 10 years! By then, we will have lost almost 25 to 30% of the workforce (today 15% of active MGs are retired) and the current shortage is estimated at 1,500 MGs…
The decline in the pension age to 67 will offer a slight boost with doctors whose social protection in guaranteed income in the event of illness or accident (private insurance) will be almost non-existent. Indeed, during the pension reform, politicians did not think that guaranteed income insurance contracts requested after age 55 to cover 2 additional years (66 and 67) were becoming unpayable! It is up to the state to compensate for the social protection that it has actually taken away from us!
We would like 50% of these future doctors to go into general medicine, which is paid up to 6 times less than other specialties and, in addition, to settle in areas with shortages (more work, more guards, fewer crèches…)!
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Our moral obligation as caregivers and the low level of remuneration have forced us for decades to agree to work 1.5 ETP. The new generation of GPs (70-80% women) rightly favors a balance between private and professional life and therefore would like to limit their number of working hours to 0.7-1 Full Time Equivalent (FTE) ) or the management of 750 to 1,000 patients.
Group work essential
Group work is preferred and unavoidable if you want to work less than 10 to 12 hours a day (call duty starts at 6 p.m. or 8 p.m. until 8 a.m.) and have continuity of care in your absence. In France, it is estimated that 4 non-physicians would be needed per general practitioner to support him in his activity. With us, the “medical houses” can be helped if they have the status of ASBL, this funding has been devolved to the regions. The work tool does not belong to anyone and is conditioned to medical activity. Personally, we have chosen an SRL to buy and fit out a building and equip it, and the costs are shared equally. Each physician owns shares. Our work tool belongs to us, it allows us to incorporate other young doctors into the group who will be more inclined to stay. It is also the means of “recovering” the own funds that we have invested when the activity ends.
We have chosen a group of doctors with secretaries (significant additional cost not compensated by impulseo II, which is regional assistance for the secretariat) leaving the patients free to choose their usual non-physician providers. Making the leap to a common building cost us almost half a million euros and, without aid, we regrettably got out of the way… although I am viscerally attached to access to care, but we are not not an ASBL…
On deck day and night
Our MG approval is conditional on participating in a custodial role. The current on-call system which benefited from a 1733 sorting redirecting “justified” calls to on-call GPs is no longer operational and to reduce the number of weekly on-duty calls per general practitioner, we want to increase our on-call territories and increase the discomfort: the guards will have to be provided outside the home, greater distances travelled, more calls, therefore no sleep and all this for 3.5 € net per hour (a volunteer firefighter colonel receives 26 € net per hour for his duty and the rest period that follows). Most of us feel that night calls should be reserved for emergencies and as such should be handled by urgent medical help or hospital emergency departments. In addition, these services have staff whose work and rest times comply with labor legislation and are for the most part less than 15 minutes from the inhabitants.
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Indeed, on the pretext that we are self-employed who can manage their working time, we were voluntarily excluded from the 2010 law on working and rest time. However, this is not the case: the need for continuity of care for the population outside the hours of the call and the obligation by the State to participate in the call, imposes on us 12 to 14 hours of call on weeknights. between 2 working days of 12 hours (i.e. 36 hours in a row) and this without recovery from night work time. The few night calls do not justify the 48 million euros to finance a dying system. Lack of sleep affects the doctor’s health and does not ensure the quality of care for the 30-40 contacts who follow a night’s call.
It should also be noted that the number of GPs needed to ensure continuity of care has been multiplied by 3: before, we had 2 doctors per weekend for urgent home visits and today, there are 2 on Saturdays and 2 Sunday for the guard post and 2 for the visits while the number of MGs melts like snow in the sun.
In summary: the abolition of night duty seems inevitable to me and failing that, it should be done on a voluntary basis and not beyond the age of 60 and with availability fees for the time of service and rest worthy of our qualifications.
Each has its place
All good health systems have a strong first line that takes care of 90% of health problems and refers patients who need it to the second or third line at lower costs. With us, each citizen can use the system as they see fit and for those who use it correctly, it turns out that the delays with most specialists are indecent and if a quick opinion is needed, we We ourselves have to justify them by telephone or email, which wastes a lot of time not devoted to treatment. It is time that, like in France, priority be given to patients referred by their GP, that those who have direct access to specialized medicine are no longer reimbursed for consultations or technical procedures. The same should apply to patients who are systematically reviewed by medical specialists without clinical necessity. This should make it possible to regain better access to specialized care for patients who need it.
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Today, to remedy the insufficiency of GP caused by partisan and linguistic policies, the State is offering us a “new deal”: a partial capitation payment (number of patients taken care of that we will have to increase so that each citizen has his GP) and to the act, the creation of new professional functions to release us from certain acts: assistants and practice nurses, the creation of front-line multidisciplinary groups and all this within a closed budget envelope…
A State far too demanding
In conclusion, to increase our quality of life, the State wants:
– that we work more and longer with fewer general practitioners and less social protection for the oldest among us;
– that we are accessible 24 hours a day, 7 days a week without respecting working and rest times to the detriment of our health and the quality of care;
– that we finance multidisciplinary groupings with equity;
– that we delegate some of our contacts to non-physicians;
– that we can respond to any request the same day;
– that we operate a good sorting for the use of specialized medicine without requiring this filter;
– that our young doctors move towards general medicine, the least well-paid specialty, and that in addition they settle in areas with shortages;
all this within a closed budget… Belgian surrealism!
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