Sunday, May 15

Major concern of the French, medical deserts invite themselves into the countryside

A veritable sea serpent, the question of medical deserts is back in the political debate on the occasion of the presidential election. If the initiatives are multiplying, none has so far made it possible to stem the phenomenon. Candidates are expected at the turn by citizens and local elected officials.

Access to care is a daily concern for many French people. Not a week goes by without the local press echoing the retirement of the only doctor in a village, leaving behind a whole patient base without a replacement.

If the phenomenon is not new, it seems to be accelerating. According to the Association of Mayors of France (AMF), 7.4 million French people lived in a medical desert in 2019, compared to 5.7 million in 2016.

In these territories, general practitioners are no longer taking on new patients, waiting times for consulting a specialist are getting longer (up to a year for an appointment with an ophthalmologist or gynecologist) and emergency services are overcrowded by patients who have not found “classic” consultations.

Serious inequalities in access to care

The problem also arises for the hospital. On average, the inhabitants of rural areas consume 20% less hospital care than those of cities and one in ten French people lives more than 30 minutes from an emergency service. An inequality that can have serious consequences, especially for the most fragile patients.

As shown in the map below (available in interactive version here), medical deserts are concentrated in the center of the country, mainly in the Center Val-de-Loire and Ile-de-France regions.

“While the population is increasing, and in particular that of the elderly, the growth in the number of doctors no longer makes it possible to keep up with demand and we are witnessing a stagnation in medical density from the 2000s”, explains researcher Emmanuel Winemaker in a note of the Association of Rural Mayors of France (AMRF).

A mixed record for the executive

In addition to the lack of doctors, the loss of attractiveness of rural life also seems to be in question. “There is a trend towards the concentration of young doctors in urban departments,” said the AMRF. An observation shared by the executive. “The life of the country doctor in French novels is no longer the one that new generations want to live”, recognized Emmanuel Macron during his trip to Creuse.

A few months before the presidential election, the government praises the results of its strategy “My Health 2022”. But on the ground, the results are struggling to be felt.

The abolition of the numerus clausus (which capped the number of admissions to medical study) will not take effect until 2030 and the multidisciplinary health centers, doubled under the Macron five-year term, do not attract as many doctors as expected. . As for the deployment of internships for interns in medicine in under-dense rural areas, it remains ineffective, for lack of a binding nature.

The freedom of installation of doctors, always a taboo

Until now, the policies undertaken by local authorities to attract doctors to rural areas relate to “installation assistance”: accommodation offered, job search assistance for the spouse, installation bonus, salary. .. Auxiliary measures that do not attack what is, in the eyes of some, the crux of the problem: the freedom of installation of doctors.

Hatred by the unions, regulation remains a taboo for a whole section of the political class. Last example in date, the proposal of the Mayenne deputy Guillaume Garot (PS) to prevent the doctors from settling in the zones already sufficiently equipped was largely rejected in the National Assembly.

Faced with the deadlock, the AMRF and other associations challenged the candidates on the issue of access to care, described as a “time bomb”. A call received five out of five by the suitors at the Elysée.

the candidates multiply the proposals

On the left, the socialist Anne Hidalgo wishes to create a status of “assistant doctor” ensuring interns in the last year deployed in “territories in tension” a remuneration “equivalent to double today, or around 3,500 euros per month”. More radical, Jean-Luc Mélenchon propose that “medical students be supported by the State” before having “ten years to the State, without the possibility of redeeming them”. Also in favor of regulation, Fabien Roussel believes that “in dense areas, a doctor should only set up to replace a departure”. He is also in favor of opening“local hospitals”.

Candidate LR Valérie Pécresse recommends creating a fourth year of internship in general medicine to send “junior doctors” to carry out their internship in under-resourced areas. Still not very precise on the subject, Marine Le Pen, the candidate of the National Rally, proposed “strong financial incentives” and remuneration “modulated according to the place of installation”.

For his part, Eric Zemmour propose that the State “urgently hires 1,000 doctors”. The candidate also defends the restoration of “duty obligations” for liberal doctors to “lighten” emergencies.

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