While France has never had so many doctors, access to healthcare is deteriorating in a large number of regions and departments.
On the eve of the presentation of the government plan to fight against medical deserts, the National Council of the Order of Physicians (CNOM) paints a grim picture of the situation in its new demographic atlas. While France has never had so many doctors – 290,974 practitioners are registered with the Order – access to care is deteriorating, and in particular in regions already in difficulty.
“Since 1979, the number of doctors has almost doubled. But this progression has slowed down over the past decade, described Dr Jean-Marcel Mourgues, president of the public health and demography section at the CNOM, during the atlas presentation on Thursday. The proportion of practicing doctors is stagnating while that of retirees is increasing. “
Source: Evolution of the number since active and retired doctors since 1979, CNOM.
6% of active retirees
In fact, between 2007 and 2017, the proportion of active doctors fell by 10 points. Today, more than two-thirds of the doctors registered with the Order work in their office, at the hospital or both. At the same time, the share of retirees increased from 14 to 20%. Of the 75,000 retired doctors, 6% put on their gowns in 2017. They are 6 times more likely to have made this choice compared to 2007.
These numerous retirements and the arrival of fresh blood favor the feminization of the profession. According to the 2017 Atlas, almost one in two doctors in France is a woman. “If the trend continues, we will reach perfect parity in 2020,” said Dr Jean-Marcel Mourgues. Doctors currently in service are also younger: 20% were under 40 in 2017 against 14% ten years earlier.
Long live the salaried workforce!
In 10 years, the way doctors practice has changed dramatically. Over the past decade, wage employment has become the majority practice (46.5% of salaried practitioners against 42.8% of liberal). In addition, there are professionals who divide their working time between their practice, the public hospital, private clinics or even PMI centers.
The departments of Meurthe-et-Moselle, Hauts-de-Seine, Seine-Saint-Denis, Paris, Val-de-Marne, Orne, Vienne, Côte-d ‘ However, Puy-de-Dôme and Hautes-Alpes have the particularity of having “an over-representation of doctors who practice as employees”, notes the Demographic Atlas 2017.
Shortage of general practitioners
But this new generation is not enough to meet the health needs of the whole of France. A difficulty linked, in part, to “the worrying drop in the number of general practitioners”. There are only 88,137 primary care practitioners across the country as the population grows.
Few in number, they are also poorly distributed over the territory. Almost all of the departments are in need of doctors. You have to go to the South of France or to the Atlantic coast to find a general practitioner. In 10 years, only Finistère, Loire-Atlantique, Savoie and the overseas territories have gained general practitioners. They are, however, few in number.
Source: Density of general practitioners in mainland France and overseas territories, COM
The ARS fail to seduce doctors
The Order of Physicians has also found that the incentives put in place by the regional health agencies (ARS) in the under-staffed departments are ineffective. Instead of welcoming new doctors, these deficit areas have seen their demographics reduced by 7% against 8% for the national average. The practitioners preferred to settle in more attractive areas. “It is the failure of the zoning of the ARS”, simply summarizes Dr. Mourgues.
For the inhabitants of the famous “diagonal of the void”, this poor medical density complicates access to care. When they need to see a doctor, they walk a minimum of 8 km. However, this diagonal which crosses France from the North-East or South-West welcomes an older population suffering more from chronic diseases such as diabetes.
Source: Distribution of acts by age group. On the left: 75 years and over, on the right: between 60 and 74 years. CNOM
In addition to all these vulnerabilities, digital coverage leaves much to be desired. “About 40% of the territory is not covered. And at a time when we are talking about telemedicine and e-health, we wanted to show that it is again and again the same areas that are disadvantaged, ”Dr Mourgues insisted.
The government will undoubtedly be very sensitive to this argument of the digital divide. These digital solutions to the shortage of doctors should indeed be at the heart of the government project aimed at guaranteeing good access to care. The roadmap of the Minister of Health, Agnès Buzyn, stipulates that deployment measures will be implemented “from 2018”.
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