INTERVIEW – To deal with medical desertification, Saône-et-Loire will pay 30 doctors, distributed according to territorial needs.
To fill the shortage of doctors in medical deserts, why not simply hire doctors? This is the project of the departmental council of Saône-et-Loire, which should launch, from the start of the next school year, the recruitment of around thirty generalists, who will therefore be directly employed by the department.
The idea seems simple, but it is the first initiative of this scale in France. In Saône-et-Loire, the density of general practitioners is low, around 84 practitioners per 100,000 inhabitants (compared to 104 for the national average). The measures put in place to encourage the installation of doctors (particularly financial incentives) have not given full satisfaction. This “departmental medical center” should promote access to care.
A 35-hour contract, 5,000 euros net per month, and a practice relieved of administrative hassles, which will be managed by the department. For the doctors who will be hired, the promise is enticing. More than the simple prospect of settling in a medical desert, which is inevitably accompanied by an overload of work. Only downside: mobility. By being employees of the department, they will be invited to practice where the needs are greatest, and could be required to travel.
André Accary, President of the Saône-et-Loire Departmental Council, has just officially announced the launch of this project which he has been preparing for two years. He details it for Why doctor.
Is Saône-et-Loire affected by medical desertification?
Andre Accary: We are still in a situation that can be described as “tolerable”. But it will deteriorate in three or four years, because of the average age of practitioners, on the one hand, but also the aging of the population, which is above the French average.
The systems already in place provide some improvements, but they are ultimately very basic. We are not far from mercurochrome on the wooden leg. I confirmed them, I tried to adapt them. The State has also set up attractive tax measures for certain territories, and not for others. We then enter into unfair competition between territories. This is not a lasting solution, and it will in no way solve the medical desertification of the department of Saône-et-Loire.
With this new project, we are going to work with all the stakeholders – Order of Physicians, ARS, elected officials – to build a complete report for the month of September, and then launch recruitment. I don’t have a magic wand, I just offer a solution. It may be a total fiasco, but I hope to meet the expectations of practitioners and the population.
Andre Accary, president of the departmental council of Saône-et-Loire: “We must launch an operation, unique in the sense that it is not done elsewhere, to avoid competition between territories…”
Why recruit 30 doctors?
Andre Accary: We took into account the demographic situation, the territorial organization, the mechanisms of the State, the evolution of the age of the population. To speak like a doctor, it is a complete diagnosis of the territory that has been made. I have come to the conclusion that we must launch an operation, unique in the sense that it is not done elsewhere, to avoid competition between territories.
But it is a first figure, which will evolve. For now, it’s 30 doctors. But if, all of a sudden, 5 generalists leave, it will be 35. I hope to proceed with the first recruitments after September. The objective is to settle the question of the medical desertification of general practitioners within 2 or 3 years.
How will installation sites be chosen?
Andre Accary: Today, construction is underway. I want to bring all the partners around the table (ARS, liberal doctors), with the elected representatives of the territory, and decide on the sites.
They will not be houses of doctors. Other communities have them, and that’s not what I want to do. We want to fill these houses. I am only talking about recruiting doctors.
Our system will be as flexible as possible. If we install departmental doctors in a geographical area, and then there is a project to install liberals, we will withdraw to settle elsewhere. I don’t want to undress Pierre to dress Paul. We will not recruit liberal doctors from the department of Saône-et-Loire to form the organization. We aim for a complementary and non-competitive solution.
This is the advantage of a departmental device, which allows this flexibility: a municipality cannot do it.
Who will pay these doctors?
Andre Accary: This is the department, which offers real security to doctors who could be recruited. We have the agreement of the CPAM and the other players, who have been consulted on the project. The doctors will be employees of the department, and they will undoubtedly also have, at least for some, other missions. For example, the department manages the Maternal and Child Protection Centers (PMI). Administrative concerns will be taken care of by the department.
We are targeting recently graduated doctors, who wish to pursue an activity in the hospital sector, in a burn-out situation in other departments, or who have a 15-20 year career and wish to return to their true profession, medical consultation, without going through a third of their time on administrative prowess.
What is the opinion of the College of Physicians on salaried work?
Andre Accary: He is very open. He gave me some recommendations, which we will take into account. I would also like to associate him with our work, before the publication of the report in September. In particular, they want us not to bring doctors and territories into competition. And that, I keep in mind.
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