200,000 jobs are to be filled in hospitals within five years. But the hospital is above all sick of poor organization and failing restructuring.
Imagine a heart attack victim performing her own cardiac massage… “If it were that simple, the hospital wouldn’t be recruiting. This message comes from the Ministry of Health, which is launching a campaign to promote hospital careers and announces 200,000 jobs to be filled over the next five years. TV spots (broadcast from February 21 to March 6), website, phone number, the communication campaign mainly targets high school and college students to help them discover “the diversity and richness” of the hospital. “The hospital needs you,” the public institutions tell them. The formula is reminiscent of that of recruiting sergeants during a period of general mobilization. Is it also urgent? Two reasons motivated the Ministry of Health: to face a growing demand for care in connection with the aging of the population, and to compensate for the retirements of hospital staff. The baby boom generation is leaving. “In 2015, one in two hospital civil servants will have retired”, indicates the National Observatory of Civil Service Jobs and Trades. Suddenly, the ministry estimates the number of non-medical personnel to be hired in the public hospital service at 140,000, and at around 50,000 for clinics and private establishments participating in the public hospital service (PSPH).
The professions most in danger of deficit are those of nurses, nursing assistants, EKG technicians and health executives. According to data from the Observatory, 102,000 nurses (general care and specialties) are expected to retire until 2015. The establishments will also need 18,000 positions for doctors, pharmacists, dentists and midwives. An estimate that puts all these professionals in the same bag… “The National Center for the Management of Hospital Practitioners has just been set up,” explains Roselyne Bachelot’s office. They work to establish a mapping of needs according to medical specialties. The Management Center will be able to communicate within a few months. So it’s a blur on medical needs.
In this period when a good part of political action is devoted to the fight against unemployment (7.9%), such an announcement seems like a godsend. But not everyone agrees on the diagnosis. For the CGT Health and Social Action Federation, “the objective remains small. It is exclusively a question of providing for the retirements foreseen in the five years. There is nothing on the thousands of vacant positions today, nothing on the thousands of professionals who no longer practice their trades. In short, this is not enough. On the side of the CFDT Social Health Federation, Yolande Briand first questions the management of human resources. “The hospital has above all a problem of national management and local management. The reforms are not very readable by staff. They are little involved in the changes. In addition, each other’s skills are not always well defined, and rewarded. Therefore, with an average rate of 15%, absenteeism is too high. ” “Recruitments are running out of steam, hospital disenchantment has never been greater,” said the National Union of Hospital Anesthesiologist and Resuscitator Practitioners (SNPHAR) which took part in the strike movement launched by emergency doctors last December. “The hospital suffers from a lack of attractiveness to doctors, who are moving towards liberal activity, judge Rachel Bocher, president of the National Intersyndicat des practitioners hospitaliers (INPH). Out of the 30,000 hospital practitioner positions, there was a shortage of 3,500 professionals in 2001, just before the 35 hours. This is even more the case today. There are deficiencies in surgery, anesthesia, intensive care, psychiatry… The essential thing for the hospital is not only to recruit but to know how to keep doctors. We must review the working conditions. »Steering problems, work organization problem, but is it reasonable to recruit in times of deficit? Nearly one in two hospitals is now in the red. The federation of hospitals in France, which brings together all public establishments, indicates that hospitals needed 1.5 billion euros to complete their budget in 2006. However, hospital staff represent 70% of operating expenses . Some no longer pay the payroll tax due to the state on time.
The Court of Auditors estimated that between 2005 and 2006, 26% of hospitals deferred this tax. The General Inspectorate of Social Affairs (IGAS) recently expressed concern about the waste of financial aid provided to establishments. According to IGAS, directors do not take advantage of staff turnover or the increase in retirements to review staff. “In Gérardmer, points out the IGAS in a report, after the closure of the surgery, the remuneration of a surgeon and an anesthetist continues to weigh on the hospital’s budget of 245,000 euros per year”.
Too many people in the hospital? “Above all, there are too many trades in the hospital (183 according to the directory established by the ministry), estimates Robert Holcman, specialist in the economy and management of health services at the National Conservatory of Arts and Crafts . And, there are too many public and private health establishments (3,223 establishments in 2007). “Same point of view, for Jean-Loup Durousset, the president of the Federation of private hospitalization (FHP).” It is always positive to promote the hospital professions, but that should not hide a necessary hospital restructuring. Admittedly, the sector of follow-up care, geriatrics and psychiatry will have to develop, but overall we must have fewer establishments in France. In addition, this recruitment campaign does not say that young candidates will have to pass a competition. This is the case for entering a nursing training institute, for being received in the second year of medicine … However, many young people are already entering these courses, but they are not always received. For the president of the FHP, it is also necessary to favor the development of those who already work in the establishments, in particular by the means of the validation of acquired experience (VAE), a system already in place to obtain the diploma of caregiver but not for that of a nurse. Same story, with the Federation of non-profit private establishments (FEHAP) which insists on its own training mechanisms and its collective agreement renovated in 2003. Thus, for the actors of the hospital world, the hospital should not only rely on a recruitment campaign to revive the motivation of its staff.
Questions to Robert Holcman (1), author of “The end of the public hospital? », Editions Lamarre, 2007.
“A lack of piloting”
Does the figure of 200,000 vacancies correspond to reality? Robert holcman. Yes, when you look at the number of establishments. As soon as an establishment exists, even at zero activity, a certain number of staff is needed to be able to welcome patients in complete safety. However, in France, the number of public and private establishments is extremely high. And as a result, they mobilize a large number of staff. Thus, we have a paradoxical situation of having at the same time a very large overall number of care staff and but when we relate this totality in relation to the number of beds we have staff shortages. So, yes to recruitment, but it being understood that there will be a drop in the number of establishments …
Needs in certain trades? HR In fact, needs are mainly felt in three professions: generalist state-certified nurses, physiotherapists, and electro-radiology technicians. On the other hand, in other types of trades, we have excesses and choices to make. 183 professions have been identified, of which around forty relate to care. On the other hand, for the rest they are support functions and sometimes quite out of step with the hospital environment: there are pastry chefs, delivery drivers, etc. There are 87,000 technical worker staff in the services, while in the medical staff. technical, we have 35,000. This means that we have a little more than double the number of staff dedicated to the maintenance of windows, doors and cars in the hospital public service than staff dedicated to scanners, at MRIs, at the pharmacy, or in laboratories.
You mean there’s no consistency… HR The system suffers above all from a lack of piloting. For example, we decided to maintain, in 2006, the privilege of recruiting and assigning hospital practitioners at the level of the Ministry of Health (editor’s note: National Management Center) whereas in principle it should have been decentralized at the level of the health ministry. The establishments. And conversely, with regard to non-renewals of retirements which would make it possible to vary significantly the volumes of staff employed in the establishments, we continue to leave the decision to the level of the establishment. However, experience shows that the heads of establishments are not in a position to take these decisions, because not renewing the personnel who are retiring inevitably means facing a social conflict which no manager does. wish to have to do. Suddenly, it would be much better to have centralized control. Interview with MG (1) Specialist in the economy and management of health services, project manager at the National Conservatory of Arts and Crafts, former director of human resources at Raymond Poincaré hospital (2003-2004).
