Medical desert, hospital crisis, caregivers at their worst: hit by the Covid after decades of restrictions, the French health system is going through a great depression as the presidential election approaches, which Macron’s five-year term failed to prevent .
“Whatever we put in place, everything falls apart, there is nothing holding them back”: in a Parisian intensive care unit, an experienced health executive is struggling to fill the many vacancies in her team of nurses.
Young people “no longer want this job” and “are not ready to make all the sacrifices” made by their elders. “And they are surely right,” she adds.
In each hospital, the same “waves” of departures followed the tides of the epidemic.
The health crisis continues to undermine a sector pressed by ten years of budgetary vice, with deleterious consequences: indebtedness, under-investment, wages at half mast. The billions from the “Ségur de la santé”, dumped between two confinements, have barely loosened the grip.
Access to general practitioners in France / AFP
Everywhere come the same testimonies of beds closed for lack of carers to “arm” them, of schedules closed at the cost of overtime and abandoned leave.
But seen from the ministry, “there is no general saturation”. On the contrary, “there is still room” in most services, despite the continuous reduction in “capacity”: 20% in twenty years, or 100,000 beds less.
Meanwhile, emergency room attendance has doubled. With 22 million passages per year, the congestion is obvious, the tension palpable. The long strike of 2019 did not come out of nowhere. There too the arms are lacking, to the point that certain services only work with temporary workers recruited at high prices.
Others post closed doors at night, leaving destitute those for whom the hospital has become the first resort.
– Managing the shortage –
Their number increases as the “medical deserts” advance. According to the definitions, between 3.7 and 7.4 million people live in an “under-dense zone”, where access to general practitioners is limited to two or three consultations per year.
With specialists, appointment times can sometimes be counted in months. The fault with the Malthusian choice of the “numerus clausus”, removed last year after having dried up the breeding ground for half a century.
Now medical demography is declining, when the French population increases and ages. A “trough” is expected in the coming years, which would be filled “by 2030” thanks to the increase in quotas of students admitted by universities.
In the meantime, the shortage will have to be managed. Repeated attempts to regulate practitioners’ freedom of installation inevitably fail: too confrontational, for an uncertain result, the constraint risking acting as a foil.
Same systematic rejection for the obligation to practice a few years in a “desert” after ten years of study. A proposal experienced as a provocation by interns already under pressure well beyond the legal maximum of 48 hours per week and without which the hospital would collapse.
Access to healthcare in France / AFP
With the presidential campaign, the idea of ”debureaucratizing” public establishments also reappeared, taken up in chorus by three of the favorites of the right and far right – Valérie Pécresse, Marine Le Pen and Eric Zemmour – with a lot of erroneous figures: far of the 30% to 35% advanced on the fly, administrative positions represent only 10% of the million employees in the sector, against 13% in the private sector.
On the left, Jean-Luc Mélenchon and Yannick Jadot, promise 100,000 additional caregivers and new salary increases, but the “Ségur” bill, financed on credit, leaves no budgetary room for maneuver, except to weigh down the social security deficit.
There remains the track of task sharing, which consists of broadening the skills of nurses, physiotherapists and other paramedics to lighten the burden on doctors. But the latter slow down any evolution, reluctant to exchange their power – and the money that goes with it – against this time which they miss so cruelly.
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