HEALTH – Since Monday April 3, the remuneration of interim medical practitioners for 24-hour call duty has been capped at €1,390 gross. Previously, the rates for a penalty payment could reach nearly €4,000.
This is one of the measures of the Rist lawwhich leagued against it, even before its entry into force and with rare unanimity, the trade unions of practitioners.
According to the Minister of Health, these amounts formerly allocated to penalty payments were not “not acceptable” and characterized “cannibalistic interim”.
An opinion that does not share the National Union of Hospital Replacement Physicians (SNMRH), which denounces “a forceful passage totally out of step with reality” from Francois Braun.
In order to slow down the application of the measure, the union brought on Wednesday April 12 before the Council of State two appeals against article 33 of the Rist law relating to the ceilings on the remuneration of doctors.
Because according to the lawyer of the SNMRH, Gilles Devers, the instruction of application was not signed by the Prime Minister and cannot therefore replace the decree of application of the law of 2021. The Rist law would therefore be inapplicable .
Pending the decision of the Council of State, the union insists on the consequences of the law, which discourages temporary staff from taking guard duty due to the drastic reduction in their remuneration.
On its Twitter account, the SNMRH maintains a worrying list of hospital services, including emergency services, which according to them are temporarily out of business or closed, in particular because of the Rist law.
Sorry @FrcsBraun serious things are happening in France, because of YOU!
The list of closed services Update of April 10 @agnesfirmin @LePoint @Le Figaro #health #hospitals #patientsendanger #la_loi_rist_tue @mdefrouville @TF1 @EgoraInfo @Sante_Gouv @elodie_lepage @libe pic.twitter.com/Zbkcgf2t7p— SNMRH (@cdmrehp) April 10, 2023
If reducing remuneration considered abusive is not necessarily displeasing, opinions converge on the worrying state of healthcare provision in France.
In a press release dated April 12, the La France Insoumise-Nupes (LFI-Nupes) group warns: “Under cover of the legitimate fight against the abusive remuneration of temporary doctors, the ‘Rist’ law, which came into force a few days ago, threatens many local services and hospitals.”
It would lead to closures “unacceptable” : “The Rist law should not be used as a pretext for the closure of establishments or services that are currently dependent on temporary medical work because of the destructive policy followed for years, in particular under Emmanuel Macron.”
The LFI-Nupes also fears “the risk of flight of interim doctors from the public to private structures”.
During the public session in the Senate on March 8, 2023, Jean Sol, elected representative of the Pyrenees-Orientales, supported the substance of the government bill.
But the senator was also worried about the possibility of “business breaks” after the entry into force of the law, with the risk of seeing many healthcare services closed in France, due to the lack of doctors: “the inequality of the French in terms of access to care will be reinforced.”
.@JeanSOL__ : “While the framework by Rist law of the remuneration of temporary medical workers in the public sector will come into force from April 3, serious concern is rising almost everywhere in the country. » #QAG pic.twitter.com/2PuFgPnHtJ
— Republicans (@lesRepublicains) March 8, 2023
In fact, the intermediaries are well and truly gone, according to Amandine Weber, Deputy Director General for Medical Affairs at Épinal Hospital: “we try to convince our former temporary workers to come back, we keep calling, that’s all we do”.
Night shifts are particularly affected by the lack of essential specialists: anesthesiologists, obstetrician-gynecologists, emergency physicians, pediatricians, etc.
The amount fixed by the State, the temporary workers no longer want it, according to Amandine Weber who evokes in half-words the medical desert of the Vosges: “Medical demography was already tense, the reform is tightening the screw a little more, it forces us to restructure ourselves. And restructuring means losing activities.”
If the continuity of care has been ensured until now, the situation is “very fragile” according to Dominique Cheveau, director of the Epinal hospital center: “deprogramming of activities, particularly in surgery” have already taken place because of the lack of anesthesiologists.
In addition, still in the same region, 30 beds were closed at the Remiremont hospital, 20 beds at Neufchâteau. As for Vittel emergencies, they are no longer accessible at night and can join the list established by the SNMRH.
Dominique Cheveau, pessimistic about the situation, indicates that“there is also a human, psychological, important price” generated by this shortage of nursing staff. “It weighs on the atmosphere of our hospitals, it generates fatigue and pressure. Eventually, it can make people leave who will have reached a saturation point.