2023-05-15 16:01:23
Seven thousand inhabitants and not a single doctor to treat them. In fifteen years of mandate, Jean-Marc Deichtmann, the mayor of Huningue (Haut-Rhin), has not known « pire moment » that day in 2017 when his town, at the crossroads of the French, Swiss and German borders, found itself without a general practitioner. Four years earlier, its municipal council had nevertheless released the tidy sum of four million euros for the construction of a brand new medical center. And the recruitment, in parallel, of four general practitioners to fill it.
Everything was going well, until the retirement of one of them, soon followed by the departure of the other three, who left to practice elsewhere following a « dissension » with the town hall. “We found ourselves in Gros-Jean as before”, summarizes the aedile, still bitter. Jean-Marc Deichtmann then decided to turn to a recruitment firm specializing in intermediation between local authorities and general practitioners. He identifies an agency that has a storefront in Strasbourg, and sends a first email. There follows a meeting by videoconference and then the signing of a contract in which the company undertakes to propose to the municipality at least two candidates in the year, for 12,000 €.
€6,000 lost and still no doctor on the horizon
“They were very enthusiastic”, remembers the Alsatian mayor. But information from the company on the progress of the research is long overdue. In one year, the mayor and his team will not receive any “precise contact details, no names, barely an email address”. The firm then proposes to renew the contract to continue the research. The mayor declines and the city recovers half of the starting sum. €6,000 lost and still no doctor on the horizon…
Established for several decades on French territory, these recruitment firms cultivate a certain discretion. “It’s a competitive market”justifies a manager, declining the request for an interview with The cross. In their portfolio of clients are communities, public hospitals and private clinics, all in desperate search of health professionals.
To find potential candidates, these companies start by doing « sourcing » : “we will be posting ads on different jobboards (job offer sites, editor’s note)on our own website and on social networks”, explains Aurélia de Mascarel, director of Activa Médical, a practice established in Rennes since 2007. Second lever, that of “breeding ground”, an address book of practitioners meticulously maintained over the years and missions. Finally, to unearth new profiles, recruitment officers use “direct approach methods”. In short: from “headhunting”. «We send emails, scan social networks and make calls”lists Aurélia de Mascarel.
“The whole of France has become a medical desert”
A risky mission at a time of growing shortage of doctors, especially general practitioners. “The whole of France has become a medical desert”summarizes Isabelle Labadie, founder of Stella Medica, a structure established in Hauts-de-Seine since 2005. A recent Senate report thus estimated that 11% of French people over the age of 17 did not have a general practitioner in 2022. during, “Communities are in competition” to overcome this phenomenon locally, acknowledges Aurélia de Mascarel.
In this tense context, the commercial logic of these firms raises questions. “It’s a market: the more disarmed mayors there are, the more potential customers they have”deplores Jean-Marc Deichtmann, mayor of Huningue. “A student or a young doctor can settle down wherever he wants because there is room everywhere. So why would they hire a firm to find a position? »wonders for her part Isabelle Trendel, mayor of a small town and head of the health delegation of the community of communes of Saint-Louis (Haut-Rhin). “We do what hospitals, private doctors or municipalities do not have the time to doanswers Soraya Abdelhak, agency manager at RH Medical. The network that we have woven is our main expertise. »
” Brain drain “
First commercial argument of the firms, this ” network ” also draws from abroad, in Southern Europe, Eastern Europe or the Maghreb. However, some of these countries, Bulgaria and Romania in the lead, are also in problematic situations: while France has 317 doctors per 100,000 inhabitants, Romania had 304 per 100,000 inhabitants in 2019. Figures among weakest within the countries of the European Union. Since its entry into the Europe of Twenty-Seven in 2007, the country has experienced considerable ” brain drain “, including doctors and nurses. Recruitment firms participate in this transfer of qualified labor to the West.
“It’s just normal labor circulation,” advances a Romanian national who « place » doctors from his country in France. “In Romania, we are starting to bring in doctors from Asia. We simply replace one medical desert with another,” she believes. In December 2022, the Romanian Minister of Health thus announced his desire to fill the vacant places in the boarding school exams with candidates from countries outside the EU. “Foreign doctors come to us on their own”defends herself Soraya Abdelhak, of RH Medical.
Medical deserts, closed schools… how to rebalance the French territory?
For René-Pierre Labarrière, president of the council of the College of Physicians in Haute-Savoie, these structures take advantage of the numerus clausus set up in France in the 1970s.. “We have refused thousands of young baccalaureate holders who would have liked to do medicinehe regrets. Instead, we get people who are certainly the elite of their countries but whom we have not trained. »
When history turns sour
Upon their arrival, these doctors are welcomed with open arms in remote municipalities, after years of fruitless research by town halls and several thousand euros spent to secure the services of cabinets, as regularly reported in the regional press. However, the story sometimes turns sour: in the Aisne, a Bulgarian doctor leaves his practice for the Côte d’Azur; another Greek practitioner is more interested in his monthly returns to the country than in his patient base; a Romanian doctor is sent back to his studies by the Order of Physicians after a year and a half of practice in a village in Morbihan…
In order to ensure the smooth running of these establishments, the departmental councils of the Order assess the level of language but also the skills of the candidates in advance during an interview with simulation. They then issue an opinion, which is sent to the National Council. From one candidate to another, the level varies a lot. « Some countries have a 90% success rate in the medical school entrance examination and others, such as France, have a rate of less than 10%, says René-Pierre Labarrière. The risk isfall on the ninetieth, which would have been widely refused in France. » For their part, all the firms interviewed by The cross provide control of the knowledge and qualifications of the professionals they support. How many will be licensed to practice? The College of Physicians assures that it does not have figures.
In Huningue, Jean-Pierre Deichtmann did not need headhunters to get his hands on his rare pearl. A former emergency physician from a nearby clinic, wishing to set up as a liberal, now occupies the medical center, with a gynecologist. A ” stroke of luck “, even if three generalist places remain to be taken…
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Fewer and fewer GPs
In ten years, the number of general practitioners working exclusively in private practice fell by 11%, from 64,142 in 2012 to 57,033 on 1isJanuary 2022.
Medical density is also declining, rising over the same period from 101.7 to 84.34 GPs per 100,000 inhabitants.
According to the localized potential accessibility indicator (APL) of the DREES, the statistical service of social ministries, the French consult their general practitioner 3.4 times a year on average, compared to 3.5 in 2019 and 3.7 in 2016.
Nearly 26 departments have at least 200 municipalities that are under-endowed with generalists. Aisne, Eure, Seine-et-Marne and Saône-et-Loire are the worst off.
Numbers are expected to rise again from 2030, in particular thanks to the abolition of the numerus clausus in 2020. France will then have 63,683 liberal general practitioners, then 75,760 in 2040 and 89,007 by 2050.
Source : Drees.
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