This Wednesday morning, at the reception of the Ajain health center (Creuse), appointments are made one after the other. “Many patients are desperately looking for a doctor. When they are offered an appointment the next day or the day after, they are relieved, almost surprised to have access to care so quickly,” explains Johanne Chevalier, the coordinator of this firm with its unique functioning.
Here, the face of the doctor changes every week. That day, it was Jean-Luc Bugeaud, a GP retired for five years, who came from Limoges (Haute-Vienne) to ensure a medical presence in this rural town of 1,075 inhabitants. The Médecins solidaires collective of which he is a member has more than forty practitioners from the four corners of France: doctors Étienne Maës from Rennes, Perrine Molinié from Vaucluse, Cindy Boizard from Aude… Practitioners who have just left the boarding school, young retirees, liberals installed or looking for replacements: all take turns, stethoscope around their neck, since the opening of the Ajain medical center on October 31, 2022.
“A family of doctors instead of a family doctor”
At the origin of this initiative, the citizen movement Bouge ton coq which works to revitalize rural areas, also opening participatory grocery stores in private commercial municipalities. And a restless 32-year-old general practitioner, Martial Jardel. To get out of the eternal debate on the obligation to settle in territories under-endowed with health professionals, this son of a country doctor first started with a diagnosis: “Why do doctors no longer come to settle in Creuse? Because it is an immense moral commitment to take on a patient base of 2,000 people over forty years. »
A sacrifice probably too heavy for a new generation of doctors at a time when the change in the relationship to work affects all sections of society. From there is born the intuition that it is necessary to conceive an organization on the mode of shared time: “There are, everywhere in France, doctors able to arrange a week in their schedule to come and treat in medical deserts. Since the family doctor is lacking, let’s call on a “family of doctors” instead.” argues Gabriel du Passage, in charge of deploying the program.
In Ajain, Doctor Jean-Luc Bernard retired on December 31, 2020, leaving his patients orphans. “We moved heaven and earth to find him a successor, assures Mayor Guy Rouchon. A sign at the entrance to the town, warning messages issued to the regional health agency, the Creuse primary health insurance fund, the College of Physicians, articles in the regional press, communication campaigns on social networks… Nothing worked. » From now on, every Monday, when the doctor of the week takes possession of the premises, the city councilor comes to greet him in person to express his gratitude.
“Patients in therapeutic default”
Because the motivations of doctors to join the Médecins solidaires operation are not financial. They are paid €800 per week, three times less than a traditional replacement. “Above all, we have the feeling of being useful, here even more than elsewhere since the patients had no longer had a doctor for almost two years”, develops Jean-Luc Bugeaud, who is doing his second week on duty. Two years that left their mark: “We sometimes see patients in therapeutic default, unbalanced diabetes, blood tests that have no longer been carried out”, he describes. With the risk of loss of luck.
“The patients were devastated”, testifies Sophie, the preparer of the village pharmacy where only a teleconsultation terminal remained as a “workaround”. “We could at least deliver an antibiotic to people who suffered from a urinary tract infection or a toothache. Just to wait a few days for a slot to become available at a doctor in the area”, she sighs. “Soon locals will be going to the vet for treatment! », quips a substitute colleague. ” Think again, replies Sophie, disillusioned. Last year, we lost our veterinarian along with our doctor, our baker and a class within the school. »
Multiply opinions on the same pathology
To prevent some from ending up neglecting their state of health, continuity of care is crucial. Dealing with several doctors does not seem to bother patients, as long as the transmission of information is organised. “When I had health problems lately, I had to go to the emergency room at Guéret hospital and it was a different doctor each time”, underlines a septuagenarian installed in the waiting room of Ajain.
“The fact that the medical file passes through several hands is even a vector of trust for patients who are the first to seek several opinions on the same pathology”, adds Martial Jardel, who bets on “a benevolent evaluation between peers”. In fact, he observes that his sisters and brothers are “particularly scrupulous in the way they fill in the medical files, so that the doctor only has to slip into the blouse of his predecessor”.
From teleconsultation to doctor rotation
Designed as a laboratory, the Ajain medical center has demonstrated its effectiveness. The doctors’ rotation schedule is full until next December. In five months, 1,700 patients consulted there and, among them, 700 decided to declare the structure as a general practitioner.
Something to inspire the town of Bellegarde-en-Marche (Creuse), located forty kilometers away, which also saw its historic doctor retire in June 2022. The public meeting on Wednesday April 5, scheduled for informing the inhabitants of the arrival of reinforcements from Solidarity Doctors next June, was eagerly awaited. For more than a year, a brand new building intended to house the town’s new health center has remained in an empty shell state, for lack of caregivers to operate it.
In Ajain, in Creuse, Médecins solidaires is a collective involving professionals from all over France to fight against the medical desertification affecting the town. / Antoine Oberdorff
Like the mayor of Ajain, citizens committed to the revitalization of their town have failed to attract doctors, despite an offer of remuneration of €5,000 net for 35 hours per week and multiple approaches to medical faculties, in France and elsewhere in Europe. “Without a doctor, a campaign like ours was doomed to decline. But we are finally going to get out of the medical desert in which we have been living for nine months, ” welcomes Jean-Marie Bertrand, president of the Association of prefiguration and accompaniment of the health center.
147 doctors in solidarity
At the rate of two Solidarity Doctors per week, no less than 100 white coats will parade each year in Bellegarde-en-Marche. “We multiply by a hundred the probability that one day a doctor will feel good and want to stay permanently”, rejoice in the congregation.
It remains to prepare the minds for the disappearance of the beloved figure of the family doctor. “The relationship that united them to their patients is magnificent. However, mobility does not affect the quality of care. We are not offering medicine at a discount,” assures Martial Jardel. The consultation times attest to this: twenty minutes for classic consultations, up to forty minutes for opening a file in the case of a patient with chronic conditions. And if the patient’s mobility requires it, home visits will be offered by the center coordinator.
At this stage, 147 doctors are registered in the Médecins solidaires network. Ultimately, the ambition of the project leaders is to bring the initiative into the common vocabulary of all interns on leaving their studies. In their eyes, the contribution of 10% of the medical profession would make it possible, without coercion, to open more than 150 nursing homes in the affected areas.
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Adapt the care offer to the territories
During a trip to Aveyron devoted to the issue of access to care in rural areas, Friday, April 7, Elisabeth Borne visited the first health center in France, in the town of Salles-Curan. The Prime Minister was arrested by one of the doctors, reported Aveyron Press Center : “We don’t suffer here, it’s the tree that hides the forest. You just have to go 20 km and you will find a 64-year-old colleague, the only doctor to practice. » In response, Elisabeth Borne confirmed the publication, on Saturday April 8, of a decree granting more flexibility to the directors of regional health agencies to adapt national rules to the reality of the territories.
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A downward trend in the number of doctors
In the department of Creuse, 7,282 people insured under the general scheme do not have an attending physician, according to data provided by the Primary Health Insurance Fund (CPAM).
La Creuse has 134 general practitioners per 100,000 inhabitants compared to 148 in mainland France, according to INSEE figures. Over the long period, between 2010 and 2023, Creuse saw its number of general practitioners decline by 35%, according to the National Council of the Order of Physicians (CNOM).
During the year 2022, 12 regular active general practitioners ceased their activity in the department, according to CNOM figures. Over the same period, only one came to settle in regular activity on the territory.