In the Dordogne in particular, the director general of the ARS of Nouvelle-Aquitaine authorized the hospitals of the department to “use as many as possible contracts “of reason 2” allowing to better remunerate the practitioners”.
A risk of circumvention of the Rist law? Barely a week after the entry into force of the salary cap for interim doctors at the hospital, a parade already seems to have been found. To keep their temporary workers and thus keep their services open, establishments offer them more remunerative contracts, called “pattern 2“, with the blessing of the regional health agencies (ARS).
Thus, in the Dordogne, the director general of the ARS of Nouvelle-Aquitaine, Benoît Elleboode, authorized the hospitals of the department to “make maximum use of reason 2 contracts to better remunerate practitioners“, reported South West this week. In particular the teams of the Sarlat hospital, whose maternity ward no longer provides deliveries since the end of March and at least until mid-April, for lack of personnel.
«The objective is to be able to use all regulatory means to avoid service closures“, defended Benoît Elleboode in The Parisian Friday. In Brittany too, hospitals offer contracts for reason 2, “including mission and meal expenses“, in order to “retain their regular temporary workers», Reports West France . In Orne, the Flers hospital center recently signed six contracts for reason 2, says APMnews.
Read alsoThe salary of interim doctors at the hospital now capped
Up to 1800 euros gross per custody
The use of this type of contract for contract practitioners is in itself completely legal. Defined by a decree published in February 2022, it can be provided “in the event of particular difficulties of recruitment or exercise for an activity necessary for the offer of care on the territory“. This contract must be concludedfor an initial period of 3 years maximum, within the limit of 6 years in total“. In this case, the practitioner can be paid up to around 1800 euros gross per day, against 1390 euros provided for in the Rist law for temporary doctors.
But, in theory, pattern 2 contracts should be longer. This is what the Ministry of Health recalled in a frequently asked questions intended for hospital staff, published last month. “The reason 2 contract is a loyalty tool for the practitioner in an establishment. In any case, it cannot be used for sessions of short duration (24h or 48h type)“Wrote in this document the Directorate General for the Provision of Care (DGOS).
It appears that some ARS allow contracts to be signed beyond the ceiling and without clear rules.
Union of Public Health Managers (SMPS)
But are these rules always respected? Last month, the Union of Public Health Managers (SMPS) called for the reason 2 contracts offered to temporary doctors “be the subject of “pattern 2 charters” establishments-ARS, in-depth checks of the ARS and above all coordinated between them». «It appears that some ARS allow contracts to be signed beyond the ceiling and without clear rules, while others rigorously control each signed contract“, said the union. The risk of abuse is also pointed out by unions. “We do not know the levels of remuneration but, with these contracts, the doctors will go to the highest bidder», worries for example in West France Caroline Tromeur, secretary of the CGT union at Carhaix hospital (Finistère).
For Éric Réboli, president of the National Union of Hospital Replacement Physicians (SNMRH), frontally opposed to any salary cap, it is a question of “a first stroke of the penknife in the Rist law“. Especially since beyond these contracts for reason 2, the emergency doctor points out, in certain departments, the circumvention of the Rist law by other means: overtime, fictitious on-call payments… “In fact the question would be to know if only one substitute is currently paid at the Rist rate in France“, asks, provocatively, the spokesperson of the SNMRH.