Tribune. The Covid-19 has reinforced the debates on our health system and its organization. Since the Debré ordinances of 1958 [créant notamment les centres hospitaliers universitaires]numerous reforms have followed one another seeking to rationalize the supply of care, to make hospital governance more coherent and to organize the implementation of health policies.
In all these reforms persist two modes of exercise which are not encouraged to operate in harmony, and a strong centralization which is a brake on an adapted territorial organization. The time has come to open a debate involving all stakeholders. An important characteristic of our health system is the existence of two sectors of practice whose functioning, organization, motivations and remuneration are totally different, which probably constitutes an obstacle to rapidly effective reforms.
It is in particular to break down the barriers between the sectors of practice that the Federation of Medical Specialties (FSM) was created, which brings together the National Professional Councils (CNP) of the 42 specialties other than general medicine, each CNP bringing together all the representative structures of the specialty (learned societies, colleges, unions and other bodies) with joint governance between employees and liberals.
Beyond organization and remuneration in the hospital
Doctors, constituting a single body during their studies, must choose between a liberal exercise or a salaried exercise, which it is then very difficult to leave and which it is usual to oppose even though the clinical profession is the same. However, the two systems are currently encountering difficulties, and the fluidity between the two is far from obvious. All of them also observe, for equivalent quantities of work, disparities in remuneration that are no longer acceptable and lead to a loss of attractiveness for certain specialties that are nevertheless essential.
Is it normal, as the statistics show, that the average income of certain specialties is more than four times, or even five, higher than those of other specialties? Similarly, it is difficult to explain to our young colleagues that by staying in hospital they will have a basic median salary for several years of just over 37,000 euros per year after fourteen years of study.
It is difficult to announce to them that they will be confronted with organizational constraints which discourage them when they see that their classmates have a freer hand in the private sector, even if they have to face heavy loads which weigh on their income. The Ségur de la santé launched the reflection, but it essentially attacked the organization and remuneration in the hospital, whereas it is necessary to broaden the reflection to the whole system.
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