This is a new measure that arouses the ire of liberal doctors, while the latter are calling for a strike on February 14 to improve their working conditions and extract an increase in the minimum rate for their consultation. On Thursday, January 19, an amendment proposed by the government was adopted within the framework of the Rist bill (named after Renaissance MP Stéphanie Rist), providing that “health establishments as well as doctors, dental surgeons, midwives and nurses [soient] collectively responsible for the permanence of care”. If the concept of “collective responsibility” remains vague for the time being, the liberal doctors denounce a hidden return to the principle of duty of care, abolished in 2002 and replaced by a collective system of permanence ambulatory care (PDSA), based on voluntary work.
“This amendment opens the door to the requisition of doctors to be on call in hospital emergency departments. However, we already work an average of 55 hours a week, it’s just not possible!”, castigates Luc Duquesnel, representative of general practitioners within the CSMF union, contacted by L’Express. “It is particularly serious to force liberal doctors, a very large part of whom are over 60, to take guard duty”, abounds the union of liberal doctors (SML), questioned by AFP.
A useless measure
To justify the measure, the government starts from the observation that “the participation in the permanence of outpatient care by doctors does not make it possible to guarantee complete coverage of the whole territory”. According to the survey carried out by the National Council of the Order of Physicians (CNOM) at the end of 2021, only 39.3% of general practitioners carried out at least one call in 2020. Despite a small jump linked to the health crisis, the volunteer rate is now less than 60% in two-thirds of the departments.
However, the CNOM also recalls that in 2021, the share of territories actually covered by outpatient care amounted to 96% on weekends and public holidays, and 95% on weekday evenings. These figures make the unions of liberal doctors say that the return of the duty of care is “a useless measure”. And that it risks pushing future doctors to give up settling.
Especially since the job is less and less attractive, according to Luc Duquesnel. In addition to the fact that GPs follow more and more patients – about 1,100 patients according to the CNAM -, the union official recalls that there is no compensatory rest when the liberals take a guard. “When I finish my night at eight o’clock in the morning, I continue an hour later with my patients for the day”, he illustrates. Result of this “difficult” pace: “Young people are increasingly giving up on becoming family doctors”, and prefer to work in unscheduled care centers, structures that receive patients without an appointment, to take care of emergency room.
To express their dissatisfaction, the unions have called for a strike by the guards since January 23, and plan to gather on February 14 in front of the Luxembourg Palace, the day of the examination of the Rist bill by the Senate. The latter would like in particular that Saturday morning be taken into account for the permanence of care, in order to obtain better remuneration, but also because “doctors want to be able to have two days off, like everyone else”, underlines MG France, the first union of general practitioners, to AFP. A prospect that the Minister of Health, François Braun, seems to be ruling out for the moment: it is “not certain that this is the best solution” to the difficulties of access to care. In a recent Ifop poll, eight out of ten French people said they were in favor of the return of the duty of care for general practitioners.