While relations are tense between the liberal doctors and the government, after the failure in March of the conventional negotiation on their tariffs, the arrival of new texts in the National Assembly still puts oil on the fire. Doctors are seeing a boomerang return, via the deputies, of various measures that they refused in the convention. This is the case with the bill (PPL) of deputy Frédéric Valletoux (Horizon, presidential majority), the examination of which began Monday in committee, before arriving for debate in the Hemicycle next Monday.
Aiming to respond to medical deserts, this PPL co-signed by nearly 200 deputies of the majority, plans to oblige doctors to join professional territorial health communities (CPTS) and creates territorial health councils (CTS) to better organize local health policy. It also broadens the powers of the regional health agencies (ARS), forces all general practitioners and specialists to participate in on-call duty, or even prohibits temporary work for all professionals at the start of their career.
Some of the unions, who are opposed to it, are calling for the cabinets to close this Friday. The association Médecins Pour Demain, at the origin of the mobilization, even considers that "to scare away the few city doctors who still exist, we could not do it better". For them, the bill would take “one more step towards 2-speed medicine (low-cost medicine versus unconventional medicine) and unequal access to care for the French”. And, according to the association, the liberal doctors responded massively to this call to strike. “Depending on the region, nearly 50 to 70% of practices are mobilizing today, whether through total or partial closure or the establishment of a customer awareness day,” says Pierre-Louis Helias, vice-president of the association. And if the parliamentarians do not hear their anger, Médecins Pour Demain warns: “We are ready to engage in a long standoff: hard strike with unlimited closure of practices, demonstrations, unilateral increase in fees, deconvention. Nothing is excluded!”.
Wanted by the President of the Republic, who announced that France would be squared by the end of the year, the CPTS aim to improve the organization of health professionals in the field. But there is a leap from thought to action. Practitioners denounce a new administrative gas plant. “Spending is going up, but it's going through the paperwork; we finance the coordination but not the care, and that takes a lot of time for the doctors", regrets Valérie Briole, rheumatologist and president of the regional union of health professionals of Île-de-France, the first French medical desert, which has lost 354 liberal doctors in one year.
“These measures will further deter young people from settling. Continuity of care is already assured. If all the doctors are on call, they will take recovery days and will not see their usual patients”, warns Valérie Briole, regretting on the other hand that “nothing is done to limit the 27 million “rabbits”, these appointments you not honored who represent the equivalent of 4000 doctors”.
For Bertrand de Rochambeau, gynecologist-obstetrician and co-president of the Avenir Spé-le Bloc union, “the hospital is dying of its constraints and its overregulation. The same officials want to bring this into the liberal exercise, which will produce the same effects”. A spade towards Frédéric Valletoux who, before being elected deputy in 2022, chaired the Hospital Federation of France for more than ten years.
But above all, the PPL, which already has more than 700 amendments, opens the door to the group led by the PS deputy Guillaume Garot to graft yet another proposal to limit the freedom of installation of doctors. A subject that the elected representative of Mayenne has been defending, for almost ten years, against the advice of all the Ministers of Health on the left and on the right. And this, even if the current minister, François Braun, reiterated once again that the constraints on installation were not only ineffective but counterproductive and have not been proven abroad.
In this tense context, the minister tried to ease tensions by reopening “flash” negotiations on Friday with 5 paramedical professions (physiotherapists, nurses, speech therapists, orthoptists and podiatrists-podiatrists) on their prices in the face of the inflationary context. But, there is no question of advancing on the subject with the doctors. At least not before September and the next Social Security budget, where the debate promises to be tense.
While Medicare offered a consultation fee of 26.50 euros, the doctors demanded 30 euros, or even 50 euros. "If there is no public money to increase prices, let doctors have the option of applying an additional fee that can be adjusted according to the patients, even if it means asking complementary health insurance to provide the poorest with funds", suggests Valérie Briole. This amounts to nothing more or less than extending “sector 2” to everyone, where the doctor is free to practice excess fees, patients being reimbursed on the basis of the social security rate. Established under Raymond Barre, sector 2 - closed in 1986 - is now reserved for a minority.
Failing to introduce this flexibility, doctors could, at the call of the UFMLS union, decide outright to deconvention, that is to say to sever all ties with the Secu. Their fees would be free, but their patients would no longer be reimbursed (“sector 3”). “Exceeded, some doctors have already taken the plunge and 2264 promise to do so”, warns Valérie Briole.