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Stats reveal truth on GP shortage

Picardie, Haute-Normandie and Poitou-Charentes among worst-affected areas

WITH average monthly salaries ranging from €5,500 to €9,000 it is strange to think doctors in France would have trouble recruiting.

However the profession is experiencing shortages, not across the whole country, but in pockets such as Picardie, Haute-Normandie and Poitou-Charentes, and not for all doctors, mainly for GPs or médecins généralistes.

Doctors’ unions have been warning about these pockets for some years: the “medical deserts,” are places in France with less than 324 doctors per 100,000 inhabitants.

The better pay for specialists means more young doctors are aiming to specialise or, at the very least, work in a hospital while the relatively low pay – and isolation of working in some departments – has turned many away from becoming GPs.

Statistics for 2010 compiled by L’Ordre National des Médecins show the poorest area for GP care is Picardie with only 239 doctors per 100,000.

The regions of Centre (244), Haute-Normandie (248), Champagne-Ardenne (256), Pays de la Loire (259), Bourgogne (262), Basse-Normandie (263) and Poitou-Charantes (271) hardly do better.

In the Côte d’Azur and Provence, however, PACA has the highest density of doctors, 374 per 100,000.

Other regions with the highest density of doctors were those to the south: Languedoc-Roussillon, Midi-Pyrenees and Aquitaine plus Ile-de-France and Alsace.

The trend is not simply a case of heading to the sun. The figures are partly due to an ageing population which requires increased medical care; and some point to the increase of female doctors who often prefer a group practice rather than setting up alone.

Fingers are also pointed at newly qualified doctors, who tend to apply for jobs in hospitals rather than setting up as GPs.

Reasons for the lack of interest in becoming a country GP could include decreasing social status, but others point to better hospital working conditions; fixed working hours, better holidays, less time on call etc.

Figures from international economic organisation OECD show the average density of doctors across France is around 340 per 100,000 compared to the UK which has just 220 per 100,000. So, comparatively, France has no shortage of doctors.

That does not explain the death of a man after a suspected heart attack or stroke in a Lyon office. Despite being called immediately, it took an hour for an ambulance to arrive; apparently because no emergency doctor was available.

Health staff said the delay did not contribute to his death, but it is worrying that in France’s second city it could take over an hour for an ambulance to arrive.

Urban GP
I have to work faster and faster each day and it’s not for the pay

I DON’T know how many people I have on my books. I’ve never counted them, I only know I have a huge practice with lots of patients. I work a minimum of 45 hours a week.

I joined the April 7 strike; partially. I wanted to strike out of solidarity with my colleagues – and because the situation, even in Lyon, is really bad – but I couldn’t do it whole-heartedly out of solidarity with my patients. Some of them are very ill and their appointments really couldn’t have waited until the next day.

When I say it’s bad I mean I find myself having to work faster and faster and also almost every day I’m squeezing in more and more appointments. In the past I often had a few empty appointments; now I never do.

Many doctors hesitate about taking on new patients, because they simply don’t have the time to treat them. The issue about €22 or €23 for a consultation is not really important. After all, as doctors we’re not exactly short of a euro. But how we’re paid is an issue.

A tariff system wouldn’t be fair: how do you judge how much to pay? A doctor with a caseload of elderly dementia patients is likely to work much harder than a doctor with a caseload of healthy 30-year-old adults. So doctors have to be paid for each consultation.

I think the problem is not so much pay as the lack of doctors. The only solution is to train more doctors.

Rural GP
People don’t want to work 70 hours and miss children growing up

I LIVE in a small commune of 1,000 in Basse-Normandie and, as the only doctor, I work 60-70 hours a week.

I didn’t go on strike as I feel we have to see how the negotiations go before taking industrial action. But I did contact the ministry to express my pride in my work and my worries about the development of this profession.

Medical desertification is a reality in some areas because we have not trained enough doctors. We must train more. More people are retiring than are qualifying as doctors and retirements have accelerated. The work has increased because of the ageing population so suddenly we’re caught short.

Now the numbers of doctors being trained is increasing but it will take 10 years to take effect and only 10% of young doctors want to be GPs. The professional isolation and the bad hours put them off, as does the fact we’re paid only about half of what other specialist doctors earn.

Mixed discipline multi-doctor health centres are a good answer but there are not enough of them.

We have won the battle to be recognised as specialists, but we are still not paid as such.

Also, doctors – more than 50% of whom are now women – want to work part-time to combine work with looking after children. People don’t want to work 70 hours a week and miss their kids growing up.

The negotiations end by June 30 but I wouldn’t be surprised to see strikes.

Personally speaking
It’s not so bad; I’ve had surgery time to fit in with my cat-sitter

AS SOMEONE who lived in a very isolated area for nearly 20 years, I have never noticed the slightest lack of medical facilities. My local town of 9,000 has five pharmacies, seven GPs, a medical laboratory, and more physios, home nurses, dentists and other medical offices than you can count.

I’ve taken children with broken bones to the local A&E where they have all been treated with amazing speed and skill. The wait for triage is on average one minute and doctors rarely more than 10 minutes.

In one case, a specialist facial surgeon 100km away did a consultation by phone with the A&E doctor, looking at digital X-rays sent by email, and drove up the next morning to perform the necessary surgery.

I’ve also had surgery scheduled to fit in with my cat sitter, and the GP has seen my children on Boxing Day. (Suspected appendicitis = too much Christmas pudding.)

One guest really did have appendicitis and was most impressed by our new local clinic. For big stuff, like body scans and heart surgery, it’s true you have to travel to the city, almost 100km away, but when our neighbour had a stroke in an isolated village at the top of a mountain, it only took 20 minutes for the medical helicopter to arrive and whisk the patient to the city.

I honour anyone striking to maintain the healthcare system at its current level, but I can’t say I have anything to complain about.

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