Many GP surgeries and specialist clinics in France are closed today (Friday, October 13) as 13 doctors’ associations strike for higher consultation fees amid a wider general strike affecting travel and schools.
It comes after the government announced that consultation fees are set to rise 6% from €25 to €26.50 for GPs and from €30 to €31.50 from November 1. Currently, the Assurance Maladie covers 70% of a visit to a GP or specialist, with a patient’s mutuelle (top-up insurance) covering much of the rest, if they have one.
But doctors have said that the fees are not high enough. During previous strikes unions have called for the fee to rise by as much as €50 for GPs, to cover inflation, additional costs, and more time-consuming responsibilities.
Self-employed GPs account for 56% of doctors in France, equating to around 115,000 to 120,000 medics.
Negotiations broke down between doctor unions and the Assurance Maladie in early 2023, after the 6% rise was proposed and confirmed. Health Minister Aurélien Rousseau announced on Wednesday, October 11 that he would reopen negotiations “very shortly”, but the strike today is still going ahead.
Dr Jean-Christophe Nogrette, deputy general secretary of GP union MG France, told FranceInfo: “It is unacceptable: €26.50 is much less than inflation over the last six years. [Consultations should rise to] at least €30 to take account of inflation rises since 2017.”
2017 was the last time that fees rose.
Some doctors’ unions have also called for a ‘renewable’ rolling strike with no end date due to ongoing concerns regarding medical consultation fees.
They have also called for ‘no shows’ at appointments to be charged (if patients do not attend a booked appointment without notice), and for doctors to have fewer administrative tasks to do, such as signing “needless” doctor’s notes.
Doctors say that they are not calling for fee rises “to make themselves rich”.
“We just want to invest in our surgeries,” said Mélanie Rica-Henry, spokesperson for the Médecins pour Demain group, which is calling for a €50 consultation fee.
Yvon Le Flohic, a member of the Union syndicale pour une médecine française libre (UFML) accepted that no-one was going to have sympathy for doctors’ monthly incomes, which are - on average - €6,700 after charges but before tax (show figures from the Caisse autonome de retraite des médecins de France).
“But the situation is particularly difficult for the younger members of the profession,” he said.
Doctors do not necessarily receive all of the consultation fee, especially if they are standing in for other GPs.
Dr Mathilde Chouquet is a locum GP from Rennes (Ille-et-Vilaine) and vice-president of the young doctors' union RéAGJIR. She explained that she has to pay part of the €25 she receives for each consultation to the doctor she is covering.
She said: “I actually receive €17.50 per consultation. Then I have to deduct the various social security contributions, which represent 20% of my turnover, or €3.5 per consultation. At the end of the day, I am left with €14.”
Doctors say that their pay has not increased despite soaring rates of inflation and falling purchasing power, increased energy bills and soaring costs at their practices.
Dr Le Flohic said that his electricity bill at his GP surgery has doubled year-on-year from 2022 to 2023, and now costs €4,000 a year. Other services, such as the medical software that allows patients to book appointments online, have also increased in price.
He also said that depending on the month, he receives between €10 and €17.50 for each €25 fee paid. The rest goes on charges, wages for staff members, social fees, retirement and insurance.
MG France has stated that this is average for GPs, depending on where they are based. On average, doctors receive between 44-56% of the fee paid, which works out as €11-14.
One GP in the 20th arrondissement in Paris told FranceInfo that he cannot even afford to hire a medical secretary because his rent is €1,700 per month. He said: “Between the surgery location [rent] and the secretary, we’ve had to make a choice.
“That’s the cost for a large surgery and having all the equipment needed to welcome people with reduced mobility,” he said.
A changing profession
The GPs on strike also say that their profession has changed beyond recognition in recent years and they are calling for more acknowledgement of this from the government and health authorities.
“When I set up my practice 30 years ago, we could see 30 patients a day, because the problems were easier to manage,” said Dr Nogrette. “Today, we are helping patients with long-term illnesses, with several problems at the same time, which requires more time and expertise.”
The Assurance Maladie, however, says that it already pays doctors to help patients with long-term conditions. Once a year, self-employed GPs receive €42 for each of their patients with a long-term condition under the age of 80. This compares to €5 euros for healthy patients aged seven to 79.
But MG France says that these lump sums only account for 15% of doctors' pay, and would “need to reach 30% to be truly worthwhile”. This would enable doctors to spend the required time with these high-need patients, without eroding their purchasing power, it said.