Men who live in the countryside die more than two years younger on average than those in cities, partly due to a town/ country divide in access to care.
This was one finding in a study by the association of French rural mayors. Rural women die on average just under one year earlier than those in cities.
The AMRF’s study found that France lacks 6,000 GPs in total across rural bassins de vie population centres to attain a ‘desirable’ ratio of one GP per 1,000 inhabitants.
The actual French average is 0.83/1,000. A bassin de vie is the area where a given population works, shops, socialises, and accesses essential services.
There are 1,666, compared to 35,000 communes, of which 1,200 are ‘rural’. In rural sectors a GP must, partly due to lesser population density, cover a 30km2 territory on average, compared to 5km2 in urban areas, says AMRF.
It wants national health statistics to focus more on doctors per km2 rather than per 1,000 inhabitants to better highlight problems rural communities face.
“It’s not fair that just because we are less numerous, we should be abandoned,” said Gilles Noël, a health issues specialist for the AMRF.
He said the study (tinyurl.com/MayorsHealth) looked at bassin de vie level for GP cover, but used departments for specialists, as they recognise that people are ready to travel up to 50km for this and do not expect to find every specialism locally.
More GPs in the south
As a rule, the south is better-served by GPs than the north and east.
For specialists, the centre and west are poorly served, though there are well-served areas on the Atlantic coast. Mr Noël, mayor of Varzy, Bourgogne-Franche-Comté, said: “Officials give us figures based on regions and departments, but within one department the picture can be different from one area to another.
“So we produced maps showing the share-out of doctors at local level, which makes clear the inequalities that exist.
“We are sounding the alarm because the situation has been getting worse for 30 years.”
The maps show where GPs are ‘lacking’ or ‘surplus’, compared to the national average. However, Mr Noel said the aim was not to complain there are “too many” doctors in urban areas compared to, say, rural areas such as Creuse, but rather to show that there are not enough in the latter.
Some places in more ‘rural’ areas buck the trend and are well-served.
The maps show, for example, that in the Dordogne, the north east is quite well served and the south west is mostly poorly served.
Thus, the area around Périgueux has 12 more GPs than ‘needed’ to meet the French average, whereas the Ribérac area needs an extra eight to level up to it.
However, only the Brantôme area, north of Périgueux, meets the ‘desirable’ aim of one per 1,000 inhabitants.
Poor access to hospital services
Another problem is access to hospital services.
City-dwellers are often served by well-funded teaching hospitals, whereas rural people are more likely to have access to a less well-equipped centre hospitalier de proximité.
“Over the last decades, the state has taken away maternity departments and sophisticated diagnostic and treatment units from the local level, saying it’s safer and better to give birth or have an operation in the town.
“But having such services locally is crucial, as it is for nurses and pharmacies, to reverse inequalities in life expectancy.
We can’t have millions without a médecin traitant.
“You can see from our study that the quality of the parcours de soins [access to a suitable series of services to deal with a condition] is not the same in a rural area as in an urban one, because there is a scarcity of health professionals, which is now really worrying.”
A médecin traitant is a person’s designated GP. A recent Senate report shows that 11% of people aged 17 or more do not have one.
Mr Noel said everyone has access to water, electricity and a school, and it should be the same with GPs. Another factor facing rural communities is that access might suddenly change.
Last year, Mr Noël’s area was well-served with two doctors.
This year, one has left the area after a divorce, the other has left to take a salaried job elsewhere.
Doctors 15km away have offered to help, but not to be médecins traitants.
Solutions proposed for better care in countryside
THE Health Minister is said to have taken seriously four proposals put forward by the AMRF after consultation with citizens and healthcare professionals when they met recently. They are:
Medical students to be offered placements in rural areas as well as in the city where they are studying. Rural placements should have cheap accommodation and transport help;
Where people do not have a GP, allow for more flexibility for problems to be dealt with and co-ordinated by other professionals. “Imagine I injure my foot: I might need to see my GP, who refers me to a nurse or physio, prescribes medicines, etc. But if I have no GP I don’t get care. In this case, we need to give permission for another professional to take charge so the wound doesn’t get infected and I end up in A&E instead”;
A ‘one-stop shop’ to be created for each department, online or in person, so when a new health professional moves to the area, they can get answers to questions and help with accommodation, children’s schooling, or help for their partner to find work. “They mustn’t feel like it’s a punishment to come to our areas”;
Find new ways to ensure essential care acts can be carried out locally – a new sharing of tasks along the lines of how pharmacists and physios vaccinated during the pandemic. For example, allowing nurses to be consulted directly for wound care, or a physio for an ankle sprain, without the need for a doctor’s prescription being required.
The act of talking to a doctor remotely via a webcam – is widely seen as a help in areas of France which lack doctors, but an MP is effectively trying to ban this now-common practice.
Caroline Fiat (left-wing La France Insoumise) managed to get an amendment adopted into 2023’s social security finance bill saying the process can only take place if another medical professional is present with the patient.
It is expected to be struck out when MPs vote on the bill.