French ‘medical deserts’: Mayor’s plea over lack of rural GPs

Up to 8 million people in France live in ‘white zones’ without regular access to a GP, prompting some MPs to call for rules that would force GPs to work in under-served areas

Up to 8 million people in France are affected by ‘medical deserts’ and do not have regular or easy access to a GP
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A mayor in rural France is calling on the government to do more to fix ‘medical deserts’ – areas with a major shortage of regular GPs, in an issue thought to affect between 6 million to 8 million people.

For example, in Manche (Normandie), almost 45,000 patients have no regular GP.

This has been partly attributed to GPs retiring and no one replacing them, and some GPs wanting significant employment packages that smaller communes are not able to satisfy.

A Senate report from January 2021 found that between 6 million-8 million people in France currently live in a ‘medical desert’, without regular access to a GP.

‘Shocking’ working demands

David Legouët, mayor of Barneville-Carteret, an affected commune in the department of Manche, told France 3 that the working conditions requested by one doctor to come and work in the area had “shocked” him.

He said that he had received an email from one GP asking for “a moving bonus, dedicated housing, a car, a plot of land to build on, and a guaranteed income of €6,777 net after tax” before he would even consider moving to the commune.

Mr Legouët said: “We are shocked. We decided to publicly denounce this. We feel powerless, a doctor can demand all sorts, and it’s unacceptable.

“GPs’ studies are paid for by the state. And what is the state? It’s the people who live in France. We pay for their studies, so they should be spread across France without leaving desert zones.

“[The current system] creates a two-tier medical system, because if you don’t have a usual GP, you only receive 60% back from the Sécurité Sociale, so it’s a double penalty.

“And don’t forget, this person [the GP] is earning €14,000 gross per month, it’s obscene. There are plenty of people who earn €1,500 per month who have no help to pay for their housing or transport costs.

Read more: Basic living expenses cost €1,059 per month in France, study finds

“In the past, these kinds of demands were done by word of mouth, but now they have no shame, they just write them.”

In 2018, then-mayor of the commune, Pierre Géhanne, had already offered a high-profile package in a bid to make the GP job more attractive. This included an apartment with a sea view, restaurant meals, and even the use of the mayor’s boat.

Currently, the commune said that it could offer GP housing paid for two years.

Mr Legouët is calling on the government to do more to help, despite feeling that GPs already receive ample benefits in return for moving to so-called ‘white zones’ (rural areas without GPs).

He said that in his commune, some residents have to wait several weeks before they can see a doctor, compared to just a few days in better-served areas.

What incentives do GPs currently receive for moving to rural ‘white zones’?

Currently, l’Assurance maladie offers an aid package of €50,000 for GPs that move to these areas, for a four-day working week.

This money is paid in two parts: 50% on signature of the contract, and 50% one year later.

For some especially-rural areas, the amount rises to €60,000.

The Manche department has already launched a communication campaign in a bid to attract GPs to the area, including a focus on the region’s beautiful landscapes, natural spaces, and sea views.

The department has also financed other schemes, such as paying for students to study at the Caen faculty, in return for their promise that they will stay in Manche to work.

GP response

Jacques Battistoni, president of GP union MG France, believes that the GP that shocked Mr Legouët “is simply making their demands in the same way as an employee negotiating employment”.

He said: “In order for [the job] to be competitive, the GP must find something equivalent to the salary and working conditions they would find in a care unit or in a care home.

“It is important today that municipalities help doctors to settle in, by ensuring that they will have reception staff or medical assistants, so that they can arrive and devote themselves to the clientele straightaway. "

Doctors themselves state that it is not always easy for them to move across the country. Many finish their long years of study at around age 30, when they may already have a permanent home, a partner, and even children in school.

Similarly, working as a GP is not always a respected job in the field, and many doctors work alone for up to 72 hours per week.

Government response

Yet, the government has discussed the issue recently, with several bills seeking to require GPs to work in medical deserts for a set period of time after qualifying.

The Senate has suggested that from November 1, 2022, any financial aid for doctors must be conditional on them having worked in at least one ‘medical desert’ for at least six months.

And tomorrow (November 19), around 40 MPs are set to propose a bill in parliament that would require young doctors to work in these so-called white zones.

One of the MPs, from Ille-et-Vilaine, told Ouest-France: “For 15 years, every minister of health has offered incentives to bring doctors to medical deserts: tax exemption, signing bonuses, remote calls, multidisciplinary health centres, regional hospital communities... Everything has been done... everything. But it still doesn’t seem to be enough.

“A radical change is needed. We therefore propose to regulate and supervise the employment of doctors, as for pharmacists. They will not be able to settle wherever they want.

“They will go to work where there is a need. This proposal provides for an obligation to practice in an ‘under-resourced’ area for three years after obtaining a doctor's diploma, and a mandatory one-year notice period before leaving.”

MP for Seine-Maritime, Sébastien Jumel, is set to present a bill on December 2 to l'Assemblée Nationale in a bid to introduce regional university courses for doctors, according to the needs of the area.

He said: “Of course, I have met doctors' unions who defend GPs’ rights to freedom, but I would counter that the equality of citizens and the right to health is just as important.”

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