When 87% of the national territory is considered a medical desert, the urgency of a professional repopulation policy becomes a political subject. This is the meaning of the bill drafted by the LR deputy for Isère, Yannick Neuder, hospital cardiologist but also secretary general in charge of health, within the Shadow Cabinet of the Republicans.
Very widely supported in the LR group in the Assembly, this PPL, which has just been tabled, includes 14 articles that the right will include on the menu of its parliamentary niche in December. “We need a shock plan against medical deserts because the patchwork bills hit the workforce, doctors and paramedics. The system is so close to the apocalypse that we must consider a multi-year law and prepare a long-term reform,” judges Yannick Neuder.
The fall in the number of doctors in France has worsened with the increase in the population. It is estimated at -11% since 2010 and -10,128 general practitioners in 12 years, according to the National Council of the Order of Physicians. For the MP, if Emmanuel Macron had the ambition in 2017 to tackle the numerus clausus ceiling, the policy pursued since then will not resolve the problem. The situation should even deteriorate until 2028, according to the Directorate of Research, Studies, Evaluation and Statistics (DREES). “We must double the number of doctors, going from 10,000 to 20,000, as England did because we know that for a doctor who leaves, we must provide more than two doctors to replace him,” explains the MP , but without hoping for results on this point for around ten years.
The Véran reform and the new rules of the numerus apertus for entry into the 2nd year of medicine are in the sights of the right in particular because they have not really marked the end of the numerus clausus. According to Neuder, the reform continues to be based on the number of places in universities which suffers from a lack of reception resources. He notes that the government ultimately only increased the proportion of future doctors by 15% without taking into account the increase in the population (15 million French people since the 1970s). He proposes to make the end of the numerus clausus effective by no longer conditioning the number of students solely on the reception capacity of the faculties but by basing the number of students according to the needs of each territory.
Yannick Neuder also warns of the need for a Marshall investment plan for faculties. Article 8 aims to stop the brain drain by bringing back young French people who have left to study abroad. Yannick Neuder observes that 10% to 15% of students tempted by medical studies come up against the wall of Parcours Sup. Despite their qualities, they are forced to expatriate to pursue their project in Portugal, Belgium, Romania… A drain of talent illustrated by the example of the 3,000 French students who tried their luck in Belgium in 2021 against Around 1,200 in 2020. “It is urgent to stop the bleeding,” insists Neuder. “Because there is a shortage of doctors in France, we must recover these young people and reintegrate them into the French system after an assessment. And we must act quickly as long as they are not yet established in these countries…”.
The other “electroshock” defended by the right to deal with shortages of doctors consists of better recognizing the skills of paramedics by facilitating the possibility of transitions as a priority to primary care medicine as proposed in article 6 of the text. “We must facilitate movement because many professionals may want to evolve. It is difficult to know, for example, how many midwives, physiotherapists or nurses are ready to return to studies to become doctors but we must open up this possibility via qualification processes,” judges the cardiologist, believing that everything must be made to arouse desires and not distract volunteers. The doctor adds that access to paramedical studies through Parcoursup in 2018 led to a sharp increase in interruptions and dropouts from the first year. In 2020, one in five nursing studies students threw in the towel according to the DREES. An observation which led him to exclude paramedical training from Parcoursup in his text.
This overhaul of studies is accompanied by regionalization measures going against the grain of coercive measures such as the system of geographical obligations. In addition to proposing to condition the number of students according to territorial needs, it wants to offer the possibility to local authorities to enter into contracts, in their territory, with all structures linked to health to create territorial boarding schools. The objective is to encourage students to complete internships with private practitioners, knowing that the probability of settling in a rural area is 2 to 3 times higher if the doctor is of rural origin and that according to the association of rural mayors (AMRF), there would be a need for one general practitioner per 1000 inhabitants in rural areas.
Yannick Neuder, close to the president of the Auvergne-Rhône-Alpes region Laurent Wauquiez, believes that the Republicans must change their approach to the social security budget (PLFSS) whose deficit is forecast at 11.2 billion euros in 2024. The parliamentarian pleads for a system more adapted to the realities of the time, capable of stabilizing the financing of a vast sector, extended to medicines. “In the interministerial meetings, everyone knows that the PLFSS was not written this summer and that it is fiscally insincere because it will not keep up with inflation. There will be a lack of funding in hospitals and EHPADs. This is why a multi-year health law is essential, like the one that exists for military programming,” he recommends.
Faced with the country’s budgetary situation and the reality of its medical deserts, the Republicans are preparing a counter-budget (the figures for which will be revealed on Tuesday). We will find these ideas for improving the health system. “Health is priceless but it has a cost and we cannot continue forever with more than 3,000 billion in debt. But without making savings at the expense of the health of the French, we can nevertheless improve the fight against social fraud, undue prescriptions or the inefficiency of certain treatments,” explains Yannick Neuder. Way of saying that the current situation requires both precautions but also an urgent change of course. “Health professionals expect a trajectory and not patches or coercion like the Valletoux law” warns the right-wing parliamentarian who warns against the discontent of doctors in the street.
