Today the junior doctors, tomorrow who else?
As everyone gears up for the Big Strike tomorrow, over whether or not some professions should be allowed special retirement privileges linked to the anti-social nature of their work, another much-less publicised strike came to an end this morning – the ten day junior doctors’ strike. The internes, or at least those hoping to work in the libérale, self-employed, part of the health system, were striking because they believed there was a move afoot to prevent them setting up practices in areas deemed to have too many doctors already (large towns, particularly in the southern half of the country, and more particularly on the Mediterranean – Montpellier for example). There was said to be pressure on them to set up instead where there are not enough doctors (France profonde). They felt this was unacceptable, went on strike for ten days and won their case. They have been promised there will be no restrictions on where they may set up their stall.
This is a spectacular (and, I repeat, less than publicised) retreat of policy, loss of nerve and defeat for common sense. In Montpellier there are too many doctors. I know of some who have so few patients they do not earn enough to make ends meet. Yet they stay, in the sun, and others continue to join them. Not that far away, in the Aveyron, Lozère and parts of the Gard, large rural areas are scarcely covered by two or three doctors, worked off their feet. My GP, I would guess in his mid 30’s, reckons to start work at 7.00 every morning and rarely finishes his house calls before 9.00 at night. If he can face it, he can work 7 days a week. If he takes a day off he risks losing patients to the man he refers to bitterly as “l’autre”. The system whereby patients could flit mindlessly from doctor to doctor (nomadisme médicale) has been tightened up, but is still engrained in many people’s heads. Of course as my GP says, there are two major advantages to being a country doctor: one is you see a much wider spread of medical problems than in a town (where there are specialists for every different type of sneeze), and two you earn a fortune. But, again as he says, “young doctors today” don’t want to work hard – or not that hard anyway, and want a varied and active social life, both of which I admit are hard to find in deeply rural France.
That’s from the doctor’s point of view. From the patients’ point of view (which is what the Minister of Health should have been defending), living in the country means a chronic lack of GP’s, self-employed physiotherapists, dentists and ophthalmologists (opticians can’t prescribe you glasses, so if you want a pair, you have to drive an hour and a half or more. An ophthalmologist in Millau told me there was not a single one in the whole of the Lozère department). It’s not that the individual service they provide is poor – it’s simply there are far too few of them to provide a proper service. It is not only rural France - large areas of the unpopular north - the Pas de Calais and areas on the Belgian border unvisited by tourists and unloved by many French, suffer the same chronic lack of doctors, especially in the hospitals. Nicolas Sarkozy recognised this and during the election campaign promised he would put an end to this surpopulation of doctors in certain areas and shortage in others. But last night his health minister backed down and gave in to the junior doctors who want to be able to choose where they live. And that’s the rub: reforms which adversely affect people who have become used to a high standard of living will simply not get through.
October 20th, 2007 at 11:12 am
More evidence of Sarkozy’s worrying tendency to promise popular solutions that in the event prove undeliverable - a trait he shares with his friend Blair, now being pretty comprehensively airbrushed out of British history. Sarko needs to watch his step - he’s been on a losing streak lately, what with Cecilia and the humiliated rugby team…could it be that les cheminots will score an early and easy victory?
October 20th, 2007 at 1:47 pm
One of the beauties of writing a blog (as oppose to a professional column) is that one can indulge in gut feelings/superstition whatever you want to call it. Yes, it does feel like he’s on a losing streak at the moment. Recently he has (deliberately) taken a back seat, having been accused of running the country single-handed, and it does not seem to work. He has to be the driver or nothing.
October 28th, 2007 at 5:46 pm
Please, do read again what we were asking for !!!!! You seem to write without knowing this subject… as many medias have done at the beginning of our strike.
Our “syndicats” stated clearly that YES there is a problem with medical demography in France and YES something HAS to be done about it. But none of the ideas the government was offering would have worked, as it is impossible for a GP to work alone in the middle of the countryside, no matter how willing he is, if he’s alone : no nurse, no laboratory, no radiologist, no physiotherapist, no ambulance service, no hospital nearby (not even mentioning, for his or her personal life, the absence of school, kindergarten, post-office and so on…). Putting a blame on doctors staying in town will NOT push them to the countryside…. Only encouraging measures can work (just allow them a few months, they are brand new !), and they will ! And if they don’t, then we are ready to talk again.
Maybe we are not ready to work as hard as the elder, even though most of us are willing to. But mostly, we want to give a good medical service to our patients, wherever they are, and that’s not possible yet in rural France.
October 28th, 2007 at 7:26 pm
Many thanks for your comment - it is exactly the kind of thing we need to hear. I did not mean to blame doctors (too dangerous, with so many in my own family), but attack the government for back-tracking on a necessary idea. What exactly were they proposing which you felt unacceptable? I accept that doctors do not want to be the first to arrive in a blighted area and find no back-up, but that is not the case where I live, one of the least populated parts of France (fewer people per square kilometre than in sub-saharan Africa). But there are self-employed nurses, the laboratory is 30 minutes away, the physiotherapist spends most of his day doing house calls, the hospital (no urgences, and limited surgery) is 30 minutes (though “They” periodically try to close it to merge with the bigger one 60 minutes away). It’s doctors and dentists we lack. There is a school (my son goes to it) for the moment there is a post office. Social life? Well, yes, that’s pretty limited. There are mayors round me who are offering to make a house available free for a GP, give her/him all the added extras a mayor can (subsidised transport etc), but still no takers
October 31st, 2007 at 12:22 am
Wow, hard to believe !
So they didn’t lie, it is possible to do a great job in some rural parts of France… But how do they advertise for it ? Does anyone still studying medicine know about your mayor looking for someone ? And does his administration tell the students BEFORE they have actually planned their lives and where they want to practice ? I guess it’s hard to change your plans at the last minute after 10 to 12 years studying and thinking about what you will do and where.
Just as an example an to show we are willing to help : during the strike, we met the head of our local CPAM and managed to work things out with them : they will come in our university once a year to meet the young interns in their 1st year and the students before they become interns, to tell them about all the opportunities our “région” offers. Until know, they only met the students once their “internat” was over, when they came to sign the “convention”, already knowing where they wanted to work. We really hope talking to very young interns will help some of them make plans to go to the countryside.
And if this doesn’t work, then I guess yes, we’ll have to find something else…
Many thanks for your very “constructive” (it that english ?) answer
October 31st, 2007 at 7:56 am
“Constructive” is certainly English, but in fact yours is far more constructive and helpful. Dialogue is always better than sermons, but it is a real shame that your point of view doesn’t get wider coverage. So thank you for that insight. I’ll find out where the mayor who is offering a house advertises it.