The sick hospital of the interim | The echoes

It’s a mail of the start of the yr 2018 which circulated lots below the mantle, or quite, below the white coat. “Discover to substitute medical doctors in public hospitals”, he proclaims, the federal government “Needs to power by decree hospitals to cut back the remuneration of medical doctors substitute 25% day and 10% over the 24 hours in 2018”.

Gold “This remuneration has not been revalued for seventeen years”. Because of this, the collective created to defend these short-term staff “Checklist of hospitals to keep away from”, as a result of they apply the decree of November 2017 which goals to manage the tariffs of the medical interim. 36 names adopted, from the hospital in Le Havre to Grenoble College Hospital, by way of Mulhouse, Quimper or Périgueux. All boycotted by the mercenaries of the hospital.

The short-term staff make the most of the dearth of medical doctors to make use of on the beast, already very sick. They put an enormous pressure on the hospital price range.

Agnès BuzynMinister of Solidarities and Well being

Lists like this one, there have been a number of for the reason that well-known decree, ready by the previous Minister of Well being Marisol Touraine and signed by his successor Agnès Buzyn. The report of MP Olivier Veran confirmed in 2013 that the wage drift of the medical interim bled the general public hospital, with an estimated further price of 500 million euros and 6,000 practitioners concerned. The present minister speaks of “Hospital cannibalism”and in September launched new measures to limit these practices. “The short-term staff make the most of the dearth of medical doctors to make use of the beast, already very sick. They significantly burden the hospital price range “, says Agnès Buzyn on the “Echos”.

Nathalie Conan-Mathieu, delegate of the Hospital Federation of France in Brittany, agrees. The interim expenditure of public hospitals within the area has risen by 30% in 2017, to greater than 23 million euros, and has continued to swell since. Nevertheless, the 43 Breton hospitals have determined to struggle. In 2018, they created an observatory of tariff practices and awarded joint public contracts, choosing 5 medical interim businesses. Goal: to use the regulatory tariff and “Make life simpler for the part-time physician who offers a hand” quite than that of “Mercenary who comes for 24 hours with out investing”explains the hospital consultant. Using short-term work doesn’t solely price cash, the administrators insist: it disrupts teamwork, doubtlessly affecting the standard of care.

three,900 euros in 24 hours

This initiative has resulted in Breton establishments being blacklisted. “The Parisian emergency physician who desires to make a properly paid freelance will go to Normandy … till the Normans do like us! “ thinker Nathalie Conan-Mathieu. The fact is much less superb. Final yr, he missed 80 full-time equivalents to carry emergency providers through the summer time. All of the hospitals, besides Lorient, needed to let go of the tariffs of the interim, in different phrases to overpay. “We speak to one another. If there may be one which creaks, everybody lets go », commented a director of a Breton hospital. “The regional well being company is aware of it, but it surely prefers to not make waves”admits considered one of his colleagues.

Because of this, removed from the regulated tariff of 1,287 euros in 2020, an appearing emergency physician prices 2,400 euros for 24 hours in regular interval and three,900 euros in occasions of pressure, in response to Nathalie Conan-Mathieu. “The issue is that we’re beginning to be in pressure on a regular basis, as a result of the medical doctors within the office work lots, are compelled to separate their go away … A state of affairs that may result in strikes in emergencies”she continues.

Interim or closure

Interim has turn out to be very important for some establishments and unavoidable virtually all over the place besides in Paris. “Once I began, we didn’t use appearing. However for 3 or 4 years, that is the one resolution to not shut “says Dominique Colas, the director of the hospital heart Lamballe, in Côtes-d'Armor. President of the Nationwide Affiliation of Native Hospitals (ANCHL), he famous that even small establishments with out emergency service endure, lack of generalists, geriatricians, rehabilitators. So when the short-term staff put their situations, the administrators finally give means. “The compensation ceiling in 2019 is 1,700 euros for 24 hours; they take the examine, however supplied they work solely eight hours. Between this and a service closure that can price us from 100 to 200,000 euros, plus the workers to reclassify, it’s rapidly seen »he explains. Typically, the resort gives the TGV from Paris, a resort room and the free canteen.

Worry within the stomach

Like its European neighbors, France lacks medical doctors, liberals or staff. This scarcity is prone to final one other ten years. On the hospital, the emptiness charge for full-time hospital practitioners elevated additional by zero.9 level in 2017 and reached 27.four% in January 2018, in response to the Nationwide Hospital Administration Middle. An enormous quantity, even when
these missing positions can be filled

by contract staff, medical doctors with a overseas diploma or time beyond regulation saved on time financial savings accounts.

Since 2014, 5 specialties have been nearly affected: radiology and medical imaging (42.2% statutory emptiness), ophthalmology (39.eight%), occupational drugs (39.2%), medical oncology (37.6%) and anesthesia-resuscitation (37.2%). In truth, the deficiency is normal, which is why the speed beneath the common of 26.7% noticed in emergency drugs has not prevented the emergency staff on the verge of burnout from being on strike since March.

The chance of an absence of gas
even the best equipped hospitals

. All have worry of their stomachs. “We’re unable to rent anesthetists below the same old situations, that’s to say about four,000 euros to 35 years, 7,000 euros to 65 years, whereas in clinic they’re provided eight,000 or 9,000 euros monthly”testifies Cédric Lussiez, director of the hospital heart Nord-Essonne, but properly positioned, simply 10 kilometers from the capital. Particularly for the reason that train is extra snug within the non-public, with fewer guards, and extra surgical procedure scheduled from Monday to Friday.

The command construction is crumbling

So to encourage the troops, we’re not too choosy about working time, we provide practitioners a analysis mission, coaching … Medical doctors who would have as soon as dreamed of accessing the standing ask to turn out to be a contract for 3 years, with 60% extra wage. “However if you happen to solely recruit for the cash, it by no means lasts a very long time”regrets Jean-Pierre Heurtel, director of Quimper-Concarneau. By the way, the hospital's command construction is crumbling. “Twenty years in the past, there have been nonetheless highly effective managers. Now they’re scared to the concept their medical doctors are leaving, they can’t give orders like within the previous days. “, observes Cédric Lussiez. This doesn’t stop resignations and part-time shifts … to go and do short-term work within the hospital reverse!

Nevertheless, most of those administrators of establishments don’t want to “moralize” the controversy on medical interim. It doesn’t rhyme something with the youthful era, who doesn’t really feel disgrace to rent his providers not like the previous. “I simply had two youngsters, my spouse doesn’t work anymore, I would like cash”, says Rachid *, emergency doctor within the Paris area, who makes use of the interim to spherical off his finish of the month: forty years previous, he earns four,000 internet euros with out counting paid guards and time beyond regulation, to which he provides four or 5 interim days for about 2,000 euros. “I present a mean of 42 hours per week within the hospital and assist out with associates. I don’t fail in my mission »he justifies himself.

The younger physician has simply acquired his head of division to spend half time to do extra interim. “When you have got youngsters, it's quick, a three-week trip through the summer time. With the interim, we are able to work once we need. My motivation is monetary, however additionally it is to not tire, to see one thing else “, he confides.

The benefit of the non-public

“I took the oath of Hippocrates, however I didn’t wish to sacrifice my private life or make a vow of poverty”provides Christine Dautheribes, anesthetist physician and founding father of the group of medical doctors substitutes in public hospitals. If the numerus clausus was too tight ten years in the past, it isn’t the fault of medical doctors, she recollects. As well as, the standing of hospital practitioner isn’t “Not enticing by way of working situations, wage, and hardship, she judges. You do weekly guards for 24 hours in a row, it's exhausting, it represents 5 years of labor and extra on the finish of profession. “ The remedy, appreciable in comparison with the median wage of the French, appears to him chick: “We don’t hesitate to pay a pc scientist or a plumber very costly, why not us, who’re bac +10 and who’ve an enormous duty? “ She asks.

Non permanent staff now not wish to conceal and really feel able of energy. “Some are spoiled youngsters who select the hospital the place they wish to go and their pay”says Eric Marcou, director of operations at Aile médicale, one of many three main businesses of medical interim, which offers all kinds of establishments in hospital practitioners, from the clinic to giant college hospitals. For the reason that decree of November 2017, he continues, medical doctors are extra prepared to show to the non-public sector, which pays higher – particularly since these establishments can get better 20% VAT on every service, not like the general public sector. “Demand is secure, however recruitment is harder,” he concluded.

Pact of hypocrites

The temp company requires these practitioners to signal a doc stating that they aren’t employed within the public service. A pact of hypocrites, to which the state subscribes because it regulated an exercise … theoretically forbidden. Rachid additionally made a written pledge to his predominant employer, the Paris Public Help-Hospitals, to not work elsewhere. A bit of paper with out a lot worth in his eyes. “Anyway, if we attempt to cease us from working extra, we'll all go away the general public hospitalhe eludes. Those that are full-time will transfer on a part-time foundation. And if we’re prevented from appearing, we’ll do medical help to repatriation, we’ll work for festivals or occasion firms. “

As for the brand new deterrent measures, comparable to the duty for the short-term employee to take out insurance coverage at his personal expense, they make the already insured individuals smile. The stick coverage undoubtedly doesn’t scare these mercenaries. A “carrot” may finally deliver them dwelling.
The government plan for the hospital

, imminent, is very anticipated by hospital practitioners increasingly tempted by the journey exterior the partitions.