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Mission coalitions: towards a new model for liberal medicine?

Thursday, April 15, 2010

Doctors, even if they have never been as many in France, settle less and less in the office, in particular general practitioners. This worrying situation, coupled with an aging of physicians in practice and a growing interest in wage-earning, led the President of the Republic asked February 1, 2010 the Dr. Michel Legmann, president of the National Council of the order of physicians (Cnom), to preside over a mission of reflection on this subject in order to propose improvement measures.

To achieve this, Dr. Legmann and its working group, comprising “politicians, liberal physicians, personalities and qualified experts” auditioned on numerous occasions by representatives of the medical professions of medical students, junior doctors and officials of large institutions.

These experts have first proceeded to a State of play, who joined the recent conclusions of the Cnom and those of trade unions:
-uneven distribution of the workforce,
-regional disparities that are increasing,
-a gradual ageing raising fears of massive retirements in the coming years,
-a feminization of the profession. Gold women “produce 30% of care less than men, presumably because their family constraints”,
-a growing interest in the choice of a non-liberal profession.

Result, the number of doctors installed in cabinet will inevitably decline in France in the coming years, while at the same time the French population will continue to grow, as well as because of its aging care needs.

In addition to aging and feminization, 3 other factors identified this disaffection are:
-the attractiveness of the wage system, that allows to protect themselves from the legalization of medical practice and work on fixed schedules;
-the training, currently focused on hospital;
-the bureaucratization of the Liberal medicine (permanent requests for writing papers, certificates, records, social security, etc.) coupled with an increase in controls and administrative obligations.

The coalitions mission therefore proposes to act on 3 axes:
-initial training, which in the future could include courses in discovery of the Liberal medicine as early as the second year, as well as 2 semesters of required specialisation courses for all internal General Medicine (against one now, or even none in some universities). Once the doctor is installed, it could be offered further training to diversify its activity.
-Installation: a regional single-window could help the doctor to settle by centralizing all information necessary; obligation current reporting of leave, lived as a harassment, could be deleted, as well as the obligation to exercise in a deficit area (contract solidarity health). By contrast a liberal exercise in such a zone would be valued;
-The conditions for exercising: groupings would be favored in order to “simplify hardware and administrative problems” and integrated into a territorial organisation with a platform of services (telemedicine, multidisciplinary, meeting local consultations, etc). New functions of health assistant”and”Coordinator support”could also be created, in order to”allow doctors to focus on their core business”, for which the conditions of remuneration could be reviewed. Finally information systems would be improved, as well as social protection of liberal practitioners (retire for example).

The authors of the report emphasize “current disenchantment of all liberal doctors, the motivation of young people and the concern of local elected representatives”, which requires “implementing bold reforms”. A challenge maybe by Nicolas Sarkozy and Roselyne Bachelot tomorrow when they travel in Seine-Saint-Denis on April 16 to announce what timetable and plan of action are envisaged for reforming the medicine of proximity.

Jean-Philippe Rivière

Source: “Definition of a new model of liberal medicine”, mission entrusted to Dr. Michel Legmann, April 2010, downloadable online on the website of the French Documentation