French MPs have approved a bill that will see doctors sent to areas in France that are lacking in MPs and healthcare provision - although the proposition is unpopular among most doctors.
MPs approved the bill on May 7, and adopted it by 99 votes in favour to nine against.
Read also: What is being proposed to help people in areas that lack doctors in France
The proposal was initially put forward by a cross-party group of more than 250 MPs, including from La France Insoumise party and the Les R茅publicains. The 鈥榝lagship鈥� part of the bill (the rule that will require GPs to seek approval to start practising in a certain area) was first approved in early April.
Overall, the bill aims to provide for 鈥渢he regulation of the establishment of doctors鈥� across France. It states:
Before setting up practice anywhere, private or salaried doctors will have to seek approval from the regional health agency (Agence R茅gionale de Sant茅, ARS)
In underserved areas, their approval application is likely to be automatically approved
In better-served areas, doctors will only be able to set up practice when another doctor leaves
The approval process will include:
A 鈥渢erritorial indicator鈥�, which takes into account the 鈥渕edical time available per patient鈥� (because in many places even if patients can get an appointment, there is rarely enough time to discuss their issues in enough detail)
A consideration of the 鈥渄emographic, health and socio-economic situation of the territory鈥� and whether it needs more doctors.
Bill proponent MP Guillaume Garot, who has been working on it since 2022, has said that it is necessary because 鈥渟ix million 麻豆传媒映画 do not have a regular doctor and eight million 麻豆传媒映画 live in a medical desert.
鈥淭his inequality creates a detrimental feeling for our Republic, which has failed in its promise of equality for all in terms of healthcare.鈥�
The bill is now set to be examined by the Senate. The criteria for determining which departments are underserved or over-resourced is a major point set to be discussed and refined.
Similar regulations on location already exist for nurses, physiotherapists, midwives, and dentists in France. Yet, until now, they have not applied to GPs and independent doctors.
Yet, in Germany, the establishment of doctors is already regulated in this way, while in the UK, doctors often do not get a choice when it comes to where they begin work.
What is an 鈥榰nderserved鈥� area or medical desert?
Currently, in simple terms, a 鈥渕edical desert鈥� is defined as an area in which patients have access to fewer than 2.5 consultations with a local GP per year on average. This may be because they cannot get an appointment, there are not enough doctors, or because they live too far away from their nearest GP surgery.
The term can also be used to describe areas in which there are not enough GPs so time with the patient is very stretched. In this case, even patients who do get an appointment may find they do not have enough time to properly explain their problem and the GP does not have enough time to offer them a good level of care.
Read also: Map: How well (or not) each French area is served by health workers
Read more: Eight facts to understand France鈥檚 issue of 鈥榤edical deserts鈥�
Read more: My experience of 鈥榤edical deserts鈥� in rural France
Ultimately, living in a medical desert can lead to a decline in the health of the population and result in poor health or even dangerous conditions due to not being able to see a health professional quickly enough, or at all.
It can also mean that hospitals become oversaturated as more people go directly to an A&E department instead of their GP, or end up having to go to hospital for a condition that could have been prevented if they had seen a GP earlier.
People with chronic conditions may not receive adequate monitoring and their issues may worsen.
How many people are affected?
Recent suggest that around 8% of people in France live in a medical desert. This equates to around 5.4 million people.
It does not only apply to rural areas, and can depend on medical provision compared to the population saturation (e.g. some areas of Ile-de-France are affected despite the number of doctors and healthcare professionals in the Paris area).
Opposition
The proposal is not popular among many doctors, particularly medical students and interns, many of whom took to the streets to demonstrate against the plans at the end of April.
鈥淭his proposal will undermine the appeal of private medicine, which is currently the first line of defence in the healthcare system,鈥� said Lucas Poittevin, president of the national medical student association l鈥橝ssociation nationale des 茅tudiants en m茅decine, at the time.
Read also: Doctors threaten strike against bill mandating where they work in France
Minister of Health Yannick Neuder is not in favour of the bill either, saying that 鈥渢he cure is worse than the disease鈥�. Instead, he has suggested that more healthcare workers should be trained. He is set to try to implement this 鈥渋n conjunction with the Senate鈥�, he told TF1 this week.
Prime Minister Fran莽ois Bayrou has stated that regulation is necessary, but has not come out in total favour of the bill. Yet, he has warned that if negotiations fail with doctors, 鈥渢he government will intervene鈥� to ensure some form of regulation is imposed.
Some healthcare practitioners have also proposed alternatives, saying that a possible measure could be to require doctors to practice for at least two days a month in underserved areas, rather than being required to relocate entirely.
鈥淚t is not freedom of establishment that jeopardises access to healthcare, but the structural shortage of doctors [and the] lack of attractiveness of the private sector,鈥� said the Jeunes M茅decins union in a statement.
Some healthcare professionals have also called for much more support for doctors who set up in underserved areas, and claim that the current incentives (such as an increase in GPs鈥� flat rate) are not enough. In late 2021, government healthcare statistics service DREES said that these financial incentives were largely insufficient to attract doctors to these areas in the numbers needed.
Alternatives?
Some other methods to help underserved areas have already started to emerge in some places. For example, some GPs have set up 鈥榤edicobuses鈥�, which visit and offer mobile consultations and other services.
They are designed as 鈥渁n essential complement where it is not possible to set up a health centre鈥�, and are mainly targeted at rural areas.
Similarly, other 鈥榟ybrid solutions鈥� include systems where patients can see a doctor via a teleconsultation (such as an online video call), and - using tools provided, such as a stethoscope - the patient can do simple tests themselves while being guided by the practitioner.
However, the government has said that these areas cannot rely on mobile buses or telehealth.
