As of Monday, April 3, temporary doctors at the hospital can no longer be paid more than what the law provides, ie 1,390 euros gross for a twenty-four hour mission.
How to stop this phenomenon of temporary doctors paid by hospitals at much higher rates than practicing practitioners, to fill the increasingly gaping holes in certain services, without putting establishments in difficulty? Seven years after the law was passed, the rates for medical interims in public hospitals will therefore finally be capped, a turn of the screw assumed by the government despite fears of service closures.
When the former minister Agnès Buzyn set the maximum rate in 2018 at 1,400 euros for twenty-four hours, those concerned replied with a ” blacklist “ from hospitals to ” avoid “. When the device is reinforced with a second law in 2021, while the price of custody has fallen to 1,170 euros, Olivier Véran suspends in extremis its entry into force, in the midst of the winter wave of Covid-19.
A year and a half later, François Braun in turn promises to put an end to “the cannibal interim” and his “drifts” – up to 4,000 euros, or even 5,000 euros gross for twenty-four hours – “who will sign the death of our public hospital service in the short term”. This does not prevent him from dropping, a week before the deadline, an increase of 20%, to 1,390 euros (gross) for twenty-four hours. “A perfectly acceptable amount”he believes.
But the minister has been preparing for a difficult spring for months. “The temporary workers will go on strike or refuse to work, we know it perfectly, it will last a month”, he predicted in October. For “crossing the line”the regional health agencies (ARS) have been tasked with bringing the “territorial solidarity” between hospitals in “all areas at risk”. How much and where? “The situation is changing every day”dodging Avenue de Ségur.
“Restore attractiveness”
In the Great East, for example, “The situation is still very fluid”, recognizes Thierry Gebel. The regional delegate of the French Hospital Federation (FHF) is less worried than at the beginning of March, when he feared the total or partial closure of 79 services. Eventually, “few will be out of stock”because many establishments “have deprogrammed part of the activity” in order to preserve “the rarest resources”starting with anesthesiologists, emergency physicians and gynecologists.
Not sure that this degraded mode is enough everywhere to avoid the open crisis. The National Union of Hospital Replacement Physicians (SNMRH) has identified 167 services “threatened with imminent closure” in a hundred hospitals, mostly located in small or medium-sized towns. The temporary workers are “at least 5,000”do we figure in the union ranks, especially in the specialties “on the job 24 hours a day” – emergencies, obstetrics, anesthesia, paediatrics… The SNMRH even mentions “at least 10,000” interims.
“We are determined to refuse any cap”warns its president, the emergency doctor Eric Reboli, however lonely in the medical community.
The unions of hospital practitioners are indeed eyeing the potential savings on temporary work – which costs hospitals 1.5 billion each year – and are asking the government to open wage negotiations. “We must restore the attractiveness of hospital medicine”, argues Thierry Godeau, president of the National Conference of Medical Commissions of hospital establishments. On behalf of his colleagues from 750 public hospitals, he wishes “talk about guards, on-call duty”or “double overtime pay”.
Claim supported by the Order of Physicians, which judges at the same time as “certain excessive practices (…) ethically no longer have a place to be” and calls the temps and “hospital administration” To “respect tact and moderation in remuneration”. The hospital directors of the Syndicate of Executives, Doctors, Dentists and Pharmacists of Public and Private Health and Social Establishments of the French Democratic Confederation of Labor (Syncass-CFDT), the leading union among these senior civil servants, hope, “to be able to count on the support of the State”so that none of their colleagues find themselves “alone to assume the closure of a service for lack of practitioners accepting the rates set by the texts”.