Would the cure be worse than the disease? It has been almost a year since the cap on temporary medical remuneration was put in place by the government, to put an end to the “excesses” of price inflation among some of these replacement practitioners at public hospitals. Since April 3, 2023, twenty-four hour care has been paid a maximum of 1,390 euros gross, under penalty of refusal from the public accountant.
Among those who, in unison, denounced the “excesses” of the system and called for this regulation of temporary employment, concern is growing in the face of a new phenomenon: the multiplication of “reason 2 contracts”. Or a form of circumvention of the new rules, within a framework authorized by public authorities. “As for the interim, there is an omerta on the subject, points out Doctor Thierry Godeau, head of the National Conference of Presidents of Medical Commissions establishing hospital centers. But if this continues, we risk completely deregulating the status of hospital practitioner! »
Provided for in the regulatory texts, the reason 2 contract, which has replaced that of clinicians since 2022, allows health establishments to recruit contract workers – for a maximum of three years, renewable once – at rates much higher than those of the grid for hospital practitioners: the ceiling is set at 119,130 euros gross per year, including a variable portion depending on objectives. This is a figure which exceeds the amount reached at the thirteenth and final level of practitioners (i.e. 112,416 euros gross, excluding permanence of care, bonuses and compensation).
“This is becoming the recruiting standard”
This contract is planned “in the event of particular difficulties in recruiting or exercising an activity necessary for the provision of healthcare in the region”, with necessary authorization from the regional health agency (ARS). But since the capping of interim employment, the floodgates have been opened much more widely in many regions, reports on the ground, to compensate. “It varies greatly depending on the territory, but it is becoming, in certain establishments, the recruitment norm”continues Doctor Godeau.
Medium-sized establishments are affected first, unlike university hospitals, which remain relatively unscathed. And this goes well beyond the former temporary workers thus retained in certain departments, he is alarmed: now, young doctors are starting out this way. “We note that the application of the conditions is too flexible and too heterogeneous to use the reason 2 contract”agrees Zaynab Riet, general delegate of the French Hospital Federation, who calls for a “national supervision”.
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