Dr Patrick Pelloux is an emergency physician and President of the Association of Emergency Physicians of France.
FIGAROVOX. - The liberal doctors start a new strike and ask for a revaluation of consultations from 25 to 50 euros. How to interpret this request? Does it seem legit to you?
Patrick Pelloux. -
We must first consider that this demand requires the doubling of their salary, which is quite substantial.
If hospital workers or railway workers asked that, everyone would be up in arms.
Then they go on strike when many liberal doctors are already on vacation, and do not take into account the absolutely catastrophic crisis that we are experiencing in public hospitals.
This strike therefore leads to an abandonment, in a way, of the population and of the demand for patients, which I find quite worrying.
I don't have to judge their strike, but I think we have a collective responsibility with regard to the sick.
In addition, I see a lot of compensation requests in their demands, but very few structuring proposals for the health system.
I also notice that large organizations like MG France, which are always proactive, do not take part in the strike.
It is therefore not known whether they really all agree with these claims.
In reality, we have enough resuscitation beds, they are there equipped, with oxygen, but what we lack to use them is personnel.
Patrick Pelloux
Does this strike reveal, more broadly, a general crisis in the health system?
The health system is currently down.
Its progressive destruction was launched in 1995 with the Juppé plan, so it is a long-term process.
This slow destruction has worsened over the past five years, although Emmanuel Macron denies any responsibility.
The State has abandoned its sovereign role of organizing the health system.
When there was the Covid crisis, the government took fright, it feared a social explosion, that people would die en masse and that this would lead to revolts.
It didn't happen because the health staff worked actively and we blew up all the limitations, on equipment, staff, overtime... But the health system was totally unprepared to a health crisis,
for 30 years, successive governments have postponed the necessary reforms.
And it was indeed the role of the confinements to avoid a collapse of the public hospital.
It allowed the state not to be faced with its responsibilities, and its inaction for years.
Those who have been tasked with managing the health crisis are the very ones who have let the public hospital die, little by little.
A number of health professionals complain about the lack of resources in public hospitals, for example there is a lack of intensive care beds in Île-de-France this week. Have we learned lessons from the health crisis?
No, the government has absolutely not changed its policy.
Today, they are trying to make us believe that the crisis is due to epidemics, to the general practitioners' strike, so as not to change hospital policy.
And the government brandishes the "National Council for Refoundation" to deceive, to let us imagine that they are undertaking major reforms, while around the table are the same people who led to the failure of the system, and nothing changes.
Regarding hospital beds, it will be nice to pay billions that will not change much.
In reality, we have enough resuscitation beds, they are there equipped, with oxygen, but what we lack to use them is personnel.
However, as long as we do not increase the salary of hospital workers by 30%,
we will not create a shock of attractiveness and recruitment.
You have to take into account inflation, the cost of living, especially in Paris.
Nurses, if they have children, can no longer survive with 2,000 euros per month.
Patients feel abandoned, so do rural hospital workers, and no politician takes the problem seriously.
However, the public hospital service makes the difference between life and death.
Patrick Pelloux
As for doctors, many integrate institutional bodies such as regional health agencies, in order to have better working conditions.
This allows them not to work weekends and nights, as well as having a reduction in responsibilities.
Others, in order to improve their salaries, multiply teleconsultations by substituting them for traditional consultations which take more time.
Instead of one consultation in one hour, they can do four over the same time.
It's called e-health, but the results are catastrophic.
And the number of people who stop their treatments and no longer consult because there are no more doctors, is increasing dramatically.
There are therefore many people who allow their disease to worsen or who have worrying symptoms, and do not react because of the lack of doctors.
Should we reform the health system in general? If yes, how ?
There are several things to change.
I think that the isolated exercise of the doctor alone in his office is over, it is necessary to move on.
Group work should be encouraged.
I also believe that it is necessary to make participation in the permanence of care compulsory for all doctors, including those who work in technostructures.
France can't train doctors, if it's so that they don't see any more patients afterwards.
Hospital doctors are obliged to be on call, to participate in the permanence of care, while city medicine has absolutely no obligation.
In addition, liberal doctors have been exempt from tax by 70% for the permanence of care since 2008. This is a real tax gift, which the public hospital world does not enjoy.
There is a real problem of inequality.
If we speak in terms of figures, a liberal doctor earns 100 euros per hour for his night calls, so he does calls for 1600 euros tax-exempt, while the hospital doctor does night calls for 243 euros taxed .
The fight against inequalities should be one of the major objectives of health system reforms.
We must also work to bring surgery back to public hospitals.
Today there are large university hospitals without orthopedic surgeons.
Finally, we must revalue psychiatry and child psychiatry, the psyche is very important.
Admittedly, all this has a price, but it is a public and social necessity.
Patients feel abandoned, so do rural hospital workers, and no politician takes the problem seriously.
However, the public hospital service makes the difference between life and death.