Direct access to physiotherapists and speech therapists: why is the Rist law a step forward for these professionals?

Laura Laplaud 1:00 p.m., February 14, 2023

It is a text that arouses the anger of liberal doctors and the happiness of other professionals concerned such as nurses, midwives, physiotherapists and speech therapists.

Liberal doctors are demonstrating this Tuesday in Paris against the bill brought by Renaissance MP Stéphanie Rist which should simplify access to care.

Improve patient care

The text provides for the broadening of the skills of several professions.

Concretely, if the law is promulgated, you will no longer need to go to your general practitioner to obtain a prescription for speech therapy or physiotherapy sessions in a health establishment.

Midwives will now be able to prescribe work stoppages without time limit and prescribe treatments and screenings to their patients and partners.

While pharmacists will have the right to screen for cervical cancer directly in pharmacies.

A text intended to improve patient care.

A bill welcomed "with the greatest interest" by Sébastien Guérard, president of the FFMKR, for whom direct access could only simplify their work.

“When you have a young mother who arrives in front of the cabinet door on a Friday evening, with a congested infant, either you examine the little one or you send him to the emergency room” knowing that the hospitals are saturated.

According to Mathilde Delespine, midwife at the University Hospital of Rennes, the bill carries claims that have been put forward for a long time by the profession.

"When we are monitoring the pregnancy of a pregnant woman, it makes no sense to ask the attending physician to only stop working. It's a consultation for nothing," she believes.

Disdainful liberal doctors?

In detail, the law also wants to expand the missions of advanced practice nurses (IPA).

They will be authorized to make primary prescriptions.

"This is where the shoe pinches," laments Sarah Degiovani, president of the National Federation of Speech Therapists.

“For the doctors, it is not possible to accept that another professional, who has a lower level of training, will eventually ensure this permanence in the territories or at times when the doctors will not be or no longer present. "

Some doctors have been very critical of this bill.

In a press release dated January 5, the College of Physicians and the unions denounced a “multi-speed medicine”.

"They are on the wrong target," said the president of the FFMKR.

"Their anger, their exasperation is the result of successive health policies that have helped to organize the shortage of doctors, as they describe it."

"We absolutely need doctors, there is no subject. I have the deepest respect for the work of doctors but I find that the posture they hold is very complicated", continues Sarah Degiovani.

A bill that has its limits

Sébastien Guérard like Sarah Degiovani would like to point out that this law guarantees a systematic return to the attending physician.

"In the absence of feedback to the doctor, the professional is not paid and it is we who carried out these measures because we are convinced that the doctor must remain at the center of the system and must remain the pilot of coordination. This is not an anti-doctor measure", assures the president of the FFMKR.

They also point out that this bill, if it remains a good step forward for their profession, does not go far enough since only physiotherapists, speech therapists, nurses working in a multi-professional health center (MSP) can benefit from direct access.

A point that does not bode well, advances Sébastien Guérard, since it affects less than 3% of physiotherapists in France, according to an IGAS report in 2021. In Paris, out of 750 speech therapists, six will be affected by the law. .