At the dawn of the wave of Covid-19 which was going to sweep over the healthcare system, he had promised "a hospital model different from what it was before, closer to our expectations and our ambitions to all".

It is officially because he considers himself unable to keep this commitment that Mr. Hirsch, 58, announced his departure from this juggernaut of the health system which employs more than 100,000 people and operates 38 hospitals.

He had been its managing director since 2013.

In a letter to staff, the senior media official with an atypical personality said: "It is because I thought I could not meet all the conditions for this commitment to be respected that I decided, there is a months, to put my post of director general of the AP-HP at the disposal of the government".

"I am convinced that many of the ills from which we suffer call for changes of the same magnitude as those which were made in 1958, when the university hospital was redesigned to restore its strength, nobility and attractiveness", he added. .

Words that resonate, at a time when the French health system and in particular the public hospital are facing a cyclical and systemic crisis which makes it tremble on its foundations.

Congested hospitals, growing medical deserts, "loss of sense" of the profession for staff, emergency services on the verge of syncope: the wounds of the healthcare system are raw at the end of more than two years of pandemic which have wrung out the caregivers.

Along with school, it is one of the two major projects of Emmanuel Macron's new five-year term, who has planned to launch his major health conference in July with the key to a "real collective revolution to be made".

In his letter to the staff, Mr. Hirsch shares his "passionate relationship" with the institution and those who make it live but also delivers a few spades.

vitriolic criticism

"At the AP-HP, we always find what makes us vibrate the most: solidarity, care, transmission, innovation, assistance, public service. We also still find there what makes us most angry. : the rigidities, the heaviness, the rivalries and the selfishness, the forces of inertia, the denigration", he wrote.

"He's a real killer. He has accelerated the processes already underway in the public hospital", comments, acid, Christophe Prud'homme, emergency doctor at Samu 93 and responsible for the CGT federation of Health and Social Action.

"His resignation is a non-event, we have little hope that the situation will change with his successor," continued the trade unionist to AFP.

According to government sources, the former chief of staff of Jean Castex at Matignon, Nicolas Revel, is the favorite to succeed him at the head of the AP-HP.

"He leaves the ship before it sinks after having ordered it for nine years", still tackles Marion Malphettes, doctor in the immuno-pathology department - threatened with closure - of the Saint-Louis hospital in Paris.

In May, a group of doctors had published in Les Echos a vitriolic column denouncing its "disastrous balance sheet" and listing a "degraded" budgetary situation, an attractiveness at half mast or even its "brutality" towards staff.

Martin Hirsch also had notoriously difficult relations with the executive regularly annoyed by positions deemed sometimes stinging or too alarmist during the health crisis, several government sources reported.

Asked about the departure of the boss of the AP-HP, the new Minister of Health Brigitte Bourguignon on the move in Vienne, soberly "welcomed the work he provided during these years for the public service".

Long stamped on the left but a member of Nicolas Sarkozy's government, Mr. Hirsch is known for his outspokenness.

It is also at the origin of the active solidarity income (RSA), which succeeded the minimum integration income (RMI).

© 2022 AFP