No more volunteering, place for a "collective obligation" of call duty in the evening, on weekends and on public holidays for all liberal doctors and caregivers: this is the meaning of an amendment to a bill brought by Renaissance MP Stéphanie Rist, voted on January 19 in the Assembly.

In 2002, following a long strike, the duty of care was removed from the code of ethics of the medical profession.

It had been replaced by a collective system of outpatient care (PDSA) based on voluntary service, with remuneration in the form of flat rates.

Two decades later, while hospital emergencies are overflowing, the pressure is mounting again on the Liberals, from the executive as well as within the framework of the negotiation of the convention which must link them to Health Insurance for the five years to come.

When the permanence of care falling under liberal practitioners "is poorly assured or more assured, everything happens to the hospital", underlined Emmanuel Macron during his wishes to the world of health, on January 6.

We must therefore "re-empower and encourage to have a permanent care in town. The French must easily find a doctor on call", scolded the President of the Republic.

Remarks little tasted by the unions of liberal practitioners, even if the head of state specified that these guards would be "better paid".

The representatives of the doctors are surprised by the threat of new "constraints" whereas according to them the PDSA, as it is currently organized, works.

Admittedly, barely 40% of GPs took part in call duty in 2020, according to a report by the Order of Physicians.

But that did not prevent more than 90% of the national territory from being covered by the permanence of care until midnight and on weekends.

"Deep Night"

Some doctors also provide "deep night" shifts (0H-8H), even if they are rare for liberals and generally very calm.

"When I finish at 8 a.m., I have no compensatory rest. At 9:15 a.m., I am at the retirement home with my patients", underlines Luc Duquesnel, representative of general practitioners within the CSMF union.

"We have a job that attracts less and less young people and we are loading the boat for us ... It's humiliating because the work, we do it", assures this doctor from Mayenne, who argues that the weekly working time of a general practitioner has been estimated at 55 hours.

For the SML union, "it is particularly serious to force liberal doctors, a very large part of whom are over 60, to take on call duty".

"Resuming consultations after a sleepless night is like working with a positive blood alcohol level", supports Corinne Le Sauder, president of the Federation of Doctors of France (FMF) and general practitioner in Loiret.

To express their dissatisfaction, the unions have called for a strike by the guards since January 23, the participants in the movement exposing themselves to requisitions.

They now have in sight the examination of the Rist bill by the Senate from February 14, and have already planned a rally that day in front of the Luxembourg Palace.

At the same time, they prepare their proposals.

In particular, they would like Saturday morning to also be taken into account for the permanence of care, in order to obtain better remuneration and because "doctors want to be able to have two days off, like everyone else", underlines MG France , the first union of generalists.

A prospect that the Minister of Health, François Braun, seemed to dismiss, "not sure that this is the best solution" to the difficulties of access to care.

© 2023 AFP