Haro on the "mercenaries". As of Monday, temporary doctors, sometimes essential to keep an emergency department or maternity department open, will no longer be able to be paid more than what the law provides.

An obvious fact that should be imposed since the creation of this ceiling in 2016. Except that its application has so far hit the walls.

When former minister Agnès Buzyn set in 2018 the maximum rate at 1,400 euros for 24 hours, the interested parties responded with a "black list" of hospitals to "avoid".

When the device is reinforced with a second law in 2021, while the price of custody has fallen to 1,170 euros, Olivier Véran suspends in extremis its entry into force, in the middle of the winter wave of Covid.

A year and a half later, François Braun promises in his turn to put an end to the "cannibal interim" and its "excesses" - up to 4,000 or even 5,000 euros gross for 24 hours - "which will sign in the short term the death of our public hospital service".

This does not prevent him from dropping, a week before the deadline, an increase of 20%, to 1,390 euros (gross) for 24:00. "A perfectly acceptable sum," he said.

But behind the scenes, the minister has been preparing for months for a difficult spring. "Temporary workers will go on strike or refuse to work, we know perfectly well, it will last a month," he predicted in October.

To "cross the line", the regional health agencies have been tasked with using "territorial solidarity" between hospitals in "all risk areas". How much and where? "The situation is changing every day," one dodges Avenue de Ségur.

"Restoring attractiveness"

In the Grand Est, for example, "the situation is still very fluid," acknowledges Thierry Gebel. The regional delegate of the France Hospital Federation (FHF) is less worried than at the beginning of March, when he feared the total or partial closure of 79 services.

Finally, "few will be out of order", because many establishments "have deprogrammed part of the activity" in order to preserve "the scarcest resources", starting with anesthesiologists, emergency physicians and gynecologists.

Not sure that this degraded mode is enough everywhere to avoid the open crisis. The union of hospital substitute doctors (SNMRH) has identified 167 services "threatened with imminent closure" in a hundred hospitals, most of them located in small or medium-sized cities. Non-exhaustive list where no specialty is spared: surgery, pediatrics, psychiatry...

"We are determined to refuse any +cap+," warns its president, emergency physician Eric Reboli, although lonely in the medical community.

The unions of hospital practitioners are indeed eyeing the potential savings on the interim - which costs hospitals 1.5 billion each year - and ask the government to open a wage negotiation.

"We must restore attractiveness for hospital medicine," also pleads Thierry Godeau, president of the national conference of medical commissions of hospital establishments. On behalf of his colleagues in 750 public hospitals, he wants to "talk about guards, on-call duty", or "double overtime pay".

Claim supported by the Order of Physicians, which judges at the same time that "certain excessive practices (...) are ethically no longer ethically relevant" and calls on temporary workers and "hospital administration" to "respect tact and moderation in remuneration".

The hospital directors of the Syncass-CFDT, the first union among these senior civil servants, hope to "be able to count on the support of the State", so that none of their colleagues finds themselves "alone to assume the closure of a service for lack of practitioners accepting the rates set by the texts".

© 2023 AFP