After the entry into force of the Rist law, some establishments fear that they will not be able to replace all the practitioners during the summer period.
Will hospitals keep all of their departments open this summer? The question arises in hospitals, after a particularly difficult month of April to complete schedules without closing beds. The application, at the beginning of April, of the Rist law, which caps the salaries of temporary doctors at 1,390 euros gross per 24-hour call, has weakened the functioning of hospitals, already shaken by the Covid-19 crisis and chronic shortages. of staff. “The management teams are suffering, as are the medical and nursing teams”regrets Jérôme Goeminne, President of the Union of Public Health Managers (SMPS).
>> Hospital crisis: why does the law capping the salaries of temporary doctors raise fears of new difficulties?
In a tight budgetary context for the hospital, this law aims to put an end to the logic of supply and demand which pushed establishments to offer much higher prices to substitutes than to incumbents. “Temporary work is almost two billion euros per year for the public hospital”, figured the president of the French Hospital Federation, Arnaud Robinet, on franceinfo, Saturday April 29. IHowever, the use of this type of contract is essential for the proper functioning of many hospitals. To the point of threatening the maintenance of certain services.
Maternities have already closed
The use of temporary workers is mainly practiced in regional hospital groups (GHT), located in medium-sized towns. There is even “endemic”, observes Quentin Henaff, in charge of human resources at the French Hospital Federation (FHF). For example, the Grand Cognac hospitals have 50 temporary doctors for 67 permanent staff. Conversely, university hospitals (CHU), located in metropolitan areas, do without it more easily. At the Rennes University Hospital, they represent 0.6% of the medical staff.
“According to the answers to a questionnaire that we circulated, we would be 20% of hospitals to have closed services or beds”, since the application of the Rist law, says Jérôme Goeminne. This is the case of the maternity wards of Sedan (Ardennes), Sarlat (Dordogne) or Guingamp (Côtes-d’Armor). For his part, the National Union of Hospital Replacement Physicians (SNMRH) identified 389 establishments, out of just over 1,300 in France, forced to deprogram operations or close services during the last week of April. “There are weaknesses, but they existed before the implementation of this law“assured François Braun, the Minister of Health, on France Inter.
“I prefer to reduce the sails”
However, summer is fast approaching. Due to the holidays, the July and August schedules have always been difficult to organize and the Rist law has added a knot to the puzzle. The Cœur Grand Est group strives every day to find a doctor. In this GHT which brings together eight establishments from Meuse to Haute-Marne, the medical affairs department, responsible for recruiting practitioners, has only one idea in mind: to convince substitute doctors, contract or interim, to join the faster their team for a fixed term.
For a job, “we sometimes see four to five times the practitionerexplains its director, Jérôme Goeminne, with, each time, an hour and a half of maintenance and four people around the table. Not to mention all the administrative work. It must be said that in this hospital, before April 2023, 17% of replacement doctors were paid beyond the regulatory ceiling. “In all, this represents 80 doctors to be recruited and each time, the same process.” A very time-consuming task, which led Jérôme Goeminne’s team to put other issues on hold, such as staff training, risk issues around workplace safety or team organization.
If he managed to complete the April schedules without exceeding the authorized ceiling, the director does not hide his concern for the months to come. “Like every year, we will be forced to close beds“, he laments. Ditto at the GHT du Grand Cognac, where his colleague Julien Bilhaut estimates that he will have to do without 40 beds to guarantee patient safety. “I don’t want to DIYhe justifies. I prefer to reduce the sails and set a course, to secure and reassure the staff, because the period is terribly anxiety-provoking.”
A more binding alternative contract
Almost 700 km away, Pierre Pinzelli, director of the Avignon and Cavaillon hospitals, wants to be more optimistic. “When the text was announced, we had fears and questions”, he admits. Finally, the month of April has passed “without suspension of activity or modification of the care offer”. Its solutions: the reorganization of its services and the implementation “an individual dialogue with each doctor”. To do this, rather than temporary contracts, he proposed so-called “pattern 2” contracts, provided for by the Rist law.
These make it possible to exceed the new ceiling by remunerating 24-hour care up to 1,700 euros, provided that the Regional Health Agency accepts it and that the practitioner makes a long-term commitment. “With these offers, the ratios have changed. Before April, we had 65% of temporary doctors in the emergency room and around 50% in the other departments”, explains Pierre Pinzelli. Since April, the trend has been “inverting”. Interim now only represents “15 to 25% [des effectifs] according to services”he assures.
Jérôme Goeminne has also chosen these contracts to ensure the sustainability of his teams: “We have signed around twenty of them, in agreement with the ARS, because even if they are more expensive, practitioners commit on average for three years.” However, the president of the SMPS, a great defender of the measure, recognizes that “this summer and the following months” are going to be very difficult.
“There will be many holes”
If solutions were found at Easter, not all of them are sustainable. Like the additional guards provided by the holders, which increase the workload and therefore the risk of new departures from the hospital. “It will go wrong in some establishments”predicts Eric Reboli, president of the SNMRH. “For example, in Bastia, how will they do during the holidays? Trigger a white plan that will requisition staff and prevent everyone’s vacation? The incumbents aren’t going to like it at all.”
To avoid this announced catastrophe, the director of medical affairs at the Rennes University Hospital, Julie Courpron, intends “sanctuarize the holidays of July and August” of his teams. “But it will be very complicated, because we know that there will be many holes in the schedules. We are thinking as much as possible to share resources and guarantee the maintenance of all activities. We managed to spend April, but will we spend the summer No one can tell.” Uncertainty is already hovering over the months of May and June, when “some specialties are still not filled”.