“On opening day at 8 a.m. there were already 14 people”

A giant of private medicine to solve the problem of medical deserts: the Ramsay Santé group, an Australian multinational and leader of private hospitals in France, opened in 2022 four health centers of a new kind. The doctors there are salaried, do not work more than 40 hours per week and the organization of care is streamlined to accommodate more patients.

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The first of these health centers opened in Pierrelatte, in the Drôme, where it was eagerly awaited. Among the 15,000 inhabitants of the city, a third have no attending physician. This was the case of Simone, 69, whom we met in the waiting room of the new Ramsay center which opened at the end of January: “There are not many doctors in the city. Ours left in December on retirement. I still have a fairly serious pathology so I absolutely needed a doctor. The day the practice opened , I came to the door at 8 a.m. and there were 14 people there.”

Four days after the opening of the center, there were already 600 patients registered in the schedules. The objective of the establishment being that each of its four general practitioners treats 50% more patients than a liberal doctor. To achieve this, the center optimizes medical time: two secretaries manage administration and payment. A nurse compiles a complete patient file with the patient’s history, current treatment(s) and lifestyles. By delegating all these tasks, the doctor saves time and can thus treat more patients.

The mode of remuneration of doctors is also overhauled. In these centres, GPs are not paid per consultation but on a flat rate basis. Health insurance pays the Ramsay center an annual sum for each patient. The older the patient, the more serious his illness and the larger the sum. An operation that raises the concern of certain professional organizations.

“The group does not spend a pennydeplores Jérôme Marty, general practitioner and president of the French Union for a free medicine. On the other hand, the center has doctors who are paid by national solidarity. For them, it’s all good! They calculated the number of diabetic patients they are going to have and the cost of managing diabetes over the year. They present the note to the Health Insurance saying: ‘It will do so much, give us an envelope, we manage it and we pay the employees.‘ But the clinic is responsible for not going over the envelope.”

“We don’t want this supermarket medicine. It’s not the place for these groups to come to independent medicine that protects the patient.”

Jérôme Marty, President of the French Union for Free Medicine

at franceinfo

Jérôme Marty and others evoke a sorting of patients according to their profitability. It is still a bit early to tell. Ramsay also refutes this accusation.

With this lump sum paid to Ramsay, the company pays general practitioners. This salary is synonymous with stability: fixed salary, a limited number of hours and 40 hours per week. This convinced Dr. Anne Dubois Garnier, who has just joined the center. She found there a comfort of life that she did not have when she practiced as a liberal: “There is pressure related to paperwork and quite simply to the number of patients. We are not machines! We say yes, but at the cost of hours and hours of work. For me, doing medicine general, the job that I love, 40 hours a week over four days, that changes everything. I think that’s what will allow young doctors to get into this dynamic.”

And the wage system seems to work: the town hall of Pierrelatte has seen it. For years, she has been trying to attract, without success, new practitioners to her town, while in a few months, the Ramsay group will allow the installation of four general practitioners at once. A first success therefore for the health giant which does not intend to stop there. If this local experimentation is convincing, Ramsay wishes to create many centers all over France.