Public hospitals are trying to anticipate the future ceiling on the remuneration of temporary doctors. Reinforcements yet essential to the proper functioning of certain services.
They are called the “mercenaries” of the hospital, sometimes paid for in gold. From Monday April 3, the government will try to put an end to the excesses in the salaries of temporary doctors, who earn “up to €6,000” for 24 hours of work, says the Minister of Health. From now on, the law will apply with a salary capped at almost 1,400 euros gross for 24 hours, a ceiling raised by the Minister of Health, François Braun, on Sunday March 26.
>> Crisis in the hospital: how the Minister of Health wants to tackle temporary doctors
The government expects weeks of arm wrestling, because some temporary workers have indicated that under these conditions, they will no longer work at the hospital and say that they will last several months if necessary. Among them, Dr. Eric Reboli, he is an emergency doctor and also president of the union of hospital replacement doctors. According to his calculations, the maximum remuneration of 1,390 euros gross for 24 hours of work, amounts to less than 40 € net per hour. This is insufficient according to him: “We are asked to go to establishments which are in difficulty, where we replace one or even two doctors at a time.”
Extended days
Eric Reboli denounces a workload “enormous”, “24 hours straight without sleeping, most of the time without eating” describes the doctor, “and then afterwards, we hit the road again to go home, whereas the day before, we slept at the hotel and possibly covered hundreds of kilometres”. “We hold the hospital at arm’s length, notes Eric Reboli, And it is the temporary workers who plug the hole, who sometimes travel hundreds of kilometers to prevent a service, an establishment, a block, a maternity hospital from closing.“
According to the Minister of Health, some temporary workers take up to €6,000 for 24 hours of work. “These are exceptions”, answers Eric Reboli directly, “there are around 10,000 to 12,000 temporary workers in France, not 12,000 of us earn €6,000 per shift. On average, for a 24-hour shift, I earn around €1,500. If we deduct paid leave and precariousness, this represents the sum of €50 per hour. For a doctor with a Bac+10 level, that seems to me to be a fair salary. The maximum that I was offered was €2,500 for 24 hours in a hospital at the other end of France, nobody wants to go there”
“Our hospital has the largest technical platform in the department, Rodez cannot close its emergencies. That’s impossible”.
Head of the emergency unit at Rodez hospitalat franceinfo
For their part, public hospitals are preparing to do without these temporary workers. Within the emergency department of Rodez, in Aveyron, four positions of doctors are not filled and a dozen temporary workers take turns. They are paid up to €1,400 for 24-hour care. But for the month of April, these replacements have not made it known whether they will work, so Dr. Séverine Cahun, the head of the pole, has made her schedules without them. “In April, all incumbents will work between 30 and 40 hours of overtime”, explains Dr. Cahun, “it’s a little more than what we usually do”. But in the service, everyone accepted, “It’s already difficult enough as it is, so we are all united and we all do additional time on a voluntary basis”.
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How to do without temporary workers, what are the other solutions? These questions, the departmental director of the Regional Health Agency, Benjamin Arnal, has been working on for several months. “We must also work on adapting the offer, deprogramming certain activities, for example, such as those which would not have immediate consequences on the health of patients”, explains Benjamin Arnal. The departmental director of the Regional Health Agency can also count on support outside the department, “especially with the support of the CHU if possible. There have been requests that have been made, for example in South Aveyron for occasional support, for the first few days, if there are temporary workers, who do not come We really try to find all possible ways of organizing and helping each other.”
Moreover, a bonus is provided for doctors, the territorial solidarity bonus, between 1,700 and 2,200 € per additional day of work. “It’s a bonus that allows a practitioner to go strengthen, help, lend a hand to an establishment in the near or more distant territory, sometimes only for one or two dates. But it allows you to pass milestones”explains Aurélia Gambaraza, director in charge of medical affairs at Rodez hospital.
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By applying a cap on remuneration, the government hopes first to save money. According to the Ministry of Health, temporary medical work costs French hospitals 1.5 billion euros each year. By making the interim less interesting, the aim is also that the replacements finally decide to make a long-term commitment with an establishment. Today, a third of doctor’s positions are not filled in hospitals.
In Rodez, hiring, retaining, is the wish of the director, Vincent Prévoteau, also president of the Association of Hospital Directors: “The challenge is to have the tools to be able to recruit, so that we can consolidate our teams. And we know that stable teams, complete teams are also vectors of quality and safety.“. In the meantime, the question remains whether Monday, April 3, hospitals will be able to operate without some of their usual interim doctors and how long will they last without having to close services.