“We have an imminent risk of disruptions in access to care”, affirms Thursday May 19 on franceinfo Rémi Salomon, president of the conference of presidents of the medical commissions of establishment of CHU while the public hospital is on the verge of explosion for lack of nursing staff as in Bordeaux where patients have been hosted by volunteers“. “There is a lack of beds. There is a lack of nurses to operate the operating theaters. There is a lack of emergency physicians to run the emergency services”warns Rémi Salomon for whom the job is no longer attractive.
franceinfo: How is the French hospital doing?
Remi Solomon: It’s not new. We have already said for quite a long time that we had difficulties in the hospital. There is a lot of talk these days about emergency services. Maternities are in great difficulty in many places. There is an imminent risk of disruptions in access to care. When I say an imminent risk, it is already happening and it is likely to worsen quite considerably during the summer, that is to say at the time of the holidays.
Is the situation worse than two years ago when Covid-19 arrived?
Yes. This is what is paradoxical, because we have seen how much the hospital and the entire health system had played their role during this Covid-19 crisis which was nevertheless something. It was quite incredible to see all these health professionals in town, at the hospital, mobilizing and giving all their energy to deal with the considerable influx of patients. We knew how to do it, we organized ourselves. It’s an exciting job that I love. All the caregivers I meet love this job and we are quite dedicated. We are ready to give a lot, but dedication has limits.
At the time of the Covid-19 crisis, all French people saw how important the hospital was. We said “whatever it takes”, it has to work. We put in a lot of money to make up for all the delay. We made up for some of the delay. The delay, it’s been twenty years that we take it. When the hospital budget is set, essentially on financial criteria, because there is public spending, each time there is a little shortfall. And so, indeed, after a while, there is a shortage of nurses because the working conditions and the salaries are not sufficient.
How many jobs are currently missing in hospitals?
Probably tens of thousands. There are beds in every hospital that are closed due to lack of staff. And so there are 10%, 15%, 20%, sometimes more, of beds closed for lack of staff. It is perhaps a little more important in Île-de-France, because there is a cost of living problem for paramedical personnel. It is more expensive in Île-de-France and therefore salaries are not up to the cost of living. But everywhere there are no beds. There is a lack of nurses to run the operating rooms. There is a lack of emergency physicians to run the emergency services.
Are they caregivers who have abandoned the profession or are these recruitment problems?
It’s both. What I fear a lot at the moment and what I observe is a kind of disengagement. I told you about dedication. There, there is exhaustion and a lack of recognition. So, after a while, people say: ‘I prefer to preserve myself, preserve my family life, my personal life. I can’t keep wearing myself out like this. It is an exciting but demanding job. There are strong constraints: night work, weekend work. And when you are called back, for example, on leave because you have to fill out the on-call list, it’s very restrictive. One night, for a nurse, it’s an extra euro per hour, it’s 10 euros more per night. It’s ridiculous ! Compulsory remuneration is not sufficiently remunerated. This is the first step the next Minister of Health must take.
Should all salaries be increased?
I don’t think it’s necessarily necessary to raise all wages right away. There have already been revaluations, even if they are not sufficient. What needs to be done urgently is constraint. Pay the constraint. Nights, weekends, holidays. It is really imperative. And to do so in a meaningful way. But it’s not just that, there will be many other things to do.
Will caregivers be able to take their leave?
In some places, it will be necessary to shorten the holidays. Filling the on-call schedules will probably require shortening vacations. Emergencies bear witness to the dysfunction of the entire health system. We talked about the hospital, but it’s not just the hospital. It is also upstream, that is to say what is called unscheduled care, which is mainly covered by city medicine, but also by the hospital when city medicine can no longer do so. There are many places where city medicine is struggling. There are not enough doctors. There are medical deserts and people, at that time, go to the hospital. To ensure continuity of care, all caregivers in the city and at the hospital must participate.
Can you imagine caregivers refusing to shorten their vacations?
The situation obliges us. It is hard to imagine that in a country like France there could be places where there is no longer any possibility of accessing healthcare. I think there will be a necessary regulation. Me, I have enough confidence in the responsibility of people, of everyone, at the hospital, in the city to participate and avoid that we find ourselves in August without caregivers.