New president of the Council of the Order of Physicians of Haute-Marne, Dr Christophe Bremard says to what extent the reduction in the provision of care, especially in the center and the south, alarms the entire profession. Especially since the department had its hour of glory.
“We are losing a lot in terms of the scope of care offered and its quality.” As an illustration of this declining situation, the new president of the Council of the Order of Physicians (COM) summons it quickly. “On Friday (May 24, Editor’s note), I called social security: we can no longer perform an electromyogram… so, for example, we can no longer operate on carpal tunnel. “It’s a loss in the provision of care.” However, there is no question for Dr Christophe Bremard, surrounded by the general secretary Dr Maria Ferreira and the treasurer of the COM, Dr Jean Thévenot, to sound a massive charge. Quite the contrary, especially as services continue to “work very well” in Haute-Marne. Thus, among others, at Chaumont, digestive surgery, nephrology, ophthalmology, cardiology, rheumatology; in Langres, orthopedics, cardio rehabilitation, and, on both sites, internal medicine with the collaboration of the Dijon University Hospital in particular. The observation is much more one of dismay, even sorrow. As we are witnessing the collapse of a framework of which the territory could be proud. “We had two mini-CHUs with quality people… and, over time, we saw the supply of care diminish,” summarizes Dr. Thévenot.
Missing “basic disciplines”
“We have a reduction in “peripheral specialists” (CHU practitioners practicing occasionally). The hospital will say that they are coming and, yes, we are happy to have them, they are happy to come, if we did not have them, it would be worse.” The start of the provision of care is quantitative. “We also have the cooperation of GHT 21-52… but these are hyper-specialized consultations,” points out Dr Thévenot. However, the deficiency is rife among the “basic disciplines” – thus, shortly, there will no longer be a gastroenterologist in Chaumont, and pulmonology is also “in crisis”. If there are… five neurologists “coming from the periphery”, they work for half-days. These are leaps and bounds which, in the eyes of Dr Bremard, are insufficient to meet demand. For her part, Dr Maria Ferreira says that “neurology has gone to Bar-le-Duc”. Moreover, points out the geriatrician from Saint-Dizier, “pooling allows us to close services”.
Outstretched hand… elusive
“There are no more medical secretaries…”. Shortage against which Health Insurance plans to fight by “providing medical assistants” – an experiment expected to last three years. Unacceptable, Dr Bremard decides, unacceptable… because it is unachievable. “The condition for their coverage is an increase in the doctor’s volume of activity by 10%.” It also turns out that the activity of doctors in Haute-Marne is already above the national average, which it often exceeds… by double. Thus, for his part, the general practitioner Bremard is absolutely unable to “return” more consultations than those he provides per year – 600.
Leak rate versus traffic jam
“Langres has digested its public-private pooling; Chaumont, no. The Langrois clearly understood that they were going to be stripped naked.” However, President Bremard focuses on one factual fact: “university hospitals are incapable of absorbing our patients”. However, before approving its plan for a new healthcare offering, the regional health agency argued that a “leak rate” – towards the Dijon University Hospital – legitimized the stripping of the southern hospital site. . “The one we observe is the work of Chaumontais”, indicates conversely the trio. Which drives the point home: “and it can only get worse”.
Do it with a new mindset
“The desire to respond to service provision… having in mind the image of the “previous doctor”” is, in the eyes of Dr. Bremard, an oxymoron. Yes, the mindset of new generations of doctors has changed, and the “feminization effect” of the profession has had nothing to do with it for a long time. For their elders who remain active, it is true that “working a lot” is not a “subject”: they were “formatted like that”, their profession was part of the “priesthood”, except that their successors have another vision of their profession. “New people try to protect themselves – that’s what Doctolib is primarily for.”
Patients on the sidelines
“Social care provision is disappearing.” Like Dr Thévenot and Dr Ferreira, Dr Bremard worked in dispensaries… which we no longer find. “The practice of our profession there was remarkable because we only did care.” And to ask why doctors would not be salaried there in the morning, before working as freelancers in the afternoon. At the same time, in Haute-Marne, 600 patients with long-term illnesses do not have a doctor. The doctors are angry with them. And the affair is set to last: in Haute-Marne, one in two general practitioners is over 60 years old. “Often, it is specialists who renew a classic treatment – a rheumatologist who will prescribe medication for the heart.” So, “the Health Insurance mediator asks the doctors to help out but they are already overbooked”.
Mess
“We have a lot of goodwill. The doctors who work in Haute-Marne have chosen to settle there.” Dr Bremard emphasizes that “exercise is much richer”, with, on top of that, “quality of life” being the key. The enthusiasm of the president of the COM applies to the patients, “who are nice”.
New breath in the north
“We are now in mutual aid.” Dr Ferreira is pleased that “in the north”, it is the doctors who are thinking about the organization between the different sites of the GHT Cœur Grand Est. “A common administration simplifies operations and doctors share their working time between the establishments it oversees”
Fabienne Ausserre
Bad signal
The requisition of the Langres orthopedic surgeon Dr Antonio Vidal (daily jhm of May 11), which the security forces went to notify him at his home on Thursday, May 9, was experienced as the result of an error of reasoning and/or a provocation by the new president of the COM. “Dr Vidal had done 80 hours in the row…”. And it was therefore necessary, he deduced, that he “line up” some more when an emergency doctor from Chaumont could have been called.” Did the prefectural authority have exact knowledge of the data in the equation to be solved? It is not excluded that no. Furthermore, the unfortunate conclusion of this episode came after a series of exchanges which, in the eyes of Dr. Bremard, symbolize the impossibility of speaking to each other between “administrators” and practitioners – to the point that the latter wonder if the former do not purposely run into a “separate” lexical corridor.
Against shortcuts
Dr Bremard returns to questions to which public opinion responds hastily – therefore giving in to “shortcuts”.
Medical homes. There is a reason to discourage building medical homes. A doctor works there 35 hours, performing 20 procedures per day. However, on a budgetary level, “it doesn’t work”. “It leaves a deficit of €1,000 per month.”
Sector 3. It was a first in Haute-Marne. In Andelot, three doctors have broken down – slipping into “sector 3”, the reimbursement for a consultation is almost zero (it is exactly €0.60). Contrary to rumor, all three participate in ongoing care – a contribution which was slow to become effective due to their difficulties in ensuring that the administration allowed them to receive patients covered by the CMU alone. Their decision to depart from convention, the trio of “rebels” (which is explained on doctolib) takes the risk of having made a choice which will not necessarily be sustainable in the long term.
Medicobus. Itinerant buses bringing a doctor to villages which do not have one is a project of the ARS Grand Est to which the Department of Haute-Marne has joined – providing for two “traveling medical practices”. “But the community cannot find staff.”
Helpers. “It’s not the aid that should feed us.” Like farmers, doctors want to make a living from their work. The price of a general practitioner’s consultation, even recently increased to €30, remains a subject of tension. Especially since “the advice of a shaman” costs €60 without upsetting the client. “French doctors are no longer priced on the European market…” concludes Dr Bremard.
Clutter. It is administrative in nature… and looks like an invention of Father Ubu. “For aid to be paid to transform a bathtub into a shower, Chaumont Habitat requires that a certificate be issued to the patient…”
