Health in the Grand Est: getting an appointment with a specialist can take months

In a context of strong tensions between supply and demand for care (General Medicine + Specialized Medicine), the Regional Union of Health Professionals – Liberal Doctors of the Grand Est (URPS ML Grand Est) conducted a study to measure the deadlines for obtaining an appointment in 2024, with nine medical specialties: cardiology, dermatology, orthopedic surgery, gastroenterology, medical gynecology and obstetrics, ENT, pediatrics, psychiatry and rheumatology. The survey covered 2,143 doctors in total. Let us point out from the outset that the appointments requested are by new patients (who are therefore not part of the specialist’s patient base) and according to two scenarios: 1 scenario (S1) where the patient contacts the specialist directly (by telephone or internet) for a non-urgent reason and a second (S2) where the patient is referred by a treating physician for a semi-urgent case.

We learn, for example, that to obtain an appointment with one of the 415 cardiologists in the region, it takes 108 median days (50% less, 50% more) in the case of scenario 1, knowing that only one in two patients manages to obtain an appointment (by telephone or via the internet). It is 20 median days, in scenario 2. At a psychiatrist (389): it is 16 days but with only 17% of appointments obtained (S1) and 8 days in S2 with 19% of appointments obtained. At a pediatrician (209): 8 days (S1) with 48% appointments obtained and 1 day (S2) with 26% appointments.

A “tsunami” of retirements

In short, it’s a long process and it’s clear that in many cases, the patient (who lives up to his name) has to work hard to find an appointment. Surprising? Not really. This is not a scoop, we have known for years that with the reform of the numerus clausus (which limits the number of students) we are no longer training enough doctors: from 8,500 at the beginning of the 70s to less than 4,000 in the 90s. And this while at the same time the needs for care have increased given the aging of the population. But that’s not all. “We are dealing with an unprecedented, exceptional mass of retirements of specialist doctors, which has never happened before,” explained Dr. Thierry Bour, treasurer of URPS ML Grand Est, who commented on the results and spoke of “ a veritable tsunami of departures.” Between 2011 and 2022, cessations of activity increased by 54 to 114%, depending on the specialties.

In Lorraine, the rural departments (Meuse and Vosges) have to deal with a more marked shortage of specialists with respectively 3.4% and 6.7% of the regional population, for 1.9% and 3.3% of specialists. For Moselle and Meurthe-et-Moselle, the data are 18.8% and 14.6%; and 13.2% and 16.2%. However, there “is no obvious correlation between density of specialists and appointment times”, specifies Dr Bour. Understand that it is not more complicated to obtain an appointment with the dermatologist in Meuse than in Moselle and simpler to obtain one with a pediatrician in the Vosges than in Meurthe-et-Moselle. Another observation: the idea that specialists work less than before is being undermined. “Specialists work an average of 55 hours/week and 10% more than 20 years ago (URPS ML GE 2023 study),” specifies the survey.

The situation will improve

A positive note to end on. The situation is very complicated but it will get better. First of all because the number of specialists is increasing. For Lorraine, there will be 6% more doctors from 2030, 21% from 2035 and 54% within 20 years (source: Drees). Then because the demographics are declining (which poses other problems). To support these trends and make short-term improvements, the URPS ML Grand Est is calling for an increase in specialist doctor time (notably through a generalization of independent internships for interns), freeing up time (hiring medical assistants, tools digital, etc.) and make specialists more accessible through the development of secondary sites, in particular. “The fundamentals are good, young people are arriving in large numbers, and departures will quickly decrease. In addition, group exercise is developing and modernizing. Let us be careful not to introduce new, pseudo-innovative regulatory or legislative developments that could break this momentum towards a rapid improvement of the situation,” concludes Dr. Bour.