On December 5, 2024, the prefect of Aude signed a decree “noting an exceptional influx of population and allowing the issuance of authorizations to practice medicine, as a doctor's assistant, to postgraduate students medical.” A very relative solution to the lack of practitioners. Dr Clary, general practitioner from Trebe and associate professor of general medicine at the university department of general medicine of Montpellier-Nîmes, points out the limits of the system.
On December 5, the prefect of Aude Christian Pouget signed a decree “prepared by the regional health agency (ARS)”specified the prefecture, asked about the modalities of application of the text. A decree “noting an exceptional influx of population and allowing the issuance of authorizations to practice medicine, as a doctor's assistant, to students of 3e cycle of medical studies”, which had already been taken “in similar conditions in the Aude department in recent years, either generally for the entire department since Covid, or for territories more targeted on geographical areas previously”. At the end of 2018, the prefect at the time had signed three decrees in all respects similar, for the commune of Montredon-des-Corbières, the territory of the multidisciplinary health center in the Razimbaud district in Narbonne, and finally the Saint-Jean district. /Saint-Pierre, again in Narbonne. A year earlier, in 2017, other decrees targeted the 27 municipalities served by the Saint-Laurent de la Cabrerisse medical center or, already, the Saint-Jean/Saint-Pierre district.
The Aude department faces a serious health threat
To define “the exceptional influx of population”the decree targets the practice of medicine in “areas characterized by a situation of imbalance between the provision of care and the needs of the population, generating an insufficiency or even a lack of provision of care, in one or more specialties”. A situation clearly established in the department, the decree continues: “Due to the shortage of doctors and the existing tension on the health system, the upcoming winter season, the Aude department faces a serious health threat,” with famous influx linked to a “insufficient number of general practitioners in practice to meet the health needs of the population”. Findings which, under the Public Health Code, therefore make it possible to respond to the request for a “departmental council of the order of doctors” Who “regularly requests advice from the prefect of Aude” the making of this decree. What, extends the prefecture, “bring reinforcement to the areas of the department most concerned”. Areas in “tensions“, defined by an ARS decree to delimit priority intervention zones (ZIP) and complementary action zones (ZAC) and which, “today, cover the vast majority of the Aude territory”. Valid from December 15, 2024 to December 15, 2025, the order allows the council of the order to issue students of 3e authorization cycle for a maximum duration of three months, renewable for the same maximum duration.
Putting doctors who don't exist in a place where they are supposed to exist.
A remedy whose Dr Bernard Clary, general practitioner from Trebe and associate professor of general medicine at the university department of general medicine (DUMG) of Montpellier-Nîmes, points out the limits in a radical way: “It’s an example of politicians inventing solutions when they don’t have any. It’s about putting doctors who don’t exist in a place where they’re supposed to exist.” A deliberately harsh speech that the practitioner tempers: “It can help, I'm not saying that occasionally it won't help certain doctors. But it won't create doctors, and it's aimed at a population that is already performing replacements.” Students of 3e cycle targeted by the decrees are in fact, specifies Dr Clary, “students who have finished their course, are after their 9th year, but have not yet passed their thesis. Currently, they are already doing replacements but for short periods of time. This decree allows them to have collaborator type contracts, which these students cannot aim for, with assistant status, over longer periods of time.” It remains that, with a “vivier” which the Trebeian doctor estimates at 420 students, the room for maneuver is hardly encouraging: “These orders are taken for places where there are difficulties. But today, everyone is affected: the city centers of Toulouse and Montpellier are medical deserts. This is the result of an absence of will policy. We wanted to reduce medical demand by reducing supply.”
“We have more hopes with the modulation of the 4th year”
In 2023, François Braun, short-lived Minister of Health, announced the official creation of a 4th year of the specialized studies diploma (DES) in general medicine. An additional year based on two six-month internships in a private practice, with participation in on-call care in the evenings and weekends. And in return, remuneration and the status of Junior Doctors. It is on November 1, 2026 that the reform should apply with, specifies Dr Clary, “4,500 students who will therefore practice for a year, where there are doctors in charge of university internships, who are most often in areas where there is a shortage of general practitioners”. An internship which will be based on the principle of “matching”specifies the Trebeian doctor, with reciprocal agreement from the student and the internship supervisor: “They will be required to do things specific to the territory. And this may encourage them to settle down.” Assuring you have “more hopes with the modulation of the 4th year” that with the decree authorizing practice as an assistant, the associate professor at the department of general medicine of Montpellier-Nîmes also recalls another need: “May municipalities lend a hand by facilitating the construction and installation of practices rather than stores.”
