in Gironde, pulmonologists are alarmed by the lack of practitioners

Le Figaro Bordeaux

Lung cancer, asthma, smoker’s bronchitis or even sleep apnea… Each of these diseases requires the care of a pulmonologist. But in Gironde, even on the recommendation of your general practitioner, the delays in obtaining a first appointment reach six to eight months, according to several specialists. A situation that they consider intolerable and which they denounce in an open letter, addressed to the Regional Health Agency (ARS), on Friday. Doctors Emmanuel Monge and Laurent Nguyen, members of the association of private pulmonologists of the South West (APPSO), as well as doctors Julie Macey (Haut Lévêque hospital in Pessac), Laurent Portel (Robert Boulin hospital in Libourne) and Jean-Michel Peloni (Bagatelle hospital in Talence), all three of whom are heads of the pulmonology department in their establishment, estimate that there are only 27 active pulmonologists left in Gironde. An insufficient figure for the needs of the Gironde population according to them, while they also see patients from neighboring departments, such as Landes, also poorly provided in this area.

“I am based in a practice where five years ago, before Covid-19, there were still six pulmonologists with deadlines of 3 months. Soon there will only be two of us left and all the requests for general practitioners are focused on us…”alerts the D^r Emmanuel Monge. Bottom line: the least serious patients are far from being a priority. “It will drag on, they may become discouraged and not come at the risk of becoming the seriously ill of tomorrow”worries the doctor who initiated this collective forum. “We have a role to play in prevention, in particular with tobacco and a sedentary lifestyle which are the primary lung risk factors… But we no longer have time with these overloaded schedules”complete the D^r Laurent Portel, head of the pulmonology department at the Robert-Boulin hospital in Libourne. “It’s complicated on a daily basis, when you have 10 or 15 appointment requests per day, to add all the patients to the calendar. There is therefore a desire to make them aware so that they understand that our secretaries are doing their best when they give them an appointment in six months.”

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Closed number

These pulmonologists call on the ARS Nouvelle-Aquitaine, this being their “supervisory authority”, but they are aware that there is no «solution miracle» to their situation. For them, the observation is threefold. First, there are not enough pulmonologists on the job or in training due to the numerus clausus. Then, the baby boomer generation is aging: its pulmonologists are retiring on the one hand and its members, who are mechanically increasing in number compared to the French age pyramid, require more care. Finally, today’s doctors work less than before. “Today, young doctors refuse to work 80 hours a week. They have a family life and hobbies, so we need two doctors to replace the one we had twenty years ago. And that’s great, but we didn’t anticipate it.”analyzes the D^r Laurent Portel. Faced with the observation of “progressive degradation conditions of exercise” of their specialty and “medicine in general”these pulmonologists express their “urgent need for public authorities to listen to fight against medical deserts”.

Willing to receive the signatories of this open letter to discuss developments that would make it possible to better distribute the care needs of the sector, the ARS Nouvelle-Aquitaine explains “recognize the feelings of these pulmonologists in their daily practice”. But its director in Gironde, Bénédicte Motte, nevertheless wishes to qualify the figures drawn up by the signatories of this forum. “In 2024, the trend [en termes d’effectifs, NDLR] is rather positive: there are 38 pulmonologists in Gironde, or 3.9 specialists per 100,000 inhabitants. This is more than the national average which stands at 3.6 pulmonologists per 100,000 inhabitants.she explains.

According to the director of the ARS, it is therefore necessary “question the distribution of roles in the care pathway in order to better coordinate specialists, general practitioners and nurses”. In other words: thanks to the establishment of a Specialized Care Team (ESS) – a system currently being tested for cardiology in the department -, the pulmonologists of Gironde could “to unite” to better organize themselves and create protocols that would allow them to delegate part of their tasks. A lead, which leaves the D skeptical for the moment^r Emmanuel Monge. “The problem is that general practitioners are also overloaded, he emphasizes. We lack doctors, and we will not be able to resolve this problem in less than ten or fifteen years.. An observation on which he agrees with the ARS: Bénédicte Motte estimates that we will have to wait until 2030 to benefit from the effects of the removal of the numerus clausus, ratified in 2018.