Doctors threaten strike against bill mandating where they work in France

Doctors in France are threatening to strike against a new government bill that aims to limit their ability to choose where they work, and instead require them to work in areas of ‘medical deserts’.

Doctors say they are planning to strike from April 28 (this coming Monday), against the proposals, saying that the measure will “deteriorate access to healthcare” and lead to young graduates leaving the country. 

The strike will last over the course of next week, with a major demonstration planned for Paris on April 29.

“This proposal will undermine the appeal of private medicine, which is currently the first line of defence in the healthcare system,” said Lucas Poittevin, president of the national medical student association l’Association nationale des étudiants en médecine, to Le Figaro.

Read also: What to do if you need doctor during strikes

New bill on doctor locations

It comes after MPs in France adopted the new cross-party bill (proposition de loi, PPL) in early April. It is aiming to regulate the establishment of doctors across the country.

The bill states that it is “aimed at combating medical deserts”.

Read also: Map: How well (or not) each French area is served by health workers
Read more: Seven questions about ‘medical deserts’ in France 

A medical desert in France is defined as an area in which patients have trouble seeing a GP regularly, whether because they cannot get an appointment, there are not enough doctors, or because they live too far away from their nearest GP surgery.

The government defines the term specifically as an area in which patients have access to fewer than 2.5 consultations with a local GP per year on average.

It can also be used to describe areas in which there are not enough GPs so patient time is very stretched. In this case, even patients who do get an appointment may find they do not have enough time to properly explain their problem and the GP does not have enough time to offer them a good level of care.

What does the new bill state?

The new bill will:

• Require self-employed doctors to seek approval of the local Agence Régionale de Santé before establishing themselves in a certain place

• In areas with a lack of doctors, permission would be granted automatically

• In areas with a surfeit of doctors, the practitioner could only set up if another doctor leaves

Read more: What is being proposed to help people in areas that lack doctors in France

Similar regulation already exists for nurses, physiotherapists, midwives, and dentists in France, but has until now not applied to GPs and independent doctors. 

Yet, in Germany, the establishment of doctors is already regulated in this way, while in the UK, doctors often do not get a choice when it comes to where they begin work.

MP Guillaume Garot, who has been working on the bill since 2022 with a cross-party group of more than 250 MPs from across the political spectrum (from the right-wing Les Républicains to left-wing La France Insoumise), said: “Six million French people do not have a regular doctor and eight million French people live in a medical desert.

“This inequality creates a detrimental feeling for our Republic, which has failed in its promise of equality for all in terms of healthcare.”

Similarly, MP Yannick Favennec-Bécot, a co-signatory of the bill, said during parliamentary discussions that for the medical professions already regulated in this way, “the measure is producing conclusive results”.

He said: “Regulating the establishment of medical practices is not a punishment for doctors or a form of coercion, but an additional solution that is essential for patients.”

Prime Minister François Bayrou, who recently stated that regulation was necessary, is expected to present proposals on the measure in the coming days. Mr Bayrou has also warned that if negotiations fail with doctors, “the government will intervene” to ensure some form of regulation is imposed.

Existing encouragement for rural doctors?

Provisions do already exist to help encourage doctors to set up in underserved areas, with increases in GPs’ flat rate if they work in a medical desert. Yet, in late 2021, government healthcare statistics service DREES said that these financial incentives were largely insufficient to attract doctors to these areas in the numbers needed.

Other methods to help underserved areas are already emerging in some places. For example, some GPs have set up ‘medicobuses’, which visit and offer mobile consultations and other services. 

They are designed as “an essential complement where it is not possible to set up a health centre”, and are mainly targeted at rural areas.

Read more: France plans 100 medical buses to improve rural access to healthcare
Read also: French villages fight doctor shortage with medical bus 

Similarly, other ‘hybrid solutions’ include systems where patients can see a doctor via a teleconsultation (such as an online video call), and - using tools provided, such as a stethoscope - they can do simple tests themselves while being guided by the practitioner.

However, the government has said that these areas cannot rely on mobile buses or telehealth.

Current government figures suggest that 8% of people in France live in a medical desert. This equates to some 5.4 million people.