What is being proposed to help people in areas that lack doctors in France
The new law on doctor location is set to improve ‘healthcare equality’, but doctors are critical
MPs have voted in favour of the bill but the health minister said it will not solve the problem of the “lack of attractiveness of the medical profession”
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MPs in France have adopted a new cross-party bill that will aim to regulate the establishment of doctors across the country, in a bid to combat so-called ‘medical deserts’.
The ‘flagship’ article on establishing more doctors was adopted on April 2, with the rest of the bill set to be examined in early May.
‘Healthcare failings’
MP Guillaume Garot 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).
“Six million French people do not have a regular doctor and eight million French people live in a medical desert,” he said “This inequality creates a detrimental feeling for our Republic, which has failed in its promise of equality for all in terms of healthcare.”
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
The article was narrowly rejected in committee, but parliament voted largely in favour (155 votes to 85), despite opposition from the government.
Authorities in France (including the ARS) use a zoning system, as defined in article L1434-4 of the public health code, to monitor the spread of medical deserts, and to establish which areas of France are most lacking in doctors.
This includes the evaluation of several criteria, including:
Accessibility to a health professional
The characteristics of the affected population (age, people with long-term health conditions the number of people who receive healthcare benefits, etc)
The number of healthcare professionals, as well as their age and specialism
Read more: How can I find out which parts of France are lacking doctors?
‘A false good idea’?
Health Minister Yannick Neuder has said that the bill is not actually targeting the root of the problem, which is, he said, a “lack of attractiveness of the medical profession”.
“A shortage of doctors, even one that is potentially regulated, is still a shortage,” he said. At one point in negotiations, he threatened to “cut off the discussions” if the article on regulation was adopted.
MP Joëlle Mélin, from the Rassemblement national (which voted against the bill) said: “This is a ‘false good idea’ that will only aggravate the very heart of the shortage: the profession's lack of attractiveness.”
However, Jérôme Nury from LR said that “regulation must be attempted, because it brings justice and equality to the care of our fellow citizens”.
Doctor opposition
Some doctors are also against the idea. Last week, around 15 private doctor organisations published a press release, saying that the measure would have “counterproductive effects”. They even called the bill’s rules “coercive”.
These arguments were rejected by MPs, however.
“Doctors will [still] have freedom of establishment in 87% of the country,” said Philippe Vigier MP (MoDem).
Prime Minister François Bayrou said on Tuesday that he was in favour of a form of “regulation”, but said that all “stakeholders” should be involved in creating a plan.
Other elements of the bill which are set to be discussed in May, include:
Discussions on the “medical time available per patient”
Possible regulation on the healthcare and specialist characteristics of each area
Possible abolition of healthcare payment increases for patients without a regular doctor
The new bill comes under a month after MPs unanimously adopted a bill, by 142 votes in favour and 0 against, that will aim to reform the nursing profession. This is also part of plans to help reduce medical deserts.
Nurses will have more responsibility and new roles, in changes that are partly aiming to take excess load off of GPs and specialists, and enable nurses to take on more tasks in areas that are considered to have a lack of access to healthcare and GPs.
Read also: Change to nurses’ role in France: How could patients be affected?
What is a ‘medical desert’?
A medical desert is 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.
The term 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.
Read more: Eight facts to understand France’s issue of ‘medical deserts’
Read also: Seven questions about ‘medical deserts’ in France
Read more: French ‘medical deserts’: Mayor’s plea over lack of rural GPs
Recent government figures suggest that 8% of people in France live in a medical desert. This equates to around 5.4 million people.
However, the issue is less severe when looking at the three main points of access to healthcare: GPs, pharmacies, and A&E hospitals. Those in medical deserts for all three of these account for just 0.5% of the population.
For hospital access alone, the figure is 6%.
