Can health centres make up for the shortage of doctors in the Paris region?
For the past two years, the Covid crisis has highlighted the lack of hospital staff in France. But it has also revealed the difficulties ordinary citizens are facing to find a regular GP. Although the Paris region is the most densely populated in France, is paradoxically the least well provided for in terms of doctors, according to URPS, the Regional Union of Health Professions.
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The URPS union, which represents the 20,800 private doctors, compared the Ile-de-France region, including Paris and its suburbs, to a 'medical desert', according to a press release published on 9 March.
"There are currently 8,500 general practitioners (GP) in Ile-de-France. Over the last 10 years, the region has lost 3,742 doctors, including 1,821 GPs," explains Valérie Briole, President of the URPS board.
"For patients, there will be longer waiting times to access a GP, which may have been possible in 24/48 hours for an acute problem, but now extends to two or even three weeks in some areas."
Ageing population
The population is ageing, there are more multi-pathologies with a growing demand for care. At the same time, the population of doctors is also getting older. Half of the doctors are over 60 years old, a quarter over 65.
"It is estimated that about 900 GPs will set up in private practice for 1,967 GPs who will leave within 3 years and are over 65. That's going to be 1 in 2. There are doctors setting up in the Ile-de-France region but that won't cover the departures," says Briole.
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Only a quarter of young doctors have settled in Paris and its suburbs.
To remedy this, the French government has decided to increase the number of students accepted to medical school but this measure will take several years before the effects kick in.
According to URPS, among the obstacles to setting up a practice for young doctors are rental prices in Ile-de-France and the fear of working alone.
One way to address this issue has been to finance the creation of health centres with several professionals working under the same roof.
Health centres in Paris
In January 2020, some young doctors in their thirties opened a health centre in the 13th arrondissement of Paris called Maison de santé Chevaleret.
Since 2009, the 13th arrondissement of Paris has lost 31% of its general practitioners.
There are now 124 doctors, 56 of whom are aged 60 or over and will be retiring within 3 to 5 years, which represents 45 of the workforce.
The multi-professional health centre Chevaleret has five GPs, two nurses, five midwives, a physiotherapist, a speech therapist and a psychomotor therapist.
It is an independent structure that signed a contract with the ARS (Agence régionale de santé) and the CPAM (Social Security), which allows it to benefit from additional funding and was also supported by the Paris Town Hall.
"It is a wonderful tool for working together, setting up joint projects and also for trying to do something else other than consultations, which are obviously necessary, but to go a little further in the care," says Raphael Pecqueur, general practitioner at the Maison de Santé Chevaleret.
"It doesn’t solve all the problems with the shortage of doctors but it’s a tool to attract young people to settle down."
The medical centre also allows the doctors "to absorb" a slightly larger clientele than in separate practices.
"At the moment I have about 700 patients for whom I am officially their GP. Here we are 5 GPs, it allows us to absorb a number of patients that we will not necessarily follow individually each time."
"In any case, this is a partial solution to the problem of the administrative burden, which is also shared between professionals. And then it provides a certain security or quality of life in terms of working hours, because we can organise ourselves to meet patients' needs without necessarily encroaching on our personal lives and having excessively long working hours," concludes Raphael Pecqueur.
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