The next five years will have to act in the field of health, after two years of pandemic which have highlighted the suffering of caregivers in France. The director of the Assistance Publique-Hôpitaux de Paris (AP-HP), Martin Hirsch, intends to be part of the overhaul. He transmitted to the government his proposals to refound the public hospital, which reveal the echoes.
Martin Hirsch believes that the “French hospital system is in crisis. Those who work there consider that things are going from bad to worse. Bed closures are not planned but suffered, depending on the availability of professionals”. This crisis affects both “small establishments and university hospitals”, but “city medicine” is also in crisis, he adds.
Ending Hospitalocentrism
Martin Hirsch first tackles “hospitalocentrism”, responsible according to him for “hospital/city competition rather than complementarity”. He proposes to build mixed structures, “linked to the hospital, but which allow salaried employment or remuneration in the form of fees but with a contractual link between the hospital and the doctors practicing in primary care”.
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Less rigidity for doctors
The director of the AP-HP first of all proposes to review the remuneration of doctors, because he considers that “the same salary for all doctors, whatever their specialty, leads to frustrations, injustices and departures, ( …) while there are considerable differences between disciplines”. It therefore suggests the establishment of a remuneration in three parts: the first “floor” fixed nationally and by statute, the second according to a geographical coefficient linked to the cost of living in the region and the third in the hand of the establishment, in order to better remunerate “certain specialties, certain functions, a particular investment in the life of the establishment, skills or a particular technicality”.
Martin Hirsch also advocates for the end of lifetime appointments in an establishment. According to him, doctors could be appointed in a region and assigned to a renewable five-year period in an establishment.
More skills for paramedics
“Paramedics cannot be considered as mere performers (up to the name of “non-medical personnel”), but must participate in the management of the hospital, in the development of professions, in the major choices. Their restricted place is one of the explanations for the malaise”, writes the director of Public Assistance. He wants to review their training and pay. “The objective would be to guarantee that a substantial part of hospital paramedics can access these career developments towards more technicality, more responsibility, more initiatives and more remuneration”, wishes Martin Hirsch. He even mentions the possibility that they can access “university-hospital” responsibilities in the same way as doctors.
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