As the summer holidays draw to a close, the outgoing government and practitioners’ unions share the same observation about emergency services during this traditionally complicated period: that of persistent tension, mainly due to a lack of staff. The consensus ends there. For the former, things have improved in two years, under the effect of post-Covid measures. The latter, however, believe that they have clearly deteriorated, with examples such as in Brest where elderly patients had to wait more than 10 hours.
Of the 650 emergency services in France, around fifty are under strain, points out the resigning Minister of Health, Frédéric Valletoux. “It’s still too much,” he admits in an interview with ‘Les Echos’, “but it’s better than two years ago.” The reference to 2022 is not insignificant: aggravated by the summer holidays and the fatigue of caregivers exhausted by Covid, the executive had then launched a flash mission. Entrusted to François Braun, then an emergency physician who later became a minister, it resulted in an order for measures.
“A long way”
Among them, the revaluation of on-call duty has been perpetuated since then, says Frédéric Valletoux. The healthcare access services (SAS), a regulation system towards private medicine, have been installed in 93% of departments. It will be fully deployed by the end of the year. “It is still recent, but the first feedback, in Finistère for example, shows that it relieves the emergency services,” he continues.
According to him, the situation remains critical in many places but it is improving in many others. “It is a long road and we are at a pivotal moment when certain measures are beginning to produce their effects,” pleads the minister. What is more, the part of the December law establishing a new distribution of guards between clinics and hospitals will relieve the pressure at night, on weekends and on public holidays.
“Watered-down communication like every year”, “reassuring words” out of touch, “announcements”… President of the Samu-Urgences de France union, Doctor Marc Noizet, paints a much darker picture. The organization is waiting for September 15 and the results of its annual survey to release its figures, but for it one thing is certain: there are far more than 50 services under pressure.
“The situations are very contrasting, but I think that if we were to accumulate all the establishments, the trend would probably be towards overall deterioration,” he said in an interview with “Le Quotidien du médecin”. The crisis in emergency rooms? A crisis “in the health system that is cracking everywhere”. “We are recovering everything that others can no longer do. But if we strengthen the supply in the city in its capacity to manage its patients and if specialists manage their active file differently, we will have fewer patients in emergency rooms,” he maintains.
No additional intern positions
If since Covid, the state of health of emergency services coming out of the summer break has been scrutinized, the 2024 vintage has taken on a particular color with the “affair” of the 1,500 fewer intern positions in hospitals at the start of the school year. Rather than wipe away the slack of the reform of their exam (it was launched in 2019 for a first application this year, Editor’s note), a large number of students preferred to repeat their 6th year: 7% compared to 3% usually, according to the Conference of Deans of Medicine quoted by AFP. As a result, “only” 7,974 positions were opened by decree, 16% fewer than in 2023.
Less space overall and therefore less space per speciality, even if the ministry claims to have preserved the highest priority ones such as paediatrics or psychiatry, and an allocation which is made according to the exit rank of the exam: students have spoken out to denounce an injustice, without however being followed by their representative associations.
“Each year, the number of open positions is aligned with the number of students to be distributed. What’s more, the failure rate has remained below 2%. We will get the students back next year,” tempers Frédéric Valletoux. While the dematerialized allocation procedure begins this Friday, no additional positions will be opened. To do so would also amount to penalizing general medicine or “small” university hospitals, he adds. It is up to the next government to review, or not, the 2019 reform.
