Doubling the basic consultation to 50 euros is not unanimous among young doctors. If their liberal colleagues from the “Doctors for Tomorrow” collective, supported by several trade unions, hit the pavement in Paris on Thursday January 5, the autonomous grouping of installed and substitute young doctors (ReAGJIR)* has, at the same time, delivered other proposals to Health Insurance to improve access to care. Its president, Elise Fraih, was interviewed in particular as part of a flash mission on the administrative overload of doctors. Interview.
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Capital: You object to the consultation billed at 50 euros (against 25 today) at the general practitioner. Aren’t you afraid of alienating many of your liberal colleagues?
Elise Frai: This could actually be labeled “unpopular opinion” on social media. If we are in favor of a revaluation of basic consultation, we suggest indexing it to inflation. We could also create a new quote, dedicated to complex counseling, especially when we receive elderly people or patients suffering from depression or a work problem. And why not to welcome a new patient, because it also takes time to get to know him.
Capital: So, depending on the type of patients you receive, do you propose applying a higher rate, as specialists already do, who have a rate for complex visits and also another for so-called “very” complex visits?
Elise Frai: No, it is not about systematically evaluating the consultation in this way. Taking our time once often allows the follow up to be a little shorter. When you become a doctor treating a new patient, for example, the first consultation serves to retrace his medical history in order to compile his file as accurately as possible. We provide information on drug allergies, surgical history, etc. Once you’ve done this job the first time, you don’t necessarily need to consider subsequent consultations complex.
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Capital: You still say that you are in favor of updating the basic consultation. Why not double the current amount proposed by liberal colleagues?
Elise Frai: Often the unions that bring this consultation to 50 euros are ultra-liberal. At ReAGJIR, we are rather in favor of mixed remuneration, which mixes fee for service and packages. We are very attached, for example, to the structure package, which helps doctors to better manage their practices, to equip themselves better with computers, in particular. And above all to the attending physician patient package dedicated to patient follow-up. Perhaps because we represent young people who have been established for less than 5 years. Mechanically, there is a big turnover among our members because, after 5 years, they leave ReAGJIR. But what young people tell us is that they don’t deny a salary exercise because they are very afraid of the discomfort and administrative overload associated with the liberal mode.
Capital: That’s right, you were interviewed by the Health Insurance as part of a flash mission dedicated to administrative overload. What did you offer?
Elise Frai : In the short term, we want to reduce administrative overhead to save time and spend more time on care. For this, we can deal with useless medical certificates by listing them, perhaps by decree. I am thinking of the authorization to give doliprane in nurseries. Because it was never really framed. We have to make duplicate prescriptions for daycare. But we could say that in this type of facility they know what to do in case of fever in the newborn, unless they welcome a particular child who has a history and contraindications. As far as the certificate of aptitude for community life is concerned, things could be facilitated with vaccinations entered by computer in the My Health space. All parents have to do is print the list. But again, I’m not talking about medical certificates for playing chess!
Capital: But has there already been progress on medical certificates for sport?
Elise Frai: Yes, but the problem is that the decree that loosened these restrictions only concerns sports federations. However, there are many clubs outside of these structures that impose their own requirements. These sports fitness certificates are currently only used for prevention, which can be integrated into prevention appointments, etc.
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Capital: many patients remember this period in which it was possible to call their doctor or secretary directly to make an appointment. Hasn’t booking consultations on platforms like Doctolib also overwhelmed doctors?
Elise Frai : This is the big problem of the medical question in studies. The ideal is for the doctor to regulate. Unfortunately, we don’t have time for this in our consultations. The second best solution is to have a physical secretary in the office who knows the patients well. A physician assistant could very well do it too. This is an opportunity to implement specific protocols in which the doctor says to the secretary “when there is that, call me, when there is this, the same”. Really, my dream is to have a physical answering machine. But you still need to have enough office space to hire a secretary and a medical assistant. Our premises are not expandable. And the very expensive rents, especially in Île-de-France, which is the country’s first medical desert, are very restrictive…
Capital: More surprisingly, you propose that patients can self-call in sickness for short periods. How come ?
Elise Frai: We start from the principle that if patients know what they have and are reassured, there is no reason to ask us to say “excuse me doctor, it’s just because of a work stoppage”. If they have to stop for two or three days, they can do it themselves. It’s a bit like in the United States where workers are entitled to “sick days”, a limited number of days in which they can rest when they are ill.
Capital: what about daily allowances in this case?
Elise Frai: If the self-declaration of suspension from work were possible for two or three days, nothing would change for the patient. The health insurance law already imposes a waiting period of three working days during which no compensation is paid.
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Capital: But the patient still needs to know if his symptoms do not justify the consultation of his doctor…
Elise Frai: The patient should consult as soon as he feels that things are not going well for him. Indeed, if a patient is worried because he has been coughing for five days, he will consult. Maybe it wasn’t that bad, but the doctor has to explain things to him in an educational way. Again, we mostly search for “sorry doc, it’s just for”. As a reminder, patients could self-declare on sick leave during the Covid crisis. There is no question of making them feel guilty in the midst of a triple epidemic. But we propose to better educate the population about what a virus is. That the symptoms are often mild. A population that better controls its own body and health is a population that controls… its own health needs.
*This union has around 450 members and represents young general practitioners (less than five years old), substitutes and academics.
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