Tension and Debate over Sick Leaves in Vienne: Are General Practitioners Granting Too Many?

As in many departments, health expenses linked to work stoppages are increasing in Vienne: +4.7% between the first half of 2022 and 2023, or €41M compared to €39M, excluding Covid. In accordance with national directives, the Primary Health Insurance Fund is calling on arrested employees, businesses and general practitioners. “We are not in systematic control, rather in support », notes in passing the director, Sylvie Landrieau. From “fraternal exchanges” to “prior contracting” (see box), an arsenal of measures is deployed to reduce the “bill” for daily allowances, even if the CPAM assures that it does not have “no quantified objective”.

“Precarious psychological health”

An unwelcome witch hunt? Some doctors think so, including Philippe Bouchant. “In thirty-three years of practice, I have never seen the population in such a precarious state of psychological healthtestifies the general practitioner, representative of the union of private doctors. And inevitably, the duration of the stops is longer…” According to the Malakoff-Humanis Health Barometer 2023, psychological disorders now come in second place in the reasons for sick leave, ahead of musculoskeletal disorders. And young people are not spared (52% have at least taken sick leave during the year). “We are increasingly called upon by our medical colleagues, themselves increasingly called upon by employers in difficulty and employees suffering at work”, assures Clément Grignoux, psychologist from the Occupational Health Service Association (ASSTV). A second psychologist joined him in July 2023, a sign that the needs are immense.

“Stress at work”

At Medef and CPME, we have not seen an increase in absenteeism, even if the general delegate of Medef recognizes that “the health and well-being of employees is a real subject”, at the same level as recruitment. His CPME counterpart receives a “little phenomenon” around unsuitability for positions. For Christophe Rabusssier, on the other hand, the trend is clear. “We are seeing an explosion of psychological disorders, sometimes to the point of burnout, which cause extremely long sick leave. Many employees suffer from stress at work », adds the general secretary of CFDT 86, which campaigns for more prevention and training of managers. Unsurprisingly, health is at the forefront of the most affected sectors. The “My psychological support” system put in place by the CPAM seems in this case a bandage on a wooden leg. The government has set a target of €250 million in savings on the Health Insurance budget in 2024.

Seven doctors supervised

The current campaign of the CPAM de la Vienne on the subject of work stoppages has led the organization to take an interest in eight doctors for whom it has“questions about the volume of prescriptions”. One of them, which ends at the end of the year, will not be followed up. Six others benefit from an “objective contract” between September and February 2024. Clearly, they will have to“develop their practices”, says Sylvie Landrieau. A doctor has been placed “under prior agreement”, in other words each work stoppage prescribed by him will be examined by the medical advisor. In all cases, a reduction in the number of daily allowances reimbursed by Health Insurance is expected.