While doctors went on an indefinite strike on Friday to express their fed up, Le Dauphiné Libéré devotes its debate of the week to the question: should we better regulate the installation and retirement of doctors? Today, focus on Grenoble, where the situation is increasingly complicated among general practitioners.
By Clémence Beyrie – 06:04 | updated at 06:33
In Grenoble, there are only 71 private general practitioners. In fact, this represents 6.1 doctors per 10,000 inhabitants compared to 9.4 across the Isère department and 8.7 at the national level. Grenoble is in deficit! “Today, we consider it a utopia to find a treating doctor for everyone,” notes Kévin Margottat. President of the Grenoble Territorial Professional Health Community (CPTS*), he even estimates that 49,000 additional patients will be without a treating doctor by 2030.
Psychosocial risks
Kévin Margottat can detail these figures because a team from the CPTS launched a major survey into the state of general medicine in the capital of the Alps more than a year ago. “One of the initial requests from the Primary Health Insurance Fund – which finances the CPTS with the Regional Health Agency – was to know how many doctors were taking on new patients. »
The observation he makes is particularly alarming. Of the 152 general practitioners registered in the CPAM register, the investigation found only 71. A large discrepancy, which this Grenoble physiotherapist explains as follows: “We excluded those who disappeared from the territory due to a death or a move, but which were still referenced. And those who are over 62 years old because they are at the end of their career or with a particular practice (gynecology, homeopathy, etc.) and no longer follow patients on a regular basis as an attending physician. » 91% say they are very regularly forced to refuse new patients.
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A necessary awareness
This public health observatory did not want to stop there. “We went beyond the question “Who takes new patients?” because we actually had no idea of the number of professionals in the region, their method of practice, the number of hours they could work. We therefore looked at the qualitative side: their feelings regarding their exercise, the health system, psychosocial risks [lire ci-dessous] which they face. »
Verdict: 46% say they do not have the time to do their job well, 50% say they work more than 45 hours per week… “Through this survey, we need real awareness that goes beyond our municipal limits because the grandpa boom doctors arrive. Many will soon retire. What will we be able to offer in the years to come, both to patients and practitioners? »
We knew the situation was particularly complicated in rural areas, where finding a doctor is often a sinecure, except that this also affects large cities. For what ? “We have no answer, only assumptions,” breathes Kévin Margottat. There is the training side: the students are the first to say that they want to settle next to the internship except that the possibility of doing internships in general medicine is very limited in Grenoble for a very simple reason. : lack of availability of premises. » General practitioners would indeed be motivated to settle there, “the problem is that the square meter in Grenoble is difficult to find and very expensive”.
The issues raised by the CPTS are numerous and varied. Its president is aware of this, “there are major difficulties with the health system” and for the moment “no miracle solution” but avenues for reflection, all the same. The hope that one day, doctors can get better too.
*The CPTS is an association launched a year and a half ago to bring together all of Grenoble’s health professionals (self-employed, employees, dietitians, psychologists, teachers of adapted physical activity) and all medico-social actors in the region (communities , health centers, hospitals, patient associations or health-related associations).
The number
91 %
general practitioners in Grenoble report being very regularly forced to refuse new patients. The geographical proximity of the practice being a major criterion: many refuse patients residing far away while others only accept those within a specific geographical area. Excessive workload is the second criterion cited by doctors.
55% of the doctors questioned say they have given up on medical care or examinations in the last 12 months.
Long hours, lack of sleep…: doctors are giving up
The saying goes that shoemakers wear the worst shoes. Unfortunately, this also applies to doctors. Without giving figures to prevent us from being able to identify the practitioners concerned, Kévin Margottat says that these individual interviews carried out with “almost all the Grenoble doctors” highlighted complicated situations. “Some are already giving up. We were able to support several who were in real psychological difficulty by introducing them to courses with associations that deal with this type of profile. »
Although not all of the doctors interviewed answered these questions, general trends were nevertheless observed, with “several worrying findings”. 14% say they have never consulted a general practitioner, 45% two years ago or more, 55% have given up on medical care or examinations in the last 12 months. 55% say they skip meals due to lack of time. For 82% of them, sleep is not restorative. Finally, to the question “How is your general health?” only 14.3% say they are in very good health compared to 79% nationally! Long hours, the difficulty of reconciling professional and personal life, which is even more present among women who have a child, or even the dissatisfaction of being able to practice properly… Among certain Grenoble doctors, problems accumulate, which can even lead to a risk of burnout. The CPTS says it has heard all of this, and is considering leading a campaign to prevent psychosocial risks among doctors.
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“I can’t cope anymore”: exhausted, general practitioners close their practices permanently
Avenues for reflection to reinvent the care pathway
The Grenoble Territorial Professional Health Community relied on this inventory to define several avenues for reflection in order to improve the situation. Here are a few.
Find new premises
Per square meter in Grenoble, “it’s expensive and it’s rare”. So, Kévin Margottat indicates that he is working in a steering committee with the City and the CPAM to find premises to accommodate doctors… and not under any conditions! “We would like to have a space large enough to accommodate several projects because doctors no longer want to work alone. We are looking for places to create health or multidisciplinary centers. Ideally between the northern and southern districts because there is a big dichotomy in terms of care provision. »
Facilitate coordinated exercise
This is a request from practitioners: in cities or in the countryside, they no longer wish to be isolated. “There are many doctors motivated to set up with several or with other specialties, but sometimes they give up in the face of administrative constraints,” laments Kévin Margottat. So, he affirms it: even if it means putting together the files from A to Z, the CPTS wants to facilitate these joint health projects.
The CPTS would particularly like to create a third place to offer concrete help to doctors but also to future patients. Photo Le DL /Stéphane Pillaud
Create a third place of health for professionals…
For doctors who wish to set up, need administrative help, those who are retiring… “We would like to create a third place for health. A sort of one-stop shop where any healthcare professional, at any stage of their career, could find answers from other professionals. »
…and for future patients
It is already difficult to find a treating doctor today, when you live in Grenoble. And tomorrow ? And when we just arrived in the city? Kévin Margottat imagines “a place of consultations reserved for newcomers, not to find a treating doctor for everyone because that is impossible, but to organize the paths of patients who need one because they have a chronic pathology. » And for those who do not have any particular problems, “succeed in creating a meeting and showing them who to turn to if necessary”.
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