Here we are, 100% health has been fully effective since 1is January 2021. The modification of the “software” for taking charge of hearing disorders now allows all insureds with complementary health insurance to equip themselves without any remaining charges. It is accompanied by a review of the care pathway, in particular for presbycusis (read our report Voice in noise redraws the care pathway). Indeed, whereas previously any doctor could prescribe first-time, this will now only be possible for ENTs and general practitioners attesting to a CPD course in “medical otology”. During 2020, the College of General Medicine (CMG) and the National Professional Council (CNP) of ENT have agreed to limit the primary prescription of hearing aids by general practitioners to “adults over 60 years of age, carrier of presbycusis ”. This new device, although intended to ensure quality care by trained professionals, nevertheless risks seizing the machine …
Access to “limited” prescribers
Because training in medical otology is not ready, the device has been postponed (twice) to March 31, 2021. But how many doctors will choose to be trained and will be on this date? A situation which takes place in a context of shortage of doctors and medical desertification, the fruit of a policy of numerus clausus carried out for several decades and the failure of financial incentives for installation. Thus, the hopes raised by the progress made by the 100% health reform risk colliding with the reality on the ground. The question therefore clearly arises of the adequacy between access to prescribers and the needs of the hearing-impaired population (see our file Hard of hearing seeks prescriber).
Medical shortage and subspecialization
This issue is not specific to the audiology sector. The phenomenon was also the subject of a conference under the aegis of the Council of State in February 20201. As a backdrop to this day, the extraordinary transformation facing the healthcare professions since the early 2000s. Medical demography, aging of the population, growing specialization of disciplines … in addition to these challenges, there is the advent artificial intelligence and technological advances, such as telemedicine or e-health. So many changes that will require professionals to exercise their profession differently and which, according to Bruno Lasserre, vice-president of the Council of State, “Must lead to breaking down the partitions between professions and impose a coherent distribution of tasks in order to respond to health challenges”. For Didier Truchet, professor emeritus at Panthéon-Assas University, we must respond to “medical desertification by new efficient health courses”.
The natural evolution will be the cooperation of physicians with other professionals with broader skills.
Pr Lionel Collet, State Councilor
A redistribution of skills?
For a long time, France has been looking for ways to alleviate the shortage of doctors by creating new professions or by redistributing certain medical skills. This is the meaning of the various reports drafted by Prof. Yvon Berland between 2003 and 2011, which recommended the delegation of powers, or even the recommendations of April 2008 from the HAS.2. More recently, the Ségur de la santé provided for the creation of an “intermediate medical profession”, a sort of “missing link” between the doctor and the nurse. A Law proposition, presented in October 2020 by Stéphanie Rist (LREM, Loiret), provoked an outcry from the medical world. The creation of a new profession has once again fizzled out… The solution would therefore rather be a distribution of tasks. This is in substance the analysis delivered by le Pr Lionel Collet during the symposium at the Council of State, which observed on the one hand a drop in the general competence of doctors and on the other an increase in those of non-medical health professionals. And to conclude: “The natural evolution will be in the cooperation of doctors with other professionals with extended skills”. The hearing sector will have to find its own answers. The Igas mission, desired in our columns by Professor Collet and announced last September by Olivier Véran, should provide some leads.
