Medical Desertification

The French Senate Jan. 13 debated the “demography” of physicians, with a focus on “medical desertification” of rural areas, reports Quotidien du Medecin.

Senator Bernard Vera described the demographic situation as so degraded that it is "essential to restrict the establishment of new practices in areas already provided for."

Vera proposes to draw on the regulatory mechanisms that are now applicable to nurses (nurses cannot go into independent practice in locations that are “sufficiently” supplied). This is controlled by the SROS (Schéma regionale d’organisation sanitaire or regional health plan) which is to be applied by the new regional health authorities (ARS). Many who oppose this say it is “whittling away at the principle of freedom of practice location.”

Vera also proposes to allow specialists in general practice to collect fee supplements that are paid for other specialists. This kind of “bonus” would apply in certain, underserved areas.

Hervé Maurey, Senator from Eure said: "We will not solve the problem of medical demography with force." The program to shift nurses developed in 2008 has shown that coercion does not work. Hervé Maurey recalled that at discussions on the law HPST he had proposed several amendments, including the requirement that all young graduates to go serve three years in undeserved areas. "You will see in five or ten years," he prophesied, “you will see that the HPST law that rejects the social contract for solidarity in health, will have had no effect on medical demography.

For her part, Nora Berra, Secretary of State for Health, said that 200 medical students had already signed a contract for public service, which entitles them to a grant of EUR 1 200 per month until the end their education in exchange for a commitment to practice for an equivalent period in an underserved zone.