Death of the hospital and scandalous management of public funds
Madam, Sir,
It is a fact that there are not enough physicians in France in the public and private sectors. Numerous operating theatres and maternity or hospital departments are closing with the increasing shortage of medical staff. As an aggravating factor, the post-pandemic period had seen a dramatic wave of resignations of exhausted medical physicians and nurses, subject to a lack of recognition from the public authorities, further weakening already stretched hospitals.
As if the situation was not alarming enough, the government is now attacking locum tenens physicians through the application of the RIST law on the 3rd of April 2023 by capping their level of remuneration. The public authorities are engaging in a smear campaign, labeling these practitioners as “cannibal mercenaries” and misleading public opinion with misleading statements.
Due to the lack of sufficient healthcare professionals, the result will inevitably lead to the disappearance of public hospitals and, therefore, the public health system.
To understand this, it is necessary to recall what a locum tenens doctor is.
We are talking about a healthcare professional who has spent an average of ten years of arduous study and personal sacrifice to obtain a medical degree, depending on the specialty.
Far from the stupid and absurd cliché of “cannibal mercenaries,” the reality of locum tenens physicians is quite different: we forget that it is also thanks to them that French hospitals are still standing. These practitioners leave their families and pack their suitcases overnight to travel to the four corners of France, sometimes to respond to an emergency. They have to adapt to new medical teams for each intervention and have no paid or sick leave; their status is precarious, they have no job security, and they don’t know what tomorrow will bring. Hospitals can cancel their missions at the last minute without compensation and sometimes have to take on an activity that no one wants…
Being locum tenens means agreeing to travel extensively to ensure that a medical department or a hospital does not close due to a lack of practitioners. Therefore, the functioning and stability of the French public hospital system are largely based on the daily intervention of thousands of locum tenens in all medical departments. Those physicians are the real safety valves of the system. In such a context, who can reasonably be offended to see them being paid €60 per hour?
This situation is jeopardized by the RIST law, which aims to reduce their remuneration level to less than €40 per hour. Most locum physicians will consider this level unacceptable and will not hesitate to leave public hospitals as soon as the law is implemented.
Knowing that this law cannot reasonably be applied without seeing the hospital system collapse due to a lack of doctors, the government, in an egotistical and thoughtless power struggle, is now trying to put pressure on the private sector, asking them to apply the salary cap of the RIST law in the private healthcare sector. This initiative is being presented as an “act of solidarity.” Private clinics will probably see this as an opportunity to save money on salary budgets… That is a very bad calculation. A public/private block may give the appearance of national cohesion. In reality, it is based on extremely unstable foundations. If locum physicians reject the salary cap applied in public hospitals, why would they accept it in private clinics? Moreover, by applying these wage ceilings, clinics will no longer find replacement candidates in the same proportions as before, which should lead to a drop in their turnover (locum physicians being the source and justification of their income) and the disapproval of shareholders and other owners of private health institutions.
Public hospitals struggle to recruit, and private clinics are continuously understaffed. Suppose only 10% of the national supply of locum physicians refuse to accept the wage ceilings imposed by the RIST law. In that case, the entire health system will be left in the lurch, resting on the shoulders of insufficient practitioners. Most of them already work more than 100 hours a week and are physically unable to cope with the growing demand for healthcare.
The implementation of the RIST law will thus divert a good number of locum physicians from public hospitals and private clinics if the latter follow the “recommendations” of the health authorities. It will also encourage locum physicians to go abroad if they can, accelerate the burn-out of permanent practitioners, provoke early retirement and resignations, and accelerate professional reconversions to other sectors. In other words, the RIST law will be responsible for the demise of the public health system.
The lack of healthcare will lead to many deaths. How many deaths will the implementation of this law be responsible for when patients can no longer be treated due to a lack of healthcare professionals? What will the hospitals say to the families of deceased relatives? That there are no more physicians because the government no longer wants to pay them what they are worth? In this case, what about the responsibility of the government that chose to adopt this law?
Patients have the RIGHT to be treated. The French State has the DUTY to provide it. Paragraph 11 ofthe Preamble to the 1946 Constitution states: “The Nation guarantees to all, particularly children, mothers, and old workers, healthcare protection, material security, rest and leisure.
” The RIST Law could destroy the medical fabric and, in turn, the social fabric as a whole, reinforcing the feeling of exclusion and social injustice. The general public risks losing a precious asset.
It is worrying that this law is based on a single example, brandished as a shield by Mr. Braun, French Minister of Health. The example of a locum physician who would have asked for 5,000€ for a 24-hour shift, and “in the emergency department of a private clinic, the day before the national day of July 14th” (example collected during a meeting held on March 17th, 2023 at 3 pm, to which I personally participated).
We have 25 years of practice in the healthcare sector, working for physicians, public and private health institutions, and private practices, and we have NEVER encountered such requests. We would have never accepted this request anyway. Moreover, is this haggling the result of a direct agreement between the healthcare institution and this practitioner, or was it concluded through a temp agency? We do not know. One thing is certain: it was not done by a private agency such as ours, known for its ethical approach to locum recruitment, its philanthropic activities, and its medical recruitment management services.
From this exception in the private sector (clinics), and based on a few isolated cases not representative of locum physicians, the minister draws a gross generalization that he applies to all professionals working in the public sector!
The public hospital is thus penalized based on a marginal example from the private sector. This grotesque lie is easy to demonstrate in practice and reveals intellectual dishonesty contrary to ethical conduct.
The power struggle that the government wants to maintain with locum physicians is inappropriate and scandalous, given the consequences to patients and full-time physicians who need the contribution of locum physicians.
Question:
Is there a law in preparation to massively reduce the salary of all MPs, senators, and government members because some of them (also rare) have abused their position or failed in their ethics? The RIST law is based on conditions of practicing medicine similar to a dictatorship, with total disregard for physicians, and it reveals a false search for savings.
From the arm of strength to the arm of honor, there was only one finger.
The government’s attitude in public affairs is also a source of public concern.
You cannot run a country that claims to be democratic with an arm of honor:
-Arm of honor to the presumption of innocence in the National Assembly,
-Arm of honor to the French people every time the 49-3 is used.
-Arm of honor from the French Minister of Health, who refused to engage in a dialogue at the meeting held on 17th of March about the RIST Law, who refused to respond to comments that did not support his position. A total denial of democracy.
It questions the capacity of our ministers to lead the nation in the right direction and raises essential questions.
Note:
“The crowd has no legitimacy,” said President Macron.
Legitimacy lies solely with its representatives … elected by it.
But how can these elected representatives claim to be re-elected when, by their decisions, they assert their contempt to carry their voices and demands to the point of not intervening on their behalf when their lives are threatened for fear of losing their partisan position?
Maintaining the RIST law would further insult the most useful professionals and every citizen and be a tragedy for patients.
The risk is to aggravate an already catastrophic situation for healthcare institutions, whose carers are exhausted by insane working hours. Human beings are not robots.
It is a lie to say that new hospital beds had been created, as former Health Minister Mr. Véran said ontelevision during the pandemic. The truth is that thousands of beds have been and are still being closed, while patients need to be treated and need surgeries and post-acute care.
Entire departments have closed. Others will follow due to a lack of full-time physicians. However, there are locum physicians who can support medical departments. Refusing to pay a decent daily wage to locum physicians is an unconscious posture that can only be justified by a childish battle of egos, incompatible with the level of responsibility required by representatives of the people.
The government is targeting the wrong audience. The real ones responsible for financial mismanagement and lack of ethics are temp agencies (intermediation companies that act as
direct employers of the physicians they place in hospitals). Temp agencies add an unacceptable burden to hospital budgets compared to recruitment agencies working by mutual agreement (intermediation companies such as Prodie Santé, who are not employers of the physicians they place in hospitals).
This is illustrated by the following invoice sent to a hospital by a temp agency:
For a 24-hour shift, the staffing agency will invoice a “package” of €2,800 to the hospital, which includes the net salary of the locum doctor (approximately €1,200) as well as “management costs” of €1,600 (€1,264 + €336).
With Prodie Santé, the doctor’s salary would have been 1,200€ for a 24-hour shift, and our recruitment agency fees would have been 100€.
When the government says that temp agencies cost 1.5 billion euros a year, it does not say a word about the breakdown of this amount and the scandalous profit that temp agencies are making.
Temp agencies are up to 100% more expensive than Prodie Santé:
As indicated in each of these contracts, travel, food, and accommodation costs are not included in the package of temp agencies but are paid by the hospital.
This burdens the budgets of public hospitals and contravenes the ethic of the French Minister of Health!
If recruitment by mutual agreement is cheaper (and often more ethical and efficient) than temp recruitment, why prevent us from working?
This question is evidenced by the below communication sent by the French Ministry of Health on March 24th, 2023, to the only two recruitment agencies working by mutual agreement, Euromed and Prodie Santé. Does it indicate that our actions towards hospitals are “counterproductive” and accuses us of “deregulated practices”? Unless we are mistaken, no temp agencies are listed in this distribution list.
Something is not clear.
Similarly, why are more and more tenders solely reserved to temp agencies, with no opportunity for recruitment agencies working by mutual agreement to participate?
Two recent tenders evidence this:
-Assistance Publique des Hôpitaux de Paris (APHP consultation No. 23/021 from 15/02/2023) lists 43 hospitals for an estimated annual volume of 57,836 hours invoiced.
-NOVO Hospital (a new entity created in January 2023 from the union of three establishments in the Ile de France region) announces an estimated annual market value of €3,000,000 (AO reference 23NOVO05).
This violation of freedom of competition and equal treatment raises several concerns:
While the RIST law is intended to reduce the deficits of hospital budgets by capping the remuneration level allocated to locum physicians, why do public authorities so strongly support
the use of temp agencies, which are infinitely more costly for hospitals than recruitment by mutual agreement? How can such an economic contradiction be justified?
-This gives temp agencies exclusivity and, therefore, a monopoly on medical recruitment, which is prohibited by law.
-This “choice” is infinitely more costly for the State and Social Security, with the taxes of the French people, who are always asked to make more efforts. What about the proclaimed
search for savings? For whom? Certainly not for Social Security.
Temp agencies think money when we think service.
The pandemic has not made them change their position. In contrast, Prodie Santé offered its services to the Government free of charge (and to all the countries we provide service to around the world). During the first six months, we offered our medical community without charging a fee. During this period, we did not ask the hospitals to honor their contracts, pay for recruitments they canceled, or apply penalties for late payment, even though hospitals benefited from the “whatever it takes”measure.
Our fees are 100 euros per day, while temp agencies use and abuse the opacity of their packages to inflate locum recruitment rates.
It is also time to stop ostracising us. Time for the ARS (regional health agencies) to stop telling hospitals not to go through us but through temp agencies (when this is ruining the State by using the taxes of the French people). Time to stop prohibiting us from accessing public tenders, neglecting freedom of competition and equal treatment.
The RIST law seems to be used to justify a maneuver that instrumentalizes locum “doctors – slobs – mercenaries – cannibals” responsible for all the misfortunes of the hospital in order to throw public blame on them in such a mendacious way that it cannot be taken seriously. This maneuver becomes even less credible in its implementation.
By trying to communicate so desperately (false articles, unsigned testimonies, erroneous sensationalist data), the government wants to rally public opinion to its cause in an attempt to hide the unacceptable reality: that of the probable collusion between the State and the temporary employment agencies through the irrational and absurd use of French citizens’ taxes.
Another example of disinterest in the reality of the problems and refusal to reasonably negotiate the current conditions of practice that are totally unsuitable is the government’s proposal to increase the price of general medical consultations by 1.5 euros. A new insult, a new contempt, a new arm of honor.
On the other hand, we can see that financial resources are easily found when it comes to developing a new computer tool intended to ‘track’ hospitals that would allocate remuneration above the ceilings set by the RIST law.
There is, therefore, money for repression, sordidness, and punishment but not for improving the quality of patient care and the working conditions of those who care for them.
But what is happening to our country? If France belongs to the first-world countries category, where does the wealth go since it is obviously not redistributed socially and is used for questionable purposes in the field of public health?
What is regrettable about the French model is that it is increasingly confiscatory and leveling down, whereas it could have the ambition to raise consciousness and improve living conditions. France is sliding ineluctably towards impoverishment.
A destructive logic is going on, wiping out what was once considered the best public health system in the world.
The media should be looking for the underlying motivations that lead a government to voluntarily destroy its own public health system, to voluntarily distribute financial revenues from this situation to “consultants” and international investors, and to temp agencies. This is a real misappropriation of public resources for the benefit of a few.
Networking can sometimes be beneficial in accelerating reflection and implementing relevant actions. It loses all value to the point of becoming toxic when promoting and nourishing insatiable business interests that invade social areas that should be excluded: Health, soon education.
We simply ask current leaders, who have put themselves forward to represent the French people, to take into consideration the current and future vital urgencies regarding access to care for all. By doing so, physicians and caregivers, in general, can carry out their mission in decent conditions, with the respect they are entitled to, whether they are tenured or locums, not just in theory but in their daily practice.
There may be a utopian belief in impunity. Still, the results of future elections will certainly be the consequences of the contempt with which the French people feel they are treated in their living conditions and in their right to be taken care of for their Health. We leave it to the political and trade union actors to dream or nightmare about the France of tomorrow.
Not only because of the present government but because of several decades of inconsistency from the previous governments, we are in such a complex situation that even with all locum physicians available, we still face a shortage of physicians.
Therefore, why not rely on locum physicians available today to face these new challenges, rather than wanting to discredit them, impoverish them, making them responsible for the errors made by governments, made by some representatives of the nation, past or present?
We have a battle to wage, all together and each in our own field, to immediately respond to a public health emergency and find new directions in the management of public hospitals in the very short term. We must ensure that Social Security remains the foundation of our health system and an effective and sustainable major asset capable of responding to increasing healthcare demand.
Key point:
It is unacceptable not to increase the salaries of permanent physicians from the public sector. They have always carried out their mission daily with unfailing professionalism and humanity. They fought heroically during the pandemic, are still fighting today, and will fight tomorrow to carry out their mission to the limit of their physical and psychological resistance. And the same goes for all allied care professionals.
It is important to address the current problems in a non-partisan way.
It is no longer possible to simply pause or delay the implementation of the RIST law. The law must be withdrawn, and new rules must be implemented to prevent any overbidding in locum doctors’ daily salaries and on-calls. Instead of a law, the rules should be clearly negotiated and agreed upon.
Considering that physicians are responsible professionals, actors in solidarity with public health and locum physicians must be recognized as conscious and respectable interlocutors, not as despicable delinquents and therefore condemnable in advance, by precaution.
For any constructive exchange on this subject, please write to us at the following address:
Sincerely,
Gilles Campedel
CEO
Prodie Santé
