Loi Rist: towards the imminent death of the public hospital (Letter of October 10, 2021)


On September 23, 2021 we sent a letter to the public authorities intended to:

  • Alert the community of replacement doctors to the entry into force of article 33 of the Rist law, a provision adopted in a skilfully orchestrated media silence and aimed at reducing their remuneration by 40% from October 27. Until the arrival of our mail, no doctor was informed of what awaited him…
  • Alert on the catastrophic situation of the public hospital. In question, the cascading bed closures, correlated with the shortage of health professionals, lack of recognition, insufficient salary levels, degraded working conditions, uncompensated departures, etc. This situation leads those who remain to an accumulation of tasks and creates a situation of abuse of caregivers which itself generates abuse of patients: delays in care, caused by the lack of staff, increase mortality because healthcare professionals care come to sort out the patients they will care for.
  • Reach out to political leaders to bring our expertise (over 20 years) and try to draw the outlines of a public health system allowing caregivers to regain a central place (https://www.prodiesante.com/ en/blog/2021/10/Risks-mena%C3%A7ant-la-Sante-Publique-des-novembre-2021)

On October 10, we communicated a supplementary file whose purpose was to:

  • Demonstrate that substitute doctors are not responsible for the deficit in hospital budgets, contrary to what the reports that led to the Rist law claim.
  • Denounce the scandal of the temporary agencies, responsible for the financial mismanagement of this system of rotations of doctors within public hospitals, proof of contracts and invoices in support (https://www.prodiesante.com/fr/ blog/2021/10/loi-rist-le-scandale-des-agences-dinterim)

We highlighted the fact that if hospitals turned to employment agencies (such as Prodie Santé) instead of using temp agencies, the savings made would be monumental, on the order of a billion euros per year. Our case thus illustrates the indecent gap that exists between the model of temporary work agencies (whether they act in the form of temporary work or placement companies) and a placement agency like ours for an equivalent service.

By openly promoting the use of temporary work (allocation of €48.75/h for a substitute doctor via the interim against €8.07/h via an employment agency), the Rist law, which aims to «combat the excesses of the interim» and to make budgetary savings produces quite the opposite effect. We wonder if this logic is the result of an obvious desire to destroy the public health system, the result of appalling incompetence or if it is a mixture of the 2? Who can decently not object to such an aberration? Since the beginning of our initiative, we have refused to promote any replacement offer at the «capped price» of the law. These rates are totally disrespectful to doctors.

Still, this law reinforces the suspicion of (historical) collusion between governments and temporary work agencies (see our letter of 09/23/21). The FHF (Fédération Hospitalière de France) even accuses temporary work companies of “knowingly circumventing the law by increasing contract management costs” and thus contributing “to the Social Security deficit”. It asks the Government to establish a “charter of moralization” of the interim. It is indeed high time to call the blackmailers of the public hospital to order.

Everyone was also able to note that these same temp agencies were careful not to come forward from the moment we made all of this information public. Instead of assuming their responsibilities, they preferred to let the replacement doctors be publicly named as the main culprits of the situation.

Our fees have always been deliberately economical because we work alongside health professionals, to the point that 50% of our activity is done «pro bono», for free, which does not exist anywhere else.

Our letters are intended to defend the medical profession and to fight alongside them so that they obtain the fair recognition of their value. Because no politician has a better knowledge of reality than the caregivers themselves. We have always been in solidarity with doctors and want to put them back at the center of the health system because they are crushed by a magmatic administration disconnected from reality which has removed the logic of care from the heart of the public hospital.

Our approach allowed many stakeholders to become aware of the situation, to put pressure on the government and ultimately to roll back the application of the Rist law. But this decline is only a respite… The root of the problem has still not been addressed: judging by the distress of the territories which, one after the other, warn of the situation of shortage of caregivers and the closure of their hospital services, it is hard to believe that the Rist law will ever be applied.

However, since the rollback of the law, there has persisted a confusion apparently voluntarily maintained by the government to ensure that this situation does not change too much despite everything, which is not acceptable. The actors of the hospital world need clear and clear instructions. However, at present, they are helpless and do not know what attitude to adopt. On the other hand, it would seem that the ARS (Regional Health Agencies) do not report to the government the real problems in the field faced by caregivers and hospital management since they seem to position themselves as spectators of this situation.

The basic needs of hospitals, as well as their urgent specific needs (from pure emergency to the management of the pandemic), are therefore no longer in the hands of the management of the establishments and the carers (mainly doctors), since they now fall under the new dictates of the public authorities.

Because of this latent uncertainty, too many hospitals do not allow themselves any anticipation of their recruitment needs, considering the remuneration of temporary workers as being now capped and are thus completely deprived of a windfall of replacement doctors.

They are awaiting new instructions from the government, instructions which will probably never come (election deadlines in sight oblige…).

Finally, it is necessary that the French have another vision of their caregivers than the false one that the rulers are determined to attack, who do not hesitate to publicly disqualify them.

In his speech on November 9, 2021, the Head of State announced that his government had «supported his caregivers». If this «support» is real, why are caregivers so angry and desperate? Besides, who wouldn’t be in their place?

The political class acts according to electoral deadlines. However, if the policies pass, the doctors remain.

Therefore, we call on the government to:

  • Give a clear answer as to the repeal or the future application of article 33 of the Rist law and, if necessary, to communicate the details as well as a precise timetable
  • Recognize that substitute physicians are not responsible for hospital budget deficits

Maintain current salary levels for locum physicians

  • Increase the salaries of full hospital practitioners
  • Putting investment companies back on an equal footing with any other company because competition is legal, healthy and beneficial for hospitals
  • Strongly regulate the framework for the intervention of temporary work agencies

We keep all of these files available to interested parties and the media. We believe it is necessary for citizens to become aware of the extent of the disaster and ask themselves who is really benefiting from this situation.

Because this situation is causing the imminent death of the public hospital…


Gilles Campedel Chief Executive Officer – CEO