Loi Rist: the scandal of temporary work agencies (Letter of October 18, 2021)


Our letter of September 23 was sent to deputies and senators, health authorities (HAS, ARS, DGOS, DGFIP, etc.), the Council of the Order of Physicians, unions and associations of doctors, hospitals and substitute physicians. It represented the first step in our approach of alerting all health stakeholders to the possible risks associated with the entry into force of article L.6146-4 resulting from article 33 of the RIST law.

This letter bore fruit since on October 5, the Minister of Health announced the launch of a consultation to adapt the application of this provision on temporary medical work to the health context, and that for its part, the National Council of On October 6, the Order of Physicians launched a national campaign “To treat tomorrow” addressed to all doctors with a view to making the future of the health system a priority theme.

Thanks to this communication, many hospitals – aware of the real risk of a generalized boycott on the part of substitute doctors – wished to alert (directly or via their local political representative) the public authorities of the probable paralysis to come of the public health system.

Substitute doctors and hospitals now have the hope that the law will quickly be the subject of an adjustment allowing each party to find a point of balance.

As drafted, the decree and order of November 24, 2017 as well as article 33 of the Rist law penalize substitute doctors and make them responsible for the debt of hospitals.

If the government’s desire to “combat the excesses of the interim” is legitimate, it is on the wrong target.

In reality, the substitutes are not the culprits of this situation.

The “drifts” are due to temp agencies (intermediation companies that act as direct employers of the candidates they place with hospitals). These agencies bring an indecent overload to the budgets of hospitals, unlike placement agencies (intermediation companies which are not the employers of the candidates whom they make available to hospitals which themselves become the employer of the placed candidates. These include Prodie Santé). Here is the demonstration, it is edifying:

For the same recruitment service for 4 replacement dates in Pediatrics (2 24-hour call duty + 2 nightcall duty) in a hospital center located in Oise:

In this example, the “INTERIM AGENCY” is the employer of the replacing Pediatrician and includes in the global invoice that it sends to the client: the salary of the candidate, the social security contributions (employer’s contributions on the salary) and its own fees. Prodie Santé only pays the client its own fees. The hospital is the candidate’s employer and directly assumes the salary and employer’s expenses.

The figures speak for themselves, both in terms of the agency commission (5 times higher at AGENCE D’INTERIM) and the overall cost borne by the hospital (€3,424 more borne by the hospital via the ‘interim), and this only on the scale of 4 days of replacement! It is interesting to highlight the fact that when the replacement receives €3,494.40 in net salary, the “INTERIM AGENCY” applies a commission of €2,104, or 60% of the replacement’s salary. Prodie Santé would have applied a fixed fee of €400 (€100 per day).

Thus, 1,000,000 replacement days* per year via temporary work agencies would cost €2,580,000,000 compared to €1,724,000,000 via an employment company such as Prodie Santé, i.e. a deficit for the hospital budget of €856,000. 000€ by favoring the interim rather than the placement.

*1,000,000 days per year is a low assumption which corresponds to 2,740 replacements per day throughout France within the 1,350 hospitals in the country, which amounts to an average of 2 replacement days per establishment and per day.

Temp agencies “drown” their commission amount in a kind of “package”, which allows them to apply very high commissions. We can then understand the reason why temporary work agencies are so keen on lobbying the public authorities.

We have voluntarily masked the identity of the candidates, those of the hospitals and those of the temporary work agencies in order to respect their anonymity.

The estimate below signed between “AGENCE D’INTERIM” and the Oise hospital center makes it possible to become aware of the extent of what is a real scandal:

Even when they play the “placement” card, temporary work agencies are up to 80% more expensive than Prodie Santé (examples with 2 other “INTERIM AGENCIES”).

So what game are temp agencies up to? And why did candidates receive information from “INTERIM AGENCY 1” that the provisions of the Rist law did not apply to temporary employment agencies? From: “……………..” <……………….@……………… …………en>

TO : “……………….” <…………………@……………………… …en>

CC :

Sent: Wed, Oct 6, 2021 10:32 AM

Subject: Emergencies – Mission proposal – Multi proposals – Doctors – 05-10-2021

Hello doctor,

Interim contract = temporary agency employer

Vacation contract = Private or public establishment employer

The Rist Law applies only in the context of vacations and public establishments.

Best regards.
Hiring coordinator
….. Street ……….
Such : ………………….

Why does the RIST law, intended to combat the excesses of temporary work and to make savings on hospital budgets, favor the use of temporary work companies (the most expensive solution) to the detriment of temporary work companies? placement ?

How does this manifest? By the fact that this law disqualifies placement companies without any legal basis in favor of temporary work agencies, which it thus places in a monopoly situation. In a completely discretionary way and without any coherent argument, temporary work agencies are suddenly favored by being placed in a situation of economic monopoly or abuse of a dominant position. This anti-competitive practice, which hinders competition, aims to eliminate one or more competitors and would be liable to prosecution before the French courts.

The law establishes a flagrant breach of equality since a replacement carrying out a mission in the hospital via a temporary work company would be paid by the said company at the capped rate of €48.75 gross per hour against €8.07 gross per hour if it is presented by an investment company or if it presents itself directly. It would therefore be a difference of €40.68 gross per hour worked depending on whether or not the replacement applies to a temporary agency, and this to perform the same service.

This measure has no raison d’être other than to force replacement doctors to go through temporary work companies.

In this context, one can reasonably wonder if there is not collusion between the temporary work agencies and the public authorities…

This ostracization of investment companies or personal initiative must stop being the method chosen to force hospitals and substitute doctors to accept the inconsistent, the dubious, even the unacceptable.

As you will have understood, the “drifts of the temporary work” are in no way due to the replacement doctors or the employment companies but rather to the temporary work agencies.

We hereby invite those responsible for this issue (politicians and health authorities) to position themselves and intervene quickly to remedy this destructive situation for our public hospitals. Moreover, to be truly effective, it would be necessary to combine the 4 themes involved and intertwined in this management of public health, at least with regard to the continuity of care and the doctors who allow it:

Regulate the framework for the intervention of temporary work agencies.

Maintain current salary levels for locum physicians.

Increase the salaries of full hospital practitioners.

Put investment companies back on the same level of treatment as any other company because competition is legal, healthy and beneficial for hospitals.

We are certain that the will of the public authorities to rectify this measure will be up to their task and their obligation to preserve and support our public health and all its actors (hospitals, doctors, etc.). It should not be forgotten to meet the demand for care from all patients/citizens, which requires an active, sufficient and permanent presence of doctors, as well as caregivers in general.

What is essential is not to prohibit doctors from exercising their profession, directly or indirectly, by the set of unavoidable pressures obliging them to submit by force to the erroneous, biased or deliberately destructive conclusions of a few overzealous decision-makers.

What is crucial is not to suggest that a doctor’s salary – which is quite fairly distributed among the replacements and very unjustly insufficient among the regulars – is the cause of the financial mismanagement created by the will of the rulers of promote temporary work agencies.

To be continued, therefore, all together.

Hoping that this letter will be useful to you, please accept, Doctor, my respectful greetings.


Gilles Campedel

CEO – Chief Executive Officer

Prodie Santé