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

Madam, Sir,

On September 23rd, we sent a letter to the government authorities to:

Bring awareness to the community of locum doctors regarding the coming into effect of article 33 of the Rist law, article which was adopted with total planned media silence and which aim is to reduce by 40% the doctor’s wages from October 27th onwards. Before our letter, no locum doctor has been informed of what was coming up…

Bring awareness on the dire situation of public hospitals. Because of the growing closure of beds alongside with healthcare professional shortage, lack of recognition, insufficient wages, poor working conditions, and the non-replacement of healthcare workers who quit … This situation forces those who remain to multi-task and causes a situation of neglection of the caregivers who in turn leads to neglection of the patients: delays in patient management, due to shortage of caregivers, increase mortality rate because healthcare workers are forced to choose which patients will be treated.

Reach out to politicians to bring our expertise (more than 20 years) and help build the framework that can allow healthcare workers to become the cornerstone of the public
healthcare system.

On October 10th, we sent supplementary documents which aim was to:
Demonstrate that locum doctors are not responsible for the dire financial situation of public hospitals unlike what some reports were trying to portray, and which led to the Rist law.
Point out the scandal behind temporary employment agencies who are responsible for the financial waste of the system of doctor turnover inside public hospitals (we have available
proof of contracts and invoices)

We outlined the fact that if public hospitals request placement agencies (such as Prodie Santé) instead of temporary employment companies, the savings would be tremendous, above one billion euros a year. Our documentation explains the shocking difference between temporary employment companies’ business model (whether they act as a temporary employment or placement company) and placement agencies, as ours, for the same service.

By openly favorizing temporary employment companies (48,75€/h for a doctor via a temporary employment company versus 8,07€/h for a doctor via a placement agency), the Rist law intends to “fight the excesses of medical interim” and make budgetary savings but it has the opposite of the intended effect. We wonder if this is the result of a clear willingness to destroy the public healthcare system, the result of an astounded incompetence or a mix of both? Who cannot be fighting against such nonsense? Since the beginning of our initiative, we refuse to publish any locum offer in line with the tariff cap of the law. These tariffs are entirely disrespectful towards doctors.

Nevertheless, since the postponing of the law, the government still purposely held a confusing position to make sure that she situation would not improve, which is not acceptable. The stakeholders from the hospital world need clear guidance. Right now, they are clueless and don’t know what to do.
Also, the Regional Health Agencies (ARS) do not forward to the government the true issues, that are being faced by the caregivers and the hospital’s managements, since they seem to have taken a back seat and have no input on the situation.

The fundamental needs of the hospitals, as well as their temporary emergency needs (from emergency to pandemic management) are not handled by the direction of the hospitals and the caregivers (doctors particularly) since it must be handled in accordance with the new dictates of the government authorities.

Alongside with this uncertainty, many hospitals do not allow themselves to anticipate their recruitment needs since they consider that the doctor’s wages are now caped and are therefore fully deprived of locum doctors.
They are waiting for new instructions from the government, which will most likely never come (political elections coming up…).

At last, it is necessary that French people hold another opinion of their caregivers than the lying one spread by the rulers who publicly discredit them.

In his address on November 9th, 2021, the Head of state said that his government has “supported the caregivers”. If this “support” is real, why are the caregivers so furious and desperate? Who would not be if placed in their position?

The political leaders act accordingly with their election timeline. But if politicians go, doctors remain.

Therefore, we are asking the government to:

-Provide a clear answer regarding the repeal or coming into effect of article 33 of the Rist law and if so, give all relevant details and the exact timeline.

-Admit that locum doctors cannot be held responsible in regard to the lack of funds hospital are facing.

-Maintain the current wages of locum doctors

-Increase the wages of hospital practitioners.

-Ensure that placement agencies are treated as equally as any other agencies since
competition is legal, healthy and good for hospitals.

-Regulate the framework of temporary employment agencies.

We can provide all required documentation to whoever wants to have access. It seems necessary to bring awareness to citizens regarding the scale of the disaster so that they can ask themselves who benefits from the situation.

The current situation is slowly causing the imminent death of the public hospital.


Gilles Campedel

CEO – Chief Executive Officer

Prodie Santé