Rist Law: the destruction of the public hospital and misappropriation of public funds

Let’s get straight to the point!

Painfulness, burn-out, chronic understaffing, deteriorating working conditions, lack of equipment, low salaries… The hospital system is on the verge of collapsing. Under the pretext of fighting a false enemy to gain legitimacy in the eyes of public opinion, the State couldn’t have done a better job of worsening the situation of hospitals and leading them to their demise: massive cuts in hospital beds (21,000 between 2016 and 2021 under the Macron/Véran tandem, according to a study by the French government), permanent denigration of locum doctors and arbitrary reduction of their remuneration by 30 to 40% (Rist law), voluntary opposition from permanent practitioners and locum doctors, public lies assuring that the situation is under control when the closures of services prove the contrary, announcement effects, manipulation of figures…

Since the application of the Rist law on April 3rd, one after the other, the Paymasters General have sounded the alarm to hospitals by blocking the payment of invoices from temporary employment agencies that refuse to itemize their fees because the amounts are considered exorbitant. They thus realize the unnecessary expenses via these companies. A report is immediately made to the Regional Health Agencies (ARS), which either do not even respond or insist that hospitals use temporary employment agencies anyway! Similarly, since this law came into force, which has caused most of the replacement doctors to flee, heads of hospital departments in all four corners of France have warned of department closures, staff shortages, and “the daily disaster situation.” Faced with this very real situation, the government is bogged down in its lies and denies the obvious. Every day that this law is maintained, the health of citizens is further endangered, and the criminal responsibility of the State is increased.

What is striking and raises questions is, on the one hand, the government’s lack of action on this issue and, on the other hand, the unjustified and financially devastating insistence on the almost forced recourse to interim staffing instead of favoring the much less costly solution of contractual recruitment.

As we demonstrated in our letter of March 29, 2023 (https://prodiesante.com/fr/mort-de-lhopital-et- gestion-scandaleuse-des-fonds-publics/), for a 24-hour shift, a temporary employment agency will bill the hospital for a “package” of 3,360€ (including tax) per day of activity of the recruited doctor, which in detail amounts to 1,300€ net in favor of the practitioner + 156€ employer’s contributions + 1,264€ “agency management costs” + VAT.

In this case, the temporary employment agency’s commission is close to 100% of the candidate’s salary.

By using Prodie Santé (a contracting agency), the doctor’s salary would have been 1300€ + our fee of 100€, which is a total of 1436€ including taxes, which represents a commission of 7% of the candidate’s salary.

With the Rist law, the government has put temporary employment agencies on a pedestal by heavily encouraging hospitals to use them for their recruitment, leaving the mutual agreement agencies in a deliberate state of confusion that plunges doctors and hospitals into a state of confusion so that they can meet each other via temporary employment. An economic aberration to the detriment of the general interest. This situation raises the question of possible collusion between the State and certain temporary employment agencies.

In such a context, and in order to save their establishment, hospital managements and treasurers, now held criminally liable, should:

1/ Alert on the endangerment of people’s health because the decision of continuous closures of hospitalization beds has generated delays of care with consequences on people’s life, defects of surveillance of patients, and an increase of psychosocial risks of hospital staff, all in an explosive context of understaffing of nursing staff.

2/ Point out the exorbitant waste of public funds by forcing temporary employment agencies to recruit replacement doctors to the detriment of contractual recruitment, which is infinitely more economical.

3/ Denounce a probable corruption pact between the State and temporary employment agencies, which is the only plausible scenario that could explain the government’s insistence on imposing the use of it, a behavior that contradicts all economic logic and has dramatic consequences for public finances.

This is how the government uses public money: it is not used to improve the health care system or the living conditions of French people. On the other hand, consulting firms such as McKinsey and temporary employment agencies seem to benefit from it…

Why pay American companies a fortune and continue to ensure that French people can no longer care for themselves? Why pay temp agencies more money and pretend not to have enough money for care?

This behavior is unacceptable because it is detrimental to the citizens witnessing the progressive destruction of their healthcare system and its acceleration caused by the Rist law. The people did not give the state a mandate for this.

The sick have the right to be treated, and the State has the duty to provide for them. Paragraph 11 of the Preamble of the 1946 Constitution reads as follows: “The Nation guarantees to all, in particular to children, mothers, and old workers, the protection of health, material security, rest and leisure.”

Thus, a public official who arbitrarily violates a constitutional right is liable to prosecution in a criminal court.

The suspicious insistence of the State that hospitals use temporary employment agencies, especially since former ministers (Ms. Meryem El Khomri) or government spokespersons (Ms. Sibeth Ndiaye) have joined the legal department of a temporary employment agency, is the outline of a probable

secret agreement, which, if proven, would constitute a State scandal because of the crime of granting an unjustified advantage and misappropriation of public funds.
Will a position soon be for Mr. Olivier Véran and Mr. François Braun?

Questioned by us during a recorded meeting on March 17th about the risks of a healthcare catastrophe directly linked to the application of the Rist law, the Minister of Health used the power of his office not to answer, silence, or threaten. In reality, he invisibilizes everything that does not go in his direction and the direction of the misleading narrative he is trying to sell. This denial of democracy is not acceptable.

His comments about replacement doctors at this meeting are not acceptable either: “If doctors don’t want to go to the hospital anymore, they will just have to go elsewhere, that will clean up the system”! Doctors will appreciate this…

As long as one believes the government’s narrative is true, such behavior is a possible legitimate and proportionate infringement of fundamental rights. But as soon as one demonstrates, with evidence (which we, the Syndicat National des Médecins Remplaçants Hospitaliers and various others have done), that not only is there no basis for this narrative, but worse, that it contravenes the public interest and is a lie, it means that the government’s infringement is arbitrary, which constitutes a criminal offense.

By using the services of temporary employment agencies, temporary workers must understand that not only are these agencies shamelessly degrading public finances, but also that they are being harmed in the way their seniority at work is considered in terms of pension contributions, for example. Indeed, benefiting from extremely low social security contribution rates, temporary employment agencies pay little or no contributions on behalf of temporary workers.

By arbitrarily reducing the remuneration of temporary doctors from 65€ to 46€ per hour (ignoring a level of responsibility that no one wants, as they have patients’ lives in their hands, a precarious status, and real arduous conditions), the State is driving away temporary doctors, closing down innumerable hospital services and deliberately putting others at immediate risk of death or serious injury, as there can be no care in the absence of caregivers.

Before the Rist law, the salary of substitute physicians was neither too high nor too low in relation to the responsibilities and constraints inherent to their activity. The problem is that tenured hospital practitioners are grossly underpaid, and increasing their compensation is not on the government’s agenda.

It is essential to stop believing the national narrative that locum tenens physicians are to blame for all the ills of the hospital. It’s time to support both tenured and locum tenens physicians, or we will not be able to get care. The government’s narrative is only meant to mask the obscure objective it is pursuing, namely the programmed disappearance of the public hospital.

By maintaining the Rist law, which accelerates the deterioration of hospitals, the Minister of Health “will not relieve the congestion of emergency rooms as he claims, but will rather clog up the cemeteries,” as stated by Dr. Eric Réboli, president of the National Union of Hospital Replacement Physicians (SNMRH).

A government that refuses to realize that its own population can no longer eat properly and cannot be treated properly is an unworthy government.

A National Assembly and a Senate that are uninterested in these facts, which are not only unacceptable today but also jeopardize future access to healthcare for all citizens, will have to answer for their posture when the French people, who are finally going to be informed, give their enlightened

verdict at the ballot box.

The “information” circulating today from all the written and audiovisual media is nothing more than propaganda from the State aiming to impose a scapegoat (replacement doctors) on the general public to justify its inability to manage the problems of public health and to legitimize its will to “entrust” the management of our public health to national or foreign consultants/mercenaries/predators.

Hospital managers, political representatives, retirees, citizens, doctors, and paramedics, join this initiative by writing to contact@prodiesante.com to prevent the government from destroying the health system and avoid health insecurity that will lead to a human tragedy, otherwise the big losers will surely be the patients.


Gilles Campedel CEO
Prodie Santé