Rist Law: towards a major public health problem (letter of February 9, 2023)

Madam, Sir,

In our document dated September 2021 (available on our website www.prodiesante.com), we publicly demonstrated the collapsing risk of the public health system if the article 33 of the Rist law was to enter in effect.

Our action enabled the postponement of this article of law and brought 2 major axes to light:

-Keeping in mind that locum doctors represent 40% of the total number of doctors working for the public healthcare system, such a decision would lead to a shift of staff to the private sector, professional retraining, or expatriation. This would cause hospital practitioners to bear an impossible overload of work, causing their instant exhaustion, in a context of shortage of doctors in the public sector. Hence, patient medical management would fail leading to a collapse of the healthcare system: a major public health issue…

-In 25 years of placement of doctors for hospitals, we never had a situation where a doctor would be paid 2,500 or 3,000 for a 24h shift (maybe it’s the case through temporary
employment agencies?). This “information” is a lie spread by some medias and political leaders. Why is the government pointing out at locum doctors making them responsible for the
deficit of the budget of the hospitals? Making a rule out of an exception is iniquitous and misleads the public opinion. Since article 33 of the Rist law aims at saving money for hospitals
(the health minister stated that “the fight against medical interim excesses is a priority”), why is the government favorizing the services of temporary employment agencies although their
costs are 5 to 10 times higher than direct recruitment? (examples in the document “the scandal of temporary employment agencies”).

Even more, on a broader social and professional scale:

As a comparison, a plumber would charge 40€ to 70€ per hour, a mason would charge 30€ to 60€ per hour and a housekeeper 36€ per hour.

The hourly rate of a locum doctor is 50€, which is less than a plumber or a mason. Who can it be so low regarding the importance of the services?

With a 8 year job tenue, a hospital practitioner (PH) would have a 35€ hourly rate. The difference between a PH and a locum doctor is justified by the precariousness of the status of locum doctor.

The reality is that French doctors are under paid, and their importance is not valued. After more than 10 years of studies, oversees the health, sometimes the life of the patients. A general practitioner’s fees (25€/ consultation) and the salary of a hospital practitioner do not match this responsibility, and the dedication that requires from them to push their limits of physical strength.

In a context of dire shortage of healthcare professionals where a of them are quitting (exhaustion, poor working conditions, lack of recognition, lack of resources, low wages: a nurse earns 1.700€ per month for a full time position), wanting to bring article 33 of the Rist law to effect would be a collective suicide and would cause “the imminent death the public healthcare system” (see our documentation). Situation: hospitals are near breaking point and general deterioration of healthcare services. A dire situation for the population.

Recruitments, more equipment resources, upgrade of the profession and salary rise were promised by the government at the end of the pandemic. Once the illusionary (consciously?) announces were made the caregivers can only see that their situation is desperate and at a breaking point.

On December 1st, 2022, doctors demonstrated in the streets of Paris and other regions to show that they had enough: “Despised doctors, my vocation hurts”. Expression of a disappointment, abandonment feeling and misunderstanding from the government authorities who are denying the reality.

The concrete reality has nothing to do with the announces made by the government. Unlike what the government claims, there are not more beds and means, it’s the opposite. In a context of shut down of emergency services and other services, many hospitals and unions are considering a legal procedure “for endangerment of hospital practitioners, since the state is putting them at stake by reducing the number of beds for many years”. Doctors predict that the system is moving towards a catastrophic situation and the government authorities are responsible of endangerment of the caregivers and the patients. In its article dated July 13rd, 2022 Le Monde newspaper stated,“Shortage of general practitioners and other specialties: the healthcare system at a breaking point”.

More, the French government is the only government that refuses to reincorporate non vaccinated healthcare workers, although the vaccination status is not related to the spread of the virus. It is just an irresponsible ego issue in a situation of healthcare professional needs and the current ex 2020 pandemic situation.

In fact, most public hospitals can manage daily thanks to locum doctors. Without them, surgery rooms would shut down, the number of beds would decrease, and many consultations would be canceled. The presence of locum doctors is vital for the hospitals even in the Paris region.

Despite this alarming context, the government persists in enforcing a suicidal measure for the public health. Is the government aware of the consequences of such a measure? Without doctors, hospitals will be paralyzed, and patients would not be attended. More, we have the largest network of doctors in France and in Europe and we are in touch with many of them who are considering leaving France to find better working conditions abroad. This is a sign of a country that is unwell, a country than cannot withhold its talents and is unable to prioritize what is essential.

What is the solution?

To promote attractiveness of the profession, retain those who are already practicing, bring back those who left and recruit new caregivers, the government should justly increase the salaries. It would be a major form of recognition for the healthcare workers.

Then, given the fact that a State cannot handle all aspects related to healthcare matters, it would be advisable to allocate the responsibilities. Besides the management of hospital infrastructures which is a sate role, the state should allocate to private partners the human resources and materiel equipment’s management. Indeed, these vital and fluctuating needs for healthcare structures should be managed by those who have an expertise and have made a name:

1/ Ethics, respectful of access to healthcare based on social security access for all and not as “talent management” like American pension funds and consulting firms.

2/ Responsiveness

3/ Direct action without the intermediaries and administrative processes that put on hold the implementation. A public/private partnership acting together with one goal, beside Mc Kinsey. It is abnormal that no transparency is made to justify the tremendous amount of money given to McKinsey by the government since this money is derived from taxes paid by French people.

Since the announcement of the coming into effect of article 33 of the Rist law, many hospitals are facing a panic state (many testimonials available upon request).

The government authorities should realize the actual danger of the coming into effect of the Rist law and should review its terms, otherwise the public opinion will hold it responsible for a never-seen public health issue.

The government must provide clear explanations to its nationals:

-Why did it lie by stating that investments were made for hospitals and more beds would be open while on the contrary 5.700 beds were shut in the middle of the pandemic and it carries
on today?

-Why is the government opposing vaccinated and non-vaccinated doctors saying that the first one refuse to reinstate the second ones, although hospitals have a real need of doctors?

-Why are the government authorities not tackling the real issue of lack of healthcare professional in public hospitals, by raising the salaries and give recognition to the profession, by building rather than destroying?

-How to explain that the government refused to benefit from the help of thousands of doctors that could be freely given by us during the pandemic to save lives?

This document intends to inform the government of the clear position of locum doctors who refuse to work with the salary cap of the Rist law.

This information is sent to all the French healthcare professionals, public hospitals (ARS, HAS…), all deputies, senators, members of the government, medical board, unions and healthcare professional associations and we encourage those who wish to broadcast our message on social medias and medias to bring awareness on a situation that could lead the country to sanitary chaos never seen before.

If you wish to talk in further details about this, we invite you to join the following group:


Gilles Campedel