A general practitioner testifies: the Gironde CPAM asks him to reduce sick leave by 20%

A general practitioner in the Bordeaux metropolitan area, in the heart of a sensitive area, he is one of the 500 prescribers in France rejected by the health insurance system for writing too many sick notes. He gives his testimony

S ince mid-June, the French health insurance system has launched a "targeting" campaign targeting around 500 general practitioners considered to be high prescribers of sick leave. Under surveillance, they have six months to reduce their prescriptions by 20%. Obviously, this is intended to allow the social security system to make savings; of course, the doctors' unions are up in arms.

In the Bordeaux metropolitan area, Dr. Julien (1), who is the subject of this procedure, agreed to testify. "I received a phone call in mid-June from the deputy director of the CPAM [primary health insurance fund, editor's note] of Gironde, who first explained the national campaign on sick leave to me, then informed me that I was on the list of major prescribers. She immediately placed me under the MSO procedure [put under objective] for six months. I refused."

Dr. Julien works in disadvantaged neighborhoods, in a practice where two doctors have just retired. "I refused," he continues, "because the CPAM (Health Insurance Fund) relies on statistics and not on the reality on the ground. However, it's the reality of the needs in the area I cover, based on pathologies, not statistics. I work from 9 a.m. to 7 p.m., I get home at 9 p.m., and I feel like I've been stabbed in the back. I'm forced to undergo this control starting in October, whether I like it or not. The people I treat are vulnerable, men who work in construction, delivery drivers, women who clean, home helps: physical jobs, poorly paid. The majority of my patients are active people who get injured, exhausted and who, in addition to professional burnout, suffer from lower back pain, sciatica, musculoskeletal disorders... And many are under universal health protection" (Puma).

Before this report from the Gironde CPAM, Dr. Julien claims to have never been informed of a possible excess of sick leave. "Except once, when I had to explain and argue about the long-term sick leave. But they were validated, my prescriptions were justified. For this year's campaign, the Gironde Health Insurance recorded sick leave from September ^1, 2024 to February 28, 2025, using national and regional statistics as a reference, based on four doctors. But that doesn't mean anything; I work in a socially sensitive area. The CPAM is rejecting me for long-term sick leave, which is the only excess..."

"I experienced it as an injustice, first with anger and also a lot of guilt."

According to a study published in spring 2024 by the insurance company Malakoff Humanis, the French take an average of 34.7 days of sick leave per year, which represents approximately the equivalent of 40 full-time jobs in a company with 1,000 employees. The same study reveals that almost 20% of employees in French companies suffer from a chronic illness.

And sick leave compensation costs have literally skyrocketed in recent years. In an interview with the newspaper "Le Monde" at the end of July, Health Minister Catherine Vautrin announced the various avenues her department is considering to save €5.5 billion on healthcare costs. These include, in particular, employer coverage of sick leave up to the seventh day. And, therefore, limiting long-term sick leave by the most prescribing doctors. Other restrictive measures are under consideration.

"I experienced this restriction as an injustice," says Dr. Julien. "First with anger and also a lot of guilt. With my patients, unconsciously, this measure will affect my relationship with them, and I will prescribe minimal sick leave to patients for whom I am not the referring physician, like SOS Médecins. I am aware that if the number of sick leave prescriptions does not decrease, we will move towards a seven-day waiting period, instead of three today. Already, in my neighborhood, many people who should be are not taking time off because of these three days of waiting. It's terrible."

The Order of Physicians regularly reminds us that "prescribing a sick leave order is first and foremost a therapeutic act intended for a patient whose state of health requires it. It fully engages the physician's responsibility and must be carried out in compliance with ethical rules." Dr. Julien says that this targeting by the CPAM is a challenge to his practice and his ethics. "I have never abused the system," he insists.

(1) His name has been changed out of respect for his patients.