Medical deserts: MPs give green light to regulate doctors' establishment

This group, which ranges from LFI to nearly a third of the LR group, was launched in 2022 by Socialist MP Guillaume Garot with the slogan "when medical deserts advance, it is the Republic that retreats."

"This evening, we have put a little bit of the Republic back into our collective organization, this Republic that must watch over each of us, whoever we are, wherever we live, because our health cannot depend on our postal code," declared the MP, rapporteur of the proposed law, after the vote.

It was adopted by a large margin of 99 votes to 9. The National Rally abstained.

This text nonetheless remains inflammatory for the profession, and the debates in the Assembly were lively, in particular during the examination at the beginning of April of its key article which regulates the establishment of doctors in the territory.

Before setting up, private or salaried doctors would have to seek approval from the Regional Health Agency. This would be a legal requirement in an area lacking healthcare professionals, but in more well-supplied areas, doctors would only be able to set up when another doctor leaves.

A "territorial indicator" taking into account "medical time available per patient" and "the demographic, health and socio-economic situation of the territory" would be used to target regulation, which would potentially only concern "13% of the territory" according to its supporters.

A "cornerstone of any truly effective policy," insists the cross-party group.

But a casus belli for many doctors, particularly medical students and interns, who demonstrated at the end of April.

"It is not the freedom of establishment that jeopardizes access to care" but "the structural shortage of doctors (and the) lack of attractiveness of the private sector," according to a press release from the Young Doctors union on Monday.

Health Minister and former cardiologist Yannick Neuder (LR), while welcoming the work of the cross-party group after the vote, reiterated his position against the measure.

Competing in the Senate?

"If I had thought that this was the right treatment, the right remedy for the situation, I would have supported it," he said in the chamber.

His government, with its plan to combat medical deserts, proposes training more healthcare workers and considers that the numerus should be abolished, but also that practitioners should be required to work up to two days a month for consultations in priority areas.

The cross-party group argues that regulation and increasing the number of doctors must go hand in hand.

This text will not "solve everything, but it will change people's lives for the better, a little bit," said Green Party MP Marie Pochon.

In addition to regulating the installation, the proposed law provides for the elimination of the increase in fees for patients who are without a primary care physician.

It also establishes the reestablishment of the obligation for doctors to participate in on-call care and the installation of a first year of medicine in each department.

Adopted by the Assembly, the text must continue its shuttle in the Senate by finding space in the calendar, probably from the autumn, while the lower house will study from Monday its own bill against the shortage of doctors in the territories.

The text is viewed favorably by the government, which could attempt to introduce its plan to combat medical deserts. It has notably activated the "accelerated procedure" for examination, to reduce the legislative process for this initiative.

The text of the senatorial right shares the philosophy of the executive, which is reluctant to opt for coercive regulation: they propose that in areas best provided with practitioners, the installation of general practitioners would be conditional on their practicing part-time in parallel in an area with a shortage of caregivers.