Medical Deserts: Senate Regulates Doctors' Installation and Validates Bayrou's "Pact"

Incentive, regulation, coercion, or freedom of establishment? Long hours of debate in the upper house have confronted perspectives on a hotly contested issue: the depopulation of medical professions. Just days after the Prime Minister presented a plan to strengthen access to practitioners, his proposals are already taking shape in Parliament, in a bill from Republican Senator Philippe Mouiller.

This text was adopted by a large majority in its entirety in the evening, despite numerous abstentions on the left, before its transmission to the National Assembly. The main government measure, received rather coolly by doctors, aims to establish a "mandatory territorial solidarity mission," namely requiring all doctors practicing in well-served areas to "project" themselves into priority areas, up to two days per month.

The government's philosophy? "Ask little of a large number of doctors, rather than ask a lot of a few doctors," summarized Health Minister Yannick Neuder. This measure, proposed by the government through an amendment, was adopted by the Senate.

But many elected officials have criticized the vagueness surrounding its implementation: financial penalties, perimeter of under-populated areas, replacements in offices, etc.

The arrangements must be clarified by decree. This "emergency mission" must be coordinated with a mechanism of senatorial origin which will target the installation of doctors and which will also be specified by decree.

The Senate's idea is to make the establishment of general practitioners in well-supplied areas conditional on their working in parallel, part-time, in an area with a shortage of caregivers, via a secondary practice for example.

For specialists, setting up in a well-supplied area would be conditional on starting in the same specialty, with an exception if the specialist agrees to also practice part-time in an area affected by difficulties accessing care. Note that in this scenario, the recently established doctor will not be required, in addition, to participate in the "solidarity mission" proposed by the executive.

"Balanced supervision of facilities will empower doctors and reduce inequalities in access to care," argued Senator Corinne Imbert (LR), rapporteur on this text.

More restrictive measures rejected

These measures, the result of an agreement between the Senate and the government, compete with a much more coercive text adopted by the National Assembly at the initiative of the socialist Guillaume Garot, despite government opposition. A section of the left and some centrist elected officials in the Senate therefore attempted to introduce measures similar to Guillaume Garot's text, but more restrictive ones, but all were rejected.

Socialist Jean-Luc Fichet denounced a "backfire" to the MPs' proposal, "conveniently pulled out of a hat" but "without concern for effectiveness." Conversely, other voices felt that the text went too far in regulating practitioners, instead of tackling the shortage of doctors. "Regulation can only be achieved when we can distribute!" raged centrist Elisabeth Doineau, calling the measures a "mirage."