At least a thousand doctors targeted, if not more. Since last summer, the Health Insurance Fund (CPAM) has been attacking practitioners who prescribe “too much” sick leave. Each time, the procedure is based on comparative statistics carried out in relation to a regional average in “similar municipalities”.
Doctor Luc Griesmann, who works as a general practitioner in Belfort, is one of them. A situation that he does not understand and which exasperates him. This could lead the sixty-year-old (69 years old), who had chosen to continue his activity “for financial reasons after a professional real estate loan which went wrong”, to close his practice.
How did it start?
By receiving a letter on June 16 in full consultation. He came from the primary health insurance fund of the Territoire de Belfort. I was informed that I was a naughty boy because I had prescribed twice as much daily allowance (DIA) as a group of regional practitioners who serve as a reference. Pure statistics! And the letter mentioned a possible “put under objective” (MSO).
How did you react ?
We had been somewhat warned by our unions that this could happen. Afterwards, I had no idea that it could happen to me. Work stoppages are part of my therapy. I treat patients, not machines, and I always try to deliver the right number. When I hear certain policies talking about “work stoppages of convenience”, it calls into question both my competence as a doctor and my professional honesty. So this letter made me angry and I refused the MSO.
But it doesn’t stop there, does it?
No, a month later, I had a new referral to clearly offer me an MSO for the next six months. I had to reduce my IJ by 16% and had the right to prescribe 1,524 from September 1 to February 28. If I accepted but did not respect the objectives, I was threatened with a fine of 7,332 euros. I said no again, again on the advice of my union, the UFML (French Union for Free Medicine). Then at the end of August, the CPAM warned me of the start of a “prior agreement” (MSAP) procedure. To avoid this, I could not even defend myself before a committee because the quorum was not reached and it could not meet.
You are therefore under MSAP. What does this change for you on a daily basis?
Clearly, since January 1, I have had to transmit my work leave electronically. Before, I only did it on paper and the patient had forty-eight hours to submit it. Now, it’s done straight away over the internet and I have to justify everything in 150 characters, including spaces. The CPAM’s medical advisor could, or should I don’t know, give me feedback. I haven’t had any. One of my patients only told me that he had called her to get information and advise her on several tests.
Has all this changed the way you work?
No. I did not restrict myself and took 13 work stoppages in over three weeks in January. None were refused. I already justified them on the paper version and I find the check of the Fund normal. But she should do it medically, with a minimum of clinical examination. Medicine is done with the eyes, touch, the information we are given, hearing, etc. We cannot control with numbers! I feel cheated in a technocratic way. I’m under surveillance.
What procedures could follow?
I think that I am, at my own discretion, the subject of a new study. We will then see if my number of prescribed IJs has varied or not. If this is not the case, perhaps the CPAM will understand that the stops were all legitimate.
Does this situation make you want to give up everything?
Yes, this side of my profession disgusts me. I have three possibilities: either I break down, that’s what I’m prioritizing today but I still won’t be free from pressure from the CPAM; either I retire but financially I will struggle. Either I go back into paid employment. A doctor in the hospital, in the private sector, in a rehabilitation center and others, we leave him alone! I am deep in thought and I will decide during the year, also depending on what I am told about work stoppages.