Will the third be the right one? Seven years after the law was passed, the rates for medical interims in public hospitals will finally be capped from Monday. A turn of the screw assumed by the government despite fears of service closures.
Haro on the “mercenaries”. From Monday, temporary doctors, sometimes essential to keep an emergency service or a maternity hospital open, can no longer be paid more than what the law provides. An obvious fact that should prevail since the creation of this ceiling in 2016. Except that its application has so far come up against the walls.
When the former minister Agnès Buzyn set the maximum rate in 2018 at 1,400 euros for 24 hours, those concerned replied with a “black list” of hospitals to “avoid”. When the device is reinforced with a second law in 2021, while the price of custody has fallen to 1,170 euros, Olivier Véran suspends in extremis its entry into force, in the midst of the winter wave of Covid-19.
Up to 4,000 or even 5,000 euros gross for 24 hours
A year and a half later, François Braun in turn promises to put an end to “cannibalistic temporary work” and its “excesses” – up to 4,000 or even 5,000 euros gross for 24 hours – “which will signify death in the short term of our public hospital service. This does not prevent him from dropping, a week before the deadline, an increase of 20%, to 1,390 euros (gross) for twenty-four hours. “A perfectly acceptable amount,” he said.
But behind the scenes, the minister has been preparing for a difficult spring for months. “The temporary workers will go on strike or refuse to work, we know it perfectly, it will last a month”, he predicted already in October. To “cross the line”, the regional health agencies were responsible for bringing into play “territorial solidarity” between hospitals in “all risk areas”. How much and where? “The situation is changing every day”, do we dodge avenue de Ségur.
“Determined to refuse any ceiling”
In the Grand-Est, for example, “the situation is still very fluid”, recognizes Thierry Gebel. The regional delegate of the French Hospital Federation (FHF) is less worried than in early March, when he feared the total or partial closure of 79 services.
Finally, “few will be out of order”, because many establishments “have deprogrammed part of the activity” in order to preserve “the rarest resources”, starting with anesthesiologists, emergency doctors and gynecologists. Not sure that this degraded mode is enough everywhere to avoid the open crisis. The union of hospital replacement doctors (SNMRH) has thus identified 167 services “threatened with imminent closure” in around a hundred hospitals, most of them located in small or medium-sized towns. Non-exhaustive list where no specialty is spared: surgery, paediatrics, psychiatry… “We are determined to refuse any ceiling”, warns its president, the emergency doctor Eric Reboli, however lonely in the medical community.
Request to open salary negotiations
The unions of hospital practitioners are indeed eyeing the potential savings on the interim – which costs hospitals 1.5 billion each year – and are asking the government to open wage negotiations. “We must restore the attractiveness of hospital medicine”, also pleads Thierry Godeau, president of the national conference of medical commissions of hospital establishments. On behalf of his colleagues from 750 public hospitals, he wants to “talk about on-call duty, on-call duty”, or even “double overtime pay”.
Claim supported by the College of Physicians, which judges at the same time that “certain excessive practices […] ethically no longer have a place to be” and calls on temporary workers and “the hospital administration” to “respect tact and moderation in remuneration”. The hospital directors of the Syncass-CFDT, the leading union among these senior civil servants, hope for them “to be able to count on the support of the State”, so that none of their colleagues find themselves “alone to assume the closure of a service for lack of practitioners accepting the tariffs fixed by the texts”.