“Individually, I do not criminalize anyone. But we have a system that is not very moral and a little crazy”, summarizes Quentin Henaff, deputy head of the Hospital Human Resources division of the French Hospital Federation (FHF). In question: the interim, which has now become as essential as it is problematic.
Many doctors repeat it, “you have to have faith to stay in the public hospital today”. In addition to degraded working conditions, oversized efforts for two years, lack of recognition and red tape, these caregivers work alongside colleagues who earn much more than them, via the interim, therefore. At a time when a flash mission has just been launched on the emergency room crisis, 20 minutes has looked into the subject to explain everything to you.
What does temporary work represent in the hospital today?
We do not have precise figures. The last report dates from 2013 and was led by a certain Olivier Véran, then a socialist deputy. At the time, there were 6,000 temporary doctors, for an additional cost estimated at 500 million euros for the public hospital. Since then, the counters have soared. “The medical interim could concern between 5,000 and 10,000 doctors, estimates Quentin Henaff. But it’s a moving population: some have a foothold in the establishment and work on a temporary basis. On the other hand, this interim does not affect all specialties: emergencies, maternity wards, anesthesia seem to be the champions.
More worrying: the trend now affects paramedics, all services combined. “5 out of 42 nurses are temporary in my department, i.e. 1 out of 8, underlines Bruno Megarbane, head of the medical and toxicological resuscitation department at theLariboisiere Hospital (AP-HP). On the hospital, it is of the same order. This is a phenomenon that appeared with the Covid-19. There are 1,400 vacant nursing positions at the AP-HP, which are compensated through these contracts. »
What is the difference between interim and tenured?
If the contractor renounces the status of civil servant, he chooses his working days, his hours, the city, the service in which he exercises. “And can change the next day if something displeases him!” adds Bruno Megarbane. Today, supply is much greater than demand in care. Temporary workers prefer not to have civil servant status because at no time do they run the risk of finding themselves unemployed. »
Above all, a temporary doctor can earn two, three, sometimes even four times more than his incumbent colleague. And “the nurses who are in post receive around 30% less salary and have more constraints”, summarizes Bruno Megarbane. “What undermines the system is that you have practitioners who are paid more without assuming collective responsibility, or security protocol, or quality of care, stings Quentin Henaff. Even if the interim is not a bad thing in itself. As in any sector of activity, this allows flexibility in the event of sick or maternity leave. »
But today, the shortage feeds the overbidding. “As hospitals are extremely dependent on temporary workers, we sometimes see carpet haggling with variable prices depending on the day and location. Some will say “I wouldn’t come to work for less than 1,500 or 2,500 euros for 24 hours”. When you have a date not filled in 48 hours, the establishment is caught between two fires: you should not close your activity, especially for maternity or emergencies, but it is at the mercy of the temporary workers. Hence the recent attack by Martin Hirsch, the director general of the AP-HP, who called these doctors “mercenaries” on France Inter.
Precisely, to fight against overbidding, the Regional Health Agency of Ile-de-France had promised in January 2022 a bonus of 4,000 to 7,000 euros to temporary nurses ready to commit to a CDD of six to nine months. “None of my service accepted, continues the resuscitator. And that irritated the nurses in place even more. Why give more to the better off? »
Why is this a problem?
First concern: this unfair situation creates jealousy, discouragement… and therefore a call for air from caregivers to the interim (or the private sector). Second concern: this system D is very expensive. We spend lavishly on these temporary workers, at a time when hospitals are being asked to hunt for the slightest savings.
Finally, the third inconvenience: how to train and create a good atmosphere with temporary workers who change every day? “Hiring stopgap does not create a team, storm Jehane Fadlallah, doctor in clinical immunopathology at the Saint-Louis hospital in Paris, a service which risks closing at night for lack of nurses. For young recruits, not having a reference team is destabilizing. Besides, when you have a new nurse, he runs away. Moreover, we cannot put just anyone in just any department. All the more so when it comes to emergencies. “If you do not know the teams, the geography of the establishment to know where the drugs are in the middle of the night, the procedure for receiving a patient from the emergency room, there is an increased risk”, admits Quentin Henaff. And degraded patient follow-up.
How to regulate this practice?
It is already subject to constraints. A decree, implemented in 2017, limits the salary of an interim doctor at 1,170 euros for 24 hours. As we have seen, this ceiling is not always respected by hospitals. To tighten the bolts, the Rist law, passed in April 2021, has made controls systematic. Basically, the public accountant is required to reject payments over that amount. It took until October 2021 for the law to be translated into reality. And after a week, the ministry backtracked, understanding that many services were in danger of closing. The ministry then spoke of an entry into force for 2022. “To my knowledge, some ARS have carried out tests to try to see what the impact of the implementation of the control would be, but we have no results on the subject”, specifies Quentin Henaff.
The HR manager is advocating for real change. “Thinking that it is enough to turn off the tap in public hospitals is illusory. We are afraid of spontaneous and dramatic emergency closures ”at a time when 120 services are already experiencing great difficulty in filling the schedules. “On the other hand, it would be necessary to restructure the offer by territory, by bringing around the table the public, the private, the city, the hospital, by knowing the needs and how to meet them, he continues. But this is not the method that was used in 2017 and 2021: we pointed the finger at temporary workers and establishments that do not comply with the regulations… for lack of anything better. To see if Brigitte Bourguignon will impose another approach.