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 The 66-year-old tried for months to find a doctor after retiring to
Laval, a quiet town of 50,000 residents surrounded by rolling
fields. Her search ended at the simple center managed by the 12
veteran doctors, aged between 67 and 70, on the ground floor of an
apartment bloc.
"You need to wait at least a year to get an appointment with an
ophthalmologist," Dupas, a former secretary and salesperson, told
Reuters in the waiting room. "It was not like this years ago."
The Service Médical de Proximité (SMP), where each doctor works a
few days a month with the help of medical interns, is a local
response to a national problem that has hit Laval hard.
Although France enjoys a reputation for having one of the world's
best healthcare systems, it has an aging population and a shortage
of doctors, especially in rural areas. In Laval, only one in five
residents is believed to have a family doctor, according to local
professionals.
President Emmanuel Macron has put rural France at the heart of an
overhaul of the healthcare system which he announced on Sept. 18,
promising more money and doctors for what he called "healthcare
deserts" in areas outside big cities.
The reforms are an important test for Macron. Success could help
reverse a fall in his popularity since he was elected in May 2017,
and counter leftist criticism that he is a "president of the rich".
But with opinion polls showing healthcare is a priority for voters,
failure could badly damage his presidency.
"France obviously has good fundamentals when it comes to
healthcare," said Laurent Chambaud, the director of France's School
of Advanced Studies in Public Health. "But like in many other
developed countries, the system, which centers around hospitals, has
to reform itself to adapt to social changes."
"If it doesn't do so in the next five to 10 years, the system will
be totally saturated," he said.
FALL IN GLOBAL RANKINGS
France offers universal healthcare largely financed by government
through a system of national health insurance, though many people
buy top-up cover.
When the World Health Organization conducted its only global
healthcare survey in 2000, it rated France's system the world's
best. But the aging population, tight budgets and an increase in
burnout among doctors have taken a toll.
France ranked only 10th in a global study published last year by the
Commonwealth Fund, a private U.S. healthcare foundation. It had been
ninth in the fund's previous report in 2014, the only other time
France had been included.
As in neighbors Germany and Spain, and larger countries such as
Australia or Canada, France also has an uneven distribution of
doctors, with most attracted by work in cities where they can make
more money.
Some rural areas also lack hospitals, and hospital doctors staged a
strike in 2016 in protest at what they considered poor working
conditions and shortages.
"We have been alerting authorities for decades and nothing has
changed," said Gilles Ollivier, who serves on a regional doctors'
council in Laval.
"Many here live in rural areas where inhabitants, and some of them
very old, find themselves in small villages where there are no
shops, no post office, no schools and no doctors."
Under Macron's plans, 400 doctors will be deployed to rural areas
where coverage is thin. No hospitals will be closed and 4,000
medical assistants will be recruited to handle paperwork and make
basic checks to free up doctors.
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The president also says he will end a system under which the number
of graduates allowed to enter the medical profession each year is
limited. Doing so, he hopes, will ensure there are more new doctors
interested in working in rural areas.
PLUGGING GAPS
Laval, on the river Mayenne about 300 km (190 miles) southwest of
the capital Paris, is one of the communities where the fate of
Macron's reforms will be played out. It also shows how big a
challenge the centrist president faces.
The Mayenne region has 255 registered doctors per 100,000 residents,
one of the lowest rates in the country, official data show. The
national average is 437 and Paris has the highest rate, with more
than 1,100 doctors per 100,000.
In Laval, the SMP has helped plug the gaps. Fifteen months after it
opened its doors, it handles more than 5,500 patients. Its doctors
are regulated as others are under the French system.
"I had been looking for a family doctor for years but every time I
was turned down because they said general practices couldn't take
new patients," Fatou Diaby, 30, said in the SMP's waiting room with
her two young daughters.
"When I last became pregnant, I had nobody to go to except hospital
emergencies, which are always packed. Here someone listens."
Mayenne authorities have tried to remedy the situation by helping
doctors trained abroad, especially in eastern Europe and the Middle
East, to settle in the area. Last year, a third of new doctors
entering practice in Mayenne qualified outside France.
"WAR ZONE"
Laval's 12-storey hospital, built in 1974, has more than 1,000 beds
and admits 40,000 patients a year but has too few doctors. A lack of
funds means some patients summon nurses with old-fashioned handbells.
"It is true that we are experiencing some kind of depression," said
Andre-Gwenael Pors, the hospital's director, citing understaffing,
budget constraints and a proliferation of regulations in recent
years.
Olivier Guihery, a general practitioner who divides his time between
a Laval practice and several retirement homes, said he and his
colleagues sometimes work 100 hours a week with little or no time
for rest or holidays. It is so tough they call it "war-zone"
medicine.
"We are on the verge of burning out all the time but we have no
choice but to continue," he said.
Doctors who spoke to Reuters welcomed Macron's plans to overhaul the
system but also had concerns.
Pors said the reforms needed to be spelled out in more detail.
Ollivier, the representative of the regional doctors' council, was
wary about the recruitment of medical assistants for basic tasks.
"Getting help with the paperwork is great but do we really want
these assistants to take blood pressure or body temperature, like in
Britain? These are highly sensitive human actions," Ollivier said.
"Many of us are skeptical. We feel like all these decisions are
taken in cities and offices, away from the reality of rural areas."
(Editing by Timothy Heritage)
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