Tuesday, July 13, 2010

The French Doctors

Last night the president of France, in his “oval office” interview equivalent, mentioned the “grave crisis” of the French doctors, though the media takes little interest. In this morning news: yet another retreat of the socialized system, a list of more areas no longer covered by the state mandated insurance which all French citizens and foreign workers are obliged to pay as a “social security” tax - not to mention the private “complementary insurance” which all prudent people feel obliged to have, to help cover the now looming gaps in public financing - though the social security tax remains in full force. In the last few weeks a plan to close all surgical units which perform less than 1000 operations a month has given rise to much complaint, but in France there is always fuss at any prospect of change, because each situation has state mandated winners who don’t want to lose. But what can one expect of a “rationalized system”, other than that it be impractical and hopelessly expensive? If this sort of thing worked the USSR, Red China and the Khmer Rouge would still be going concerns.

For the doctors - that is the “generalists”, the individual doctors who constitute the front line and the mass of the troops in the battle against illness - this “grave crisis” is grave indeed. Within 2 years, unless something gives, it is altogether possible that there will be no more generalists in France. Not only are there not enough young people who want to work in this field, not only are generalists disappearing into retirement as fast as they can, not only are there whole regions of France where there is already an alarming lack of them, but those remaining are deserting the field “en masse” to take posts in the public system. There, instead of working 80 hours weeks, instead of having state-designated duty nights, instead of earning tiny state-regulated fees for specific medical acts which they are obliged to pile up and account for in order to be paid, instead of being ordered onto the carpet and interrogated by supervising magistrates every time they happen to prescribe too much of this, or not enough of that, instead of seeing what they do earn drained away in taxation which often tops 50%, instead of continuing to stagger under a quickly growing mass of regulation and bureaucratic obligation of all sorts impossible for an individual to bare, and hardly easier for doctors grouped in clinics which can afford to share a secretary, instead of all this, they will work 35 hours a week, take home a salary, and say goodbye to all that.
The consequence? Front line French health care will soon occur in “emergency rooms” only, emergency rooms already absurdly overburdened. The system will shrivel into a sclerotic inefficiency which, however, can be ignored by the public “health care givers” and their administrators, who will have no obligations beyond their employment contracts, and budgetary relation with the state. It’s not that the French doctors are not alarmed about this but they are only human. Thier energy and thier nerves have limits. Their suicide rate has reached a new high. 

And what will happen to “health care”? Need I go into details?


  1. Being a doctor, I think I would quit under that weight of garbage. I would find another way to live, maybe a farm. And I suspect a black market (white would be a better color to call it) would develop as my neighbors found me very helpful in resolving health maters they could not otherwise resolve. So, I would not be so sorry for the doctors, but for the public who is being separated from them.

  2. The farmers have their own wierd system in France. Everything works with subsidies, though they like to pretend they are independant. The farming opperations are all calculated around subsidies and cost. For example, they are paid to plant sunflowers, but the market price does not cover the cost of harvesting. So they try to not harvast - just let the stuff rot in the field, but the inspectors go around in airplains to check on what's what.
    Then, if you dared to doctor without being registered as practicing doctor - and paying your pre-work taxes to have the right - and someone snitched on you, it would be worse than murder or child molesting - about which no one cares.
    Otherwise France is a great place!