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Medical deserts: Why one in three French towns do not have enough doctors

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Medical deserts: Why one in three French towns do not have enough doctors
All photos: AFP
08:16 CEST+02:00
One in three French towns is now classed as a 'medical desert' without adequate healthcare provision. Caroline Pierron explains what this means for people living in rural France.
What is a medical desert?
 
A medical desert is a geographical zone where healthcare providers and general practitioners are severely lacking compared to the rest of the country. Medical desertification is mainly hitting rural areas with an ageing population - retiring doctors are hardly replaced and young graduates tend to establish themselves in more dynamic zones, both in terms of economy and activities.
 
In the Lot-et-Garonne départment in south west France, to take just one example, inhabitants from villages surrounded by vineyards like Saint-Aubin, Villeréal or Castillonnes near the city of Bergerac, struggle to find physicians. 
 
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If general practitioners remain reasonably available, landing an appointment with a specialist, like a dentist, feels like an obstacle course. Too few and overwhelmed, they tend to scan calls and refuse to see new patients.
 
Is the problem getting worse?
 
Back in October, a study showed that 1 out of 3 French municipalities was considered a medical desert - in the span of a decade, the number of general practitioners dropped by 8 percent and the trend continues every year. In 2015, 8.6 percent of the French population lived in towns with a shortage of medics.
 
 
 
What is the government doing about it?
 
A number of reforms are meant to get to grips with medical desertification.
 
The suppression of the numerus clausus for French medical students, starting from the 2019 school year, is one the measures bringing hope to local elected representatives fighting for access to better medical care. Since 1971, the numerus clausus rule limited the number of students admissible to medical school, but that limit will now be lifted.
 
What solutions are local authorities trying?
 
In the Lot-et-Garonne, elected members from 43 villages, united within a Communauté de Communes [Community of Towns], pooled their resources to create new health centres.
 
Two of these maisons de santé have already been built in Monflanquin and Cancon. A new centre in Villeréal should see the light of day some time in the coming year, with an extra room dedicated to telemedicine (online consultations) to simplify access to specialists. 
 
Yet Rayet mayor Aimé Bertholom points out that these centres mean substantial investments for small towns - a minimum of €400,000. He thinks the end of the numerus clausus, though a step in the right direction, will not bring enough young graduates in rural zones.
 
He said: "I believe the solution, a bit extreme I admit, would be to oblige them to practice in rural zone for the three or four years following their diploma, based on the same principle of teachers being assigned to educational priority area. People have the right to be tended to as much as students have a right to education."
 
According to him, young practitioners won't establish themselves in rural zones because they have a preconceived idea of what it is like to live in one.
 
"Sure," he said, "having your practice to the seaside on the Côte d’Azur rather than in deepest Lot-et-Garonne sounds better."
 
 
Photo: Freddie Marriage
 
So where does this leave the patients?
 
During the Saturday weekly market, the small town of Villeréal is buzzing - British residents and locals enjoy their morning coffee on the main square. But under the covered market, conversations often revolve around the problems encountered seeking medical advice, even in emergency situations.
 
Christine, 85, lives with a lingering pain preventing her from going about her business as she used to.
 
"The pain gets worse every day," she said. "I have to go to the hospital for an X-ray but they said the next slot they had was three months from now."
 
For her as for many others, going to the emergency room is not an option. "I'd rather wait than go the Bergerac emergency service - only temporary workers there now. They do see us but off-handedly and follow-up care is close to none," said Georges, 76.
 
The Rayet mayor notices medics are increasingly becoming salaried workers.
 
"Young people prefer being employees, so they work in hospitals - they want to have flexible hours. This is why towns are turning into medical deserts."
 
Freshly-graduated physicians do tend to choose being employees in clinics or hospitals, which allows them to be freer to move, guarantees them a fixed salary every month and most of all, a defined number of hours.
 
A médecin libéral [self-employed] doctor establishes his or her practice alone, has to deal with administrative work and almost never knows when their day will end.
 
Even attractive establishment incentives fail to do the trick.
 
Pascal, a Villeréal inhabitant recalled: "In Monbahus, the town hall was offering both a really nice house and a practice, rent-free, but they say one practitioner turned down the offer because there was no pool in the garden!"
 
Aimé Bertholom now wants the government to seriously tackle the issue of medical desertification.
 
"In the end, the government stance on the health system could not be more French: the cock crows at the top of his voice he is the best, while proudly standing on a pile of manure. I know France has an excellent health system, the thing is not every citizen can benefit from it."
 
You can check on here how your town ranks in regards to access to medical care.
 
 
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Peter Smith - 10 Aug 2019 14:02
We are relatively lucky, here in Montreuil-Bellay (49), with 5 GPs, but two are nearing retirement and the other three are young (relatively-speaking) mothers who have chosen to go into general practice to fit in with their families, who certainly take precedence over the patients. 'Not enough time' for home visits. When I had (ludicrously - I'm never ill) pneumonia last year, I had to be driven to the surgery to be diagnosed and treated.
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