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LIVING IN FRANCE

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

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.

Medical deserts: Why one in three French towns do not have enough doctors
All photos: AFP
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.
 
 

Member comments

  1. 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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LIVING IN FRANCE

What changes in France in July 2022

Summer's here and the time is right for national celebrations, traffic jams, strikes, Paris beaches, and ... changing the rules for new boilers.

What changes in France in July 2022

Summer holidays

The holiday season in France officially begins on Thursday, July 7th, as this is the date when school’s out for the summer. The weekend immediately after the end of the school year is expected to be a busy one on the roads and the railways as families start heading off on vacation.

READ ALSO 8 things to know about driving in France this summer

Strikes

But it wouldn’t really be summer in France without a few strikes – airport employees at Paris’ Charles de Gaulle and Orly airports will walk out on July 1st, while SNCF rail staff will strike on July 6th. Meanwhile Ryanair employees at Paris, Marseille and Toulouse airports will strike on yet-to-be-confirmed dates in July.

READ ALSO How strikes and staff shortages will affect summer in France

Parliamentary fireworks?

Prime minister Elisabeth Borne will present the government’s new programme in parliament on July 5th – this is expected to be a tricky day for the Macron government, not only does it not have the parliamentary majority that it needs to pass legislation like the new package of financial aid to help householders deal with the cost-of-living crisis, but opposition parties have indicated that they will table a motion of no confidence against Borne.

Parliament usually breaks for the summer at the end of July, but a special extended session to allow legislation to be passed means that MPs won’t get to go on holiday until at least August 9th. 

Fête nationale

July 14th is a public holiday in France, commemorating the storming of the Bastille which was the symbolic start of the French Revolution. As usual, towns and cities will host parades and fireworks – with the biggest military parade taking place on the Champs-Elysées in Paris – and many stores will remain closed.

As the national holiday falls on a Thursday this year, many French workers will take the opportunity to faire le pont.

Festival season really kicks in

You know summer’s here when France gets festival fever, with events in towns and cities across the country. You can find our pick of the summer celebrations here.

Paris Plages

The capital’s popular urban beaches return on July 9th on the banks of the Seine and beside the Bassin de la Villette in northern Paris, bringing taste of the seaside to the capital with swimming spots, desk chairs, beach games and entertainment.  

Summer sales end 

Summer sales across most of the country end on July 19th – unless you live in Alpes-Maritimes, when they run from July 6th to August 2nd, or the island of Corsica (July 13th to August 9th).

Tour de France

The Tour de France cycle race sets off on July 1st from Copenhagen and finishes up on the Champs-Elysée in Paris on July 24th.

New boilers

From July 1st, 2022, new equipment installed for heating or hot water in residential or professional buildings, must comply with a greenhouse gas emissions ceiling of 300 gCO2eq/KWh PCI. 

That’s a technical way of saying oil or coal-fired boilers can no longer be installed. Nor can any other type of boiler that exceeds the ceiling.

As per a decree published in the Journal Officiel in January, existing appliances can continue to be used, maintained and repaired, but financial aid of up to €11,000 is planned to encourage their replacement. 

Bike helmets

New standards for motorbike helmets come into effect from July 1st. Riders do not need to change their current helmets, but the “ECE 22.05” standard can no longer be issued – and all helmets sold must adhere to a new, more stringent “ECE 22.06” standards from July 2024

New cars

From July 6th new car models must be equipped with a black box that record driving parameters such as speed, acceleration or braking phases, wearing (or not) of a seat belt, indicator use, the force of the collision or engine speed, in case of accidents.

New cars II

From July 1st, the ecological bonus for anyone who buys an electric vehicle drops by €1,000, while rechargeable hybrids will be excluded from the aid system, “which will be reserved for electric vehicles whose CO2 emission rate is less than or equal to 20g/km”.

What’s in a name?

Historically, the French have been quite restrictive on the use of family names – remember the concern over the use of birth names on Covid vaccine documents? – but it becomes easier for an adult to choose to bear the name of his mother, his father, or both by a simple declaration to the civil status. All you have to do is declare your choice by form at the town hall of your home or place of birth.

Eco loans

In concert with the new boiler rules, a zero-interest loan of up to €30,000 to finance energy-saving renovations can be combined with MaPrimeRénov’, a subsidy for financing the same work, under certain conditions, from July 1st.

Rent rules

Non-professional private landlords advertising properties for rent must, from July 1st, include specific information about the property on the ad, including the size of the property in square metres, the area of town in which the property is in, the monthly rent and any supplements, whether the property is in a rent-control area, and the security deposit required. Further information, including the full list of requirements for any ad, is available here.

Perfume ban

More perfumes are to be added to a banned list for products used by children, such as soap-making kits, cosmetic sets, shampoos, or sweet-making games, or toys that have an aroma.

Atranol, chloroatranol (extracts of oak moss containing tannins), and methyl carbonate heptin, which smells like violets, will be banned from July 5th, because of their possible allergenic effects.

Furthermore, 71 new allergenic fragrances – including camphor, menthol, vanilin, eucalyptus spp. leaf oil, rose flower oil, lavendula officinalis, turpentine – will be added to the list of ingredients that must be clearly indicated on a toy or on an attached label.

Ticket resto limits

The increased ticket resto limit ended on June 30th, so from July 1st employees who receive the restaurant vouchers will once again be limited to spending €19 per day in restaurants, cafés and bars. The limit was increased to €38 during the pandemic, when workers were working from home.

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