Consultation at €30, drop in antibiotic prescriptions…: Jean-Marc Laruelle, Montpellier GP, not gentle with the Medical Convention

Jean-Marc Laruelle, généraliste montpelliérain commente la convention médicale récemment signée, sans langue de bois ! MIDI LIBRE – G. I.

Consultations at 30 € at the general practitioner, variable at the specialist, less work stoppages and antibiotic prescriptions… hellip; Montpellier general practitioner Jean-Marc Laruelle comments on the medical agreement signed this Tuesday between unions of liberal doctors and the National Health Insurance Fund (CNAM).

Health Insurance and five unions of liberal doctors have signed the new medical agreement setting, among other things, the consultation at 30 euros; at a general practitioner instead of 26.50 euros. In what state of mind did you and your FMF union sign it??

We had the choice between the plague and cholera. We lost a year, we gained nothing. In the event of non-signature, we started with an arbitration settlement unless Bercy took control. Nobody is happy with the signing.

No way to object ?

If you want to participate in the commissions that defend doctors, you must be a signatory to the agreement. For example, to obtain ’conventional” which allows you to compensate the income of active members of a union, you must sign! This is a serious problem. We can be called « sold » on social media, but we have to.

On what arguments was the initial demand based, namely a consultation at 50 € ?

The increase to 30 € simply catches up with inflation. She clearly does not live up to the « shock of attractiveness » supposed to trigger the installation of young doctors. 50 €, this makes it possible to hire on a long-term basis, to have large enough premises and to compensate for the increase in rent prices. In Paris or Montpellier, how many consultations at 30 euros? to pay his rent ?

What do you think of the deal, namely the prescription of 25% fewer antibiotics, and the reduction in sick leave?

They have marabouts or diviners at the CNAM ? In the event of an epidemic like whooping cough at the moment, Covid, allergies, antibiotics are essential. How to anticipate a drop in collective prescribing ? As for stoppages, doctors are considered “hoodlums”. We don’t arrest people for fun.

Serenity is still not there ?

50 euros was the promise of quality work. This deal is a sword of Damocles. It seemed to me that we were a “liberal” profession, what is left of liberal if we regulate everything? Health Insurance releases a file when a doctor has four times more stops prescribed compared to its neighbor. It’s a matter of statistics. But medicine is not compatible with “statistical crime” and the objectives.

The Minister announces that this convention could resolve the lack of attractiveness of rural areas. True or false?

Every three years we get a magic potion. Rural medical deserts are the result of a changing profession. Being a doctor, "before", was a priesthood. The spouse was the secretary. Today, who wants to work 80 hours a week and at night in the depths of the Creuse? Where schools and administrations are closed? We understand them. Shouldn't we start there ? These regions hold on to elderly doctors who don't want to let go of their patients.

And salaried doctors. Isn’t this a breakthrough?

The system of salaried doctors proposed by the regional president, Carole Delga, aimed to recruit 200 health professionals by 2027. But we are capping at 40 doctors. There is not one, but several solutions that involve territorial division. The Midi Pyrénées region has nothing to do with that of Languedoc-Roussillon. Moreover, there are three medical centers on call in the first, and 23 in the second.

Crisis of medical deserts or vocations ?

Many doctors get out of line. I understand them, but in 40 years of practice, I now hear young people say, “I'll change jobs if it's like that.” It hurts to hear it. My generation is one of those who embraced the profession, out of a vocation for this contact with the patient. How can we not see that the person who passes the entrance exam and who gives up then takes the place of another, and perhaps “screws up” a vocation. Is this generational ? Lawyers, notaries… I hear a bit of the same speech.

Won't the trip to Lapeyronie on June 24 of the on-call medical center that you have presided over since 2002 in Aiguelongue go to dig deeper the shortage of general practitioners in the neighborhood ?

The idea is to relieve emergency doctors of all basic consultations, namely CCMU 1 and 2 (clinical classification of emergency patients). They represent 75% of arrivals. This is a City-Hospital collaboration, in the CHU building, from 8 p.m. to midnight on weekdays, from noon to midnight on Saturday and from 8 a.m. to noon on Sunday , with voluntary staff, currently 60 doctors out of the 450 general practitioners in Montpellier. In 2028-2030 we will be inside emergencies. Until then, it is a building that adjoins them. We have received feedback from very annoyed patients because there are no longer any general practitioners in Aiguelongue. 12,000 patients are seen each year. We hope to be able to maintain a consultation point there. It’s up to the town hall to decide.

A note of optimism?

I am responsible for the on-call sector in the city of Montpellier, and we are recruiting more and more young doctors to be on-call. This should be seen as an improvement.

Bio express: Jean-Marc Laruelle, general practitioner

Installed in Grand-Rue Jean-Moulin à Montpellier, Jean-Marc Laruelle trained many interns. The generalist is also first deputy general secretary of URPS, Regional Union of Health Professionals. which represents the regional elected representatives of the six unions of liberal doctors. This ensures the interface with health authorities. Since 2002, he has chaired the Aiguelongue medical center. This is promised à a move on June 24 to CHU Lapeyronie.

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