“Medical desert. » The words evoke depopulated villages and vast unoccupied areas. However, these terms now apply, in various forms and issues, to the entire territory.
25.3 million users live in an area where the provision of private healthcare is insufficient. 15.3 million can no longer find a GP, despite being a compulsory entry point into the healthcare system since 2004. Worse. Medical deserts are no longer understood only geographically. “The entire care pathway is degraded,” notes Olivier Babinet, digital health expert (1). The very principle of equal access to care is now being called into question.
Each territory has its own reasons and dynamics: rural areas and priority areas of cities no longer attract, unlike small towns on the edge of larger ones, which see young families arriving. “These different movements are faced with the scarcity of the supply of doctors,” recalls Guillaume Chevillard, geographer and researcher at Irdes. From 1971 to 2020, a numerus clausus limited the number of medical students. And its opening since 2020 will not mechanically be able to have effects before… 2030!
The number of students remains constrained by the reception capacities and training resources of the faculties. “The number of general practitioners should decrease further until 2026, and only return to its current level beyond 2030,” confirms a recent senatorial report. 16.4% of active doctors today are over 65 years old… This is the case in Lot, for example, where the five ophthalmologists still practicing have just reached this age.
The public authorities became aware of the problem late and after having applied ineffective policies, focused on financial incentives. Since the “My health 2022” strategy, measures aim to free up medical time for doctors, by transferring certain tasks to highly specialized nurses or medical assistants (10,000 planned by the end of 2024) who can take care of patient reception and administrative costs.
Municipalities respond to local specificities of care
In the meantime, what could really change the situation is the commitment of local communities. “Their proximity allowed them to adapt to the specific needs of residents,” explains Guillaume Chevillard. Thus, health homes, or health centers in which professionals are employed, were born at the municipal level. Their success is overwhelming. While there were only around twenty in 2008, there are now 2,550 and the public authorities are aiming for a target of 4,000 by the end of 2027.
Mobile medicine, recruitment of foreign doctors, meetings organized by mayors to attract general practitioners, re-employment of retired doctors, “bridges” between regions… Local authorities drive or support a multitude of initiatives, of which we present some particularly enlightening examples (explore the box below). “No single solution is miraculous but this abundance is productive,” observes Olivier Babinet. Put together, the pieces of this puzzle reduce waiting hours in doctors’ offices, which isn’t so bad.
(1) Co-author of the work The medical deserts in question(s), Ed. Hygea, 144 p. ; €14.