between “millimetric days”, “paperwork” and “breathing”, five general practitioners open their diary

On this day when certain surgeries are closed, doctors tell franceinfo about their weeks of work, more or less long, the fruit of arbitration between the desire to treat and the need to preserve themselves.

Despite Valentine’s Day, no sweet words on the signs. The liberal doctors are called upon to close their practices and to demonstrate in Paris, Tuesday February 14, to ask the executive to “give back to city medicine resources commensurate with the challenges”. In the midst of negotiations with the Health Insurance, the representative organizations wish “an additional financial envelope” for’“improve access to care for all French people” and are concerned about developments recently passed in the National Assembly, such as a “obligation collective” to provide evening shifts. The rally is scheduled for 1 p.m. in front of the Senate, where the criticized bill is to be considered.

In a context of crisis in the health sector in France, liberal doctors are asked to take part in the collective effort, in particular by welcoming more patients to relieve the emergency services. Why not, answer some of them, provided that the price of consultations is doubled to 50 euros, in order to be able, among other things, to recruit medical assistants. But there is no question of extending their days, already punctuated by 54 hours of work on average per week, according to a study by the statistical service of the Ministry of Health dated 2019.

>> Doctors’ strike: general practitioners testify to their daily lives, between love of care, overload of patients and paperwork

What does the daily life of our general practitioners look like today? For franceinfo, five of them have agreed to open their agenda and reveal their schedule for a recent week. From Pas-de-Calais to Bouches-du-Rhône, via the Paris region, these men and women aged 37 to 64, strikers or not, talk about their days. Some flirt with 35 hours, others approach double. So many different life choices, to exercise the same profession in the service of others. Trying not to forget too much.

François Coubard: “Finishing at 7:45 p.m. is early for me”

64 years old, installed as a liberal in Aix-en-Provence (Bouches-du-Rhône). “For the first time in my 17-year career, I am on strike. La Sécu proposes to increase the consultation by 1.5 euros, in exchange for compulsory on-call duty. But someone will have to explain to me how a doctor on duty can Thursday evening can ensure his day on Friday. For eight years, I combined my practice with the SOS Médecins guards. Between calls, I slept on my examination table. After a while, my wife asked to make a choice. I stopped.

Also completed the Saturday morning consultations, and new patients accepted as attending physician. I started taking a week’s vacation every two months, and for the past two years I’ve even allowed myself an hour for lunch. Before, I ate a sandwich, or nothing at all. These choices changed my life.

On the other hand, I am one of the few doctors to have kept walk-in slots, every afternoon, until 6:15 p.m. It overflows often, not to say systematically. Not to mention that once my office is closed, I take the time to call back all the patients who need it. Finishing at 7:45 p.m. is early for me.”

Mélanie Rica-Henry: “At least two hours of paperwork a day”

Mélanie Rica-Henry’s schedule, the week of January 30, 2023. (ELLEN LOZON / FRANCEINFO)

37 years old, installed as a liberal in Guidel (Morbihan). “Usually, I consult the office on Saturday morning, once every two months. But, since December, I have been on strike that day, to demand an increase in the price of the consultation and our role as general practitioner.

When I get home at 8 p.m., my children are already in bed. Because after my last appointment at 6:30 p.m., my day is not over. I spend at least two hours a day on paperwork, sorting mail, checking patients’ test results, calling them if necessary. Not to mention the firm’s accounting. It is also for this reason that I only consult at home once a week, on Thursday mornings. These visits require more time and preparation and paperwork: you have to print the prescriptions in advance, check the files before leaving…

Compared to salaried work, the advantage of liberal medicine is that I can choose my schedule. I could start my days before 9 am, but I want to take my children to school. That’s also why I don’t work on Wednesdays. When they are older, I will consult earlier and I will work every day. For now, with an emergency physician husband, it’s complicated.”

Guillaume Dewevre: “My days are precise”

Guillaume Dewevre’s schedule, the week of January 30, 2023. (ELLEN LOZON / FRANCEINFO)

37 years old, installed as a liberal in Méricourt (Pas-de-Calais). “I work in a priority intervention zone, that is to say that the regional health agency (ARS) identified this territory as being particularly under-endowed with general practitioners. My days are therefore busy and meticulous: as there are few practicing practitioners, I try to receive as many patients as possible, at the rate of 15 minutes per consultation. I am more than 1,600 as an attending physician.

But some appointments require more time. This Thursday, I blocked 30 minutes for a patient for whom we discovered diabetes. I took the time to tell him the news, explain to him all the complications involved, the appointments to be made with the specialists. I also added a large part of therapeutic education [un programme conçu pour informer les patients sur les implications de leur maladie] and food rebalancing.

In addition to my office, I have several professional elective mandates. It takes me a lot of time, especially at the moment, with the ongoing negotiations with the Health Insurance. Usually, Wednesday afternoon is devoted to my daughter, who is one year old. But there is always a meeting that comes on top.”

Myriam Déroche: “Working more seems difficult to me”

Myriam Déroche’s schedule, the week of January 30, 2023. (ELLEN LOZON / FRANCEINFO)

43 years old, employed by the town hall of Champigny-sur-Marne (Val-de-Marne). “I have a contract of 31 hours per week to work in general medicine and gynecology in two municipal health centres. In particular, I have to ensure a permanence one Saturday morning per month. In addition, I deal with cases every Monday morning for the departmental center for disabled people (MDPH) This gives me a welcome supplement to my income, because I have two dependent children.

Work more ? It seems difficult to me. It’s a tough job, where you face people’s illnesses, but also their suffering, their social problems. I happened to no longer be able to. I don’t work on Wednesdays, which allows me to decompress. It’s a professional breath that will help me hold on over time, if I ever have to work until I’m 70.

My consultations last 20 minutes on average. If we cut corners on it to take everyone, we no longer treat people properly, and we end up in burn out. But there are solutions to be explored: in our centers, for example, we are trying to involve nurses more closely in the follow-up of our patients. This allows us to improve their care, and to free up consultation time. Thanks to that, we can see more people.”

Geert Van der Heijden: “Four days for France, and three for me”

Geert Van der Heijden’s timetable, the week of January 23, 2023. (ELLEN LOZON / FRANCEINFO)

60 years old, installed as a liberal in Isle-sur-Serein (Yonne). “After a long career in the Netherlands, with 60 or 70 hour weeks, I moved to France with my wife six years ago. We wanted to find a balance between our private life and work. I made the choice to exercise only four days a week. Four days for France, and three days for me, for my vegetable patch, my farm, my animals, my three choirs and visits from friends and family. also grants six weeks of leave per year, but never for long, so as not to overload the colleagues in my sector.

I spend about 15 minutes on each consultation, including three or four minutes for paperwork: work stoppages, transport vouchers, school certificates… If we were better paid, we could recruit and get jobs. assistance from a secretariat. This would perhaps allow me to take on one more patient per hour.

The advantage of the campaign is that patients honor their appointments. Relationships are closer than in town, with less abuse and aggression. On the other hand, home visits are very time-consuming. I often only do two or three a week, for emergencies or patients who really can’t come. In the office, I am much more efficient. Eventually I found the rhythm I wanted, and our territory is well covered.”