2023-06-08 15:37:13
This survey by the Union of Public Psychiatrists (SPH) highlights the multifactorial nature of the arduous nature of the exercise in psychiatry: permanence of care, care without consent, permanent overload of work, in a context of lack of means, create an environment very degraded work.
Identifying the factors of attractiveness or demotivation perceived by public service psychiatrists or equivalent and identifying the levers that might be applied in health establishments, such was the purpose of this survey. “unprecedented “ launched last February by the Union of Hospital Psychiatrists (SPH). This inventory of needs “in the field” was to feed the consultations on the difficulties of public psychiatry initiated by the Ministry of Health and Prevention in January, and since “stuck in neutral”according to MJ Cortès, president of the SPH.
Some thousand psychiatrists responded, with multiple profiles: a varied exercise (general psychiatry, child psychiatry, psychiatry in a prison environment, etc.), attachment to different types of establishments (CH, CHU, EPSM, ESPOC, etc.) in different regions of the territory. Most of them have the status of Hospital Practitioner (PH) and the questionnaire was able to reach nearly one in five practitioners. Respondents are mostly non-unionized. Their average age is 6.5 years. They are mostly women. Most of the psychiatrists questioned perform institutional functions, more than half are responsible for functional units. The main activity carried out mainly concerns full hospitalization and the activity of CMP. The average working time is 90%.
Satisfied with their activity? just average
Respondents are overall satisfied with their business, with an average rating of 5.7/10. However 17.46% of respondents experience “significant dissatisfaction”. Many psychiatrists think more or less regularly regarding quit their job. Some are considering spin in their establishment or in another establishment, but there are also many who are also considering leave in cabinet (28.48%) or in the clinic (16.15%), to work in temp worker (16.28%), bring forward their retirement (15.81%) or change job (15,35%).
The absence of an appeasement space, of dedicated rooms for isolation or restraint measures, is a sign of the insufficiency of means and the paradoxical constraints in which practitioners are trapped, participating in degraded care, questioning their medico-legal responsibility. and aggravating the hardship.
Between attractiveness and arduousness in professional practice
Psychiatrists remain interested in clinical activity and teamwork, but unsatisfied with administrative tasks, in particular the quotation of their activity and the certificates of care without consent. If the institutional activities do not arouse more satisfaction in their exercise (the activity of expertise still seems unattractive), those ofeducation and general interest are a source of satisfaction. Hardship mainly concerns the permanence of care, care without consent, permanent work overload and lack of resources. Hospital governance is also questioned.
Practitioners’ weeks are busy, with an estimated average of 44 hours in the service, to which must be added work at home.
The medical teams appear unstable, fragile: with nearly 25% of respondents without a holder in their department, a third with a holder practitioner who has not been replaced for more than a month, more than a quarter working with PADHUE (many of whom are uncertain regarding their status ), and three quarters of respondents with one or more unfilled vacancies in their department. ” These problems of medical demography pose problems of team cohesion and knowledge of patients. They also necessarily impact on the permanence of care, the possibilities of rest on duty and recovery, the exercise of leave rights, training, etc. The organization of the permanence of care sometimes relies on very few practitioners ” emphasizes the SPH.
Access to training seems limited, and in some cases, impossible. Not being able to meet training expectations is to make patients and professionals unsafe, and to amplify the hardship and lack of attractiveness of the profession.
Work/life balance is below average
The respondents’ assessment underlines the difficulty of reconciling private and professional life: from the point of view of time organization (4.23/10) and even more because of the mental load (3.99/10). Respondents find it difficult to schedule rest periods for the next day on duty, recuperate following disturbed on-call duty in the deep night, schedule CAs (a quarter of respondents), RTT (a third of respondents), training leave (nearly half of respondents !), and even sick leave… These difficulties, combined with the problems of medical demography, the obligations of permanence of care… contribute to the difficulty and must be recognized as major psychosocial risks.
Faced with the challenges of a suffering psychiatry
If the recognition of the profession by the medical teams, the patients and their families is well perceived, it appears clearly insufficient on the part of politicians, the ministry, the ARS and the prefectures… For the HPS, it will not be enough to recruit young practitioners. Not being able to keep experienced practitioners in post means, in addition to the effects for practitioners on their personal scale, on such a scale, participating in the loss of skills: teaching and the first steps in the field cannot be enough. to guarantee medical competence, which must be nourished by exchanges between peers and experience, just as the presence of young practitioners who come to question practices benefits the older ones. This is a virtuous circle that benefits everyone.«
Quelques enseignements spécifiques... et autres pistes - Les accords du Ségur sont majoritairement perçus comme une injustice (63%) et un facteur de démotivation pour les collègues concernés (67%), avec une grille qui devrait rattraper les 4 années perdues par les collègues. - La permanence des soins doit être mieux prise en compte et revalorisée. - L’IASL (indemnité d’activité de secteur et de liaison) pourrait être attribuée plus simplement. - La création d’une indemnité d’activité de première ligne pourrait créer un choc d’attractivité. - La limitation des possibilités d’installation en cabinet apparait comme une mauvaise idée (59,4%) qui limite l’attractivité du poste hospitalier (32%),
Ultimately, to fight once morest hardship and promote attractiveness, while psychiatrists work a lot, and in often degraded conditions, it appears that the needs are multiple and do not relate only to the necessary revaluations of the salary grid and the permanence of care. We also find in the first place the financing of psychiatry, and in a pocket handkerchief the obligation of a minimum basic equipment in human resources, architectural means and computer equipment, the evolution of hospital governance, training in psychiatry…
The very explicit results of this survey are likely to lead to recognition of the needs of practitioners and to the setting up of negotiations with the supervisory authorities to bring out the changes that are as necessary as they are urgent.
• First analyzes – Large national survey – Difficulty – Attractiveness – Targeted measures. Union of Hospital Psychiatrists (SPH), June 7, 2023.
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