Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
French general practitioners went on strike today. It’s part of an extended period of industrial action that includes refusing to process paperwork and a number of planned medical centre closures. Not every GP could participate today, however, due to a flu epidemic sweeping across France. Doctors had already closed their offices during December but there was little response from Marisol Touraine, the Minister for Health, and this was part of their planned efforts to maintain pressure.
Money is one problem. The agreed fees paid by l’Assurance Maladie seem modest. Doctors are paid €23 euro per consultation with reported average earnings for 2013 of just over €81000 p/a; (€6800 per month). There are large differentials with a quarter earning less than €36000 while others earn more than €138000. Yet GPs are also asking for recognition as medical specialists. They are unhappy too about a reduction in their activities that include, for example, vaccinations and diagnostic tests undertaken by pharmacists.
Recruitment is a problem, especially in rural areas. As the ski season enters its busiest period at the start of the school holidays, families heading towards Haute Savoie region, with its majestic mountains and stunning landscapes, might think it idyllic to move close to one of those fairytale alpine villages dressed in winter snow. What a wonderful place to work. But the local newspaper tells a different story. In Cluses, with Mont Blanc in sight, there are 59.6 GPs per 100,000 inhabitants compared to a national average of 109. And, of the 12 GPs in Cluses, seven are over 55 years old and three over sixty. As in many countries, there are insufficient family practitioners in the marketplace and young doctors prefer to specialise.
French healthcare has always been considered to be of a very high standard. Friends who have had cause to visit a family doctor in France have been complimentary about access, the quality of care, the diagnostic equipment, and the facilities including radiology. According to the Euro Health Consumer Index for 2014, whose results were released last week, France is placed 11th in Europe. Last year, the Commonwealth Fund ranked France 9th of 11 countries examined, just above Canada, with the US ranked last. And, according to Numbeo, France has the best healthcare in Europe and 4th best worldwide.
If you would like to look more closely and compare different healthcare systems worldwide, the Health Systems and Policy Monitor has a search engine that allows you to select individual countries and make comparisons across various parameters. You can, for example, compare Canada with France, looking at Primary/Ambulatory Care, and create your own PDF. Hours of entertainment – if this is what interests you.
In the meantime, it will be interesting to see what happens in France. There is unhappiness amongst GPs in many countries and, while the problems seem very similar, our French colleagues have taken the initiative with this industrial action.