French villages in “great seduction” mode

Francis Cabrel is famous in Quebec. His political and social commitment in France, on the other hand, is much less familiar to us. The singer-songwriter was born in Astaffort, a village in the Lot-et-Garonne department in southwestern France, near Toulouse. He was a city councilor there for 15 years.

Recently, he took on a cause close to his heart: recruiting a general practitioner for his small town.

Astaffort, like hundreds of French towns and villages, is on the verge of falling into the category of what the French call medical deserts. One of the recurring themes — as in Quebec, access to a family doctor — of election campaigns in France.

Two years ago, there were four GPs in the town. Two left and a third agreed to postpone his retirement for a few months. Before long, if nothing is done to recruit a second general practitioner, the 2,000 inhabitants will have to travel several kilometers to obtain care. In fact, the situation is more dramatic than that, because the doctors of Astaffort serve a region populated by 13,000 souls.

At the request of the city council and local notables, Cabrel participated, with several inhabitants, in a promotional video about the village, an initiative reminiscent of the Quebec film The great seduction.

The sequence of a few minutes does not lack humor and is worth the detour. Cabrel opens the video: “Everything here seems to be made for the happiness of its inhabitants. But a shadow hangs over the village: it lacks a general practitioner. And then, in turn, several residents and health professionals describe the many advantages of living in this village located between the sea and the mountains. The video, launched last September, has been viewed thousands of times.

The deserts multiply

Has it borne fruit? « Despite the great reputation of Cabrel and the attractions of our village, the result is long overdue, » said the mayor, Paul Bonnet. We have now decided to hire a headhunter. The mayor even appeals to Quebec doctors. “I am happy to speak to a Canadian journalist, because our village is twinned with Saint-Zénon, in Quebec [NDLR : dans la région de Lanaudière], and Francis’ sister, Martine, heads the Guyenne Gascogne-Québec association. Welcome home,” he said.

Medical deserts are multiplying in France, particularly in rural areas. According to a report by the French National Assembly published last January, approximately 12% of French people today live in a medical desert where access to a health professional is very difficult, if not impossible. And no less than 10 million people out of a population of 65 million live in an area where the quality of care is below the national average.

Unfortunately, things are not going to improve in the next few years. France, according to this report, remains one of the States of the Organization for Economic Co-operation and Development (OECD) where doctors are the oldest: the proportion of doctors over the age of 55 is 45%, against 34% on average in OECD countries. The report predicts that the number of GPs will continue to decline until 2026 at the earliest, due to retirements. If, on average, there are 140 general practitioners per 100,000 inhabitants on the national level, some departments have only 60 with, of course, strong disparities between towns and villages.

In this election year, the issue of medical deserts, traditionally covered by local media, is increasingly making headlines in national media. Politicians are challenged. The Minister of Solidarity and Health, Olivier Véran, is betting on the measures already announced during the Macron presidency (2017-2022) to reverse the trend: financial incentives, boost to telemedicine, increase in the number of medical students , delegation of certain tasks to paramedics. For him, young doctors should not be forced to settle in one place or another.

The candidates who are most likely to score well in the presidential election, such as Valérie Pécresse and Marine Le Pen, tend to agree with the government’s guidelines. Éric Zemmour, far-right candidate, and Jean-Luc Mélenchon, far-left candidate, are more directive and want to impose on young doctors the place of their practice.

While waiting for one method or another to produce results, small towns and departments are doing everything they can to attract candidates. Some build health houses and offer free rental to future doctors. Others promise to share the secretarial costs. Although these offers may seem enticing, they are far from sufficient for some. Last year, a Parisian doctor responded to an advertisement by asking for accommodation and a company car, land allowing construction to be considered, as well as a relocation and installation bonus, in exchange for coming to a small village.

An original experience

In the Pyrénées-Atlantiques department in southwestern France, the presence of medical deserts reflects the degree of attractiveness of certain regions. Part of the department faces the Atlantic Ocean. The Basque coast, where the seaside resorts of Biarritz and Saint-Jean-de-Luz are located, attracts a very wealthy population and tourists. There are many doctors there. Inside, both on the Basque side and in Béarn, several areas are sorely lacking. In 2019, local elected officials and authorities throughout the territory decided to act in order to rebalance things and anticipate retirements in a department where 63% of doctors are over 50 years old. They launched Medical Presence 64, an original project whose central concept is the personalized welcome of each candidate for settling in the department.

“There are different models for attracting young doctors to the regions,” says Nadine Hialé, project director. Most are based on financial incentives. We imagined going further by creating tailor-made support for general practitioners wishing to come to us. »

The project provides candidates with an assigned team and a single point of contact. We build personalized solutions to meet their professional and personal life plans. Thus, the team will see to facilitating the administrative procedures, mobilizing the existing financial assistance to enable the candidate to settle, supporting the search for accommodation, supporting the spouse in the search for a job, finding solutions for schooling and childcare.

The initiative also has another purpose: to revitalize the social and economic fabric. “The medical presence is an essential element of the attractiveness of the territory, says Thierry Carrère, vice-president of the departmental council. It is a determining factor in maintaining populations, especially in rural areas. »

The results are in. In three years, the project has allowed the installation of 14 doctors. Twenty-one files for a scheduled arrival in the next two years are currently under study. Finally, 25 candidates showed interest and made contact with the project managers. They are often students who begin to plan their entry into professional life after the end of their studies.

The future will tell if this initiative will succeed in stabilizing medical desertification or even in reversing the trend. Small glimmer of hope: given the high cost of living on the Basque coast, several health professionals are now looking to Béarn, says the D^D Sylvie Harmant, President of the Pyrénées-Atlantiques Order of Physicians. “Recently, nurses and physiotherapists have settled in our area. It’s fragile, but it’s a sign that we’re heading in the right direction. »