French doctors go on strike to demand reintroduction of compulsory out
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《英国医生杂志》
Emergency services at public and university hospitals in France last week began a "general and unlimited" strike, organised by the French Association of Hospital Emergency Doctors. Joined by nurses, administrators, and ambulance drivers, the striking doctors are asking not only for more staff, better working conditions, more beds, and more money but a revamp of France抯 entire emergency and out-of-hours care system.
They are also complaining that doctors with private practices do not carry out enough out-of-hours work during evenings, weekends, and holidays, forcing patients to use hospitals instead. They want to see a system introduced whereby most general practitioners with private practice are obliged to do out-of-hours work.
Dr Patrick Pelloux, president of the association, said in an open letter to Dr Philippe Douste-Blazy, the health minister, that the overuse of emergency services resulted from structural changes in French society. "Our health system has not known how to move with the demographic and cultural evolution of our society," he said.
Although the strike has created even longer waiting times, emergency departments in public hospitals continued to treat patients after hospitals forced the striking doctors to work, a move that is permitted under French law. But many strikers wore banners reading "on strike" while working.
At the peak of the strike in the middle of the week, participation was about 90% of staff in public hospitals and 80% in university hospitals, according to the government and strikers.
One of the causes of the present strike is a big rise in the number of patients visiting emergency departments. The number rose by 13% between 2000 and 2003, from 12.9 million to 14.6 million people. In 2003 the health ministry launched a three year plan to improve emergency services, with a budget of �489m (?35m; $632m), of which �175m was to be used in 2005.
But the strikers say that the money is not enough and that problems in emergency departments are exacerbated by failings in other sectors, such as inadequate care of old people, who are frequent visitors to emergency departments. Strikers also complain that emergency services are being flooded by patients with ailments as harmless as the common cold, after the government, in 2003, made out-of-hours and on-call work by general practitioners voluntary.
The government last week pushed through publication of a decree reorganising the network of on-call services throughout France, calling for emergency workers and private doctors to work together to ensure a 24 hour service. The decree allows local prefects to requisition doctors if volunteers are lacking—but it confirms the voluntary nature of on-call work.
Dr Douste-Blazy said he will study the situation again after six months, hinting that he might return to an obligatory system.
Doctors complain that on-call work adds to an already burdensome 55 to 58 hours of work a week, according to the Private Doctors Union. That union and two other doctors?unions were to meet health officials on 14 April, after the BMJ went to press, to negotiate a pay rise for out-of-hours work, which it is hoped will encourage more doctors to do such work.
On 6 April the government announced the latest figures for the country抯 social security deficit for 2004. The size of the deficit was one of the factors behind last year抯 reform of the health system. The deficit last year was higher than ever but was less than the predicted �14bn. It had risen to �11.9bn, from �10.2bn in 2003.
On 8 April Jean Castex, the director of hospitals at the Ministry of Health, met with several leaders of hospital emergency workers?unions and said the government would address the problems, but the strike continued into a second week as the strikers sought more concrete proposals.(Paris Brad Spurgeon)
They are also complaining that doctors with private practices do not carry out enough out-of-hours work during evenings, weekends, and holidays, forcing patients to use hospitals instead. They want to see a system introduced whereby most general practitioners with private practice are obliged to do out-of-hours work.
Dr Patrick Pelloux, president of the association, said in an open letter to Dr Philippe Douste-Blazy, the health minister, that the overuse of emergency services resulted from structural changes in French society. "Our health system has not known how to move with the demographic and cultural evolution of our society," he said.
Although the strike has created even longer waiting times, emergency departments in public hospitals continued to treat patients after hospitals forced the striking doctors to work, a move that is permitted under French law. But many strikers wore banners reading "on strike" while working.
At the peak of the strike in the middle of the week, participation was about 90% of staff in public hospitals and 80% in university hospitals, according to the government and strikers.
One of the causes of the present strike is a big rise in the number of patients visiting emergency departments. The number rose by 13% between 2000 and 2003, from 12.9 million to 14.6 million people. In 2003 the health ministry launched a three year plan to improve emergency services, with a budget of �489m (?35m; $632m), of which �175m was to be used in 2005.
But the strikers say that the money is not enough and that problems in emergency departments are exacerbated by failings in other sectors, such as inadequate care of old people, who are frequent visitors to emergency departments. Strikers also complain that emergency services are being flooded by patients with ailments as harmless as the common cold, after the government, in 2003, made out-of-hours and on-call work by general practitioners voluntary.
The government last week pushed through publication of a decree reorganising the network of on-call services throughout France, calling for emergency workers and private doctors to work together to ensure a 24 hour service. The decree allows local prefects to requisition doctors if volunteers are lacking—but it confirms the voluntary nature of on-call work.
Dr Douste-Blazy said he will study the situation again after six months, hinting that he might return to an obligatory system.
Doctors complain that on-call work adds to an already burdensome 55 to 58 hours of work a week, according to the Private Doctors Union. That union and two other doctors?unions were to meet health officials on 14 April, after the BMJ went to press, to negotiate a pay rise for out-of-hours work, which it is hoped will encourage more doctors to do such work.
On 6 April the government announced the latest figures for the country抯 social security deficit for 2004. The size of the deficit was one of the factors behind last year抯 reform of the health system. The deficit last year was higher than ever but was less than the predicted �14bn. It had risen to �11.9bn, from �10.2bn in 2003.
On 8 April Jean Castex, the director of hospitals at the Ministry of Health, met with several leaders of hospital emergency workers?unions and said the government would address the problems, but the strike continued into a second week as the strikers sought more concrete proposals.(Paris Brad Spurgeon)