"It's Tetris in three dimensions": Agen-Nérac emergency room under pressure during the summer period

During the summer, the department is always full. Between the reduced number of beds, the shortage of doctors, and the occasional closures of the Esquirol Saint-Hilaire clinic and the Nérac branch, the hospital staff must juggle to ensure continuity of care.

There's no summer break for the emergency department at Agen-Nérac Hospital (Chan). While patients continue to arrive, emergency staff are struggling to keep up. The cause: various factors that, when combined, disrupt emergency department operations and, consequently, patient care. Chief among them: a lack of staff.

However, since 2022, the Chan emergency room has implemented a regulatory system. The principle: patients must go through the Samu before going to the hospital. For Jean-François Cibien, an emergency physician at the Agen-Nérac hospital and president of the inter-union Actions Practitioners Hospital (APH), the method has already proven itself, but it does not prevent the constraints linked to the summer period: "The main problem remains the lack of staff and the closure of beds. And behind that, everything accumulates!"

12 beds in orthopedic surgery, eight places in outpatient surgery, 10 full hospitalization beds in internal medicine... The list of the number of closed beds is long for this summer. Jean-François Vinet, director of the Chan , informs: "We had to close these beds because we do not have the necessary staff to keep them open." The cause: departures on vacation and, behind this, the difficulties in recruiting replacement doctors.

"Today, the team includes 25 doctors, whereas we normally have a staff of 32," explains Jean-François Vinet. In this context, one solution could be to call on temporary doctors to strengthen the teams. While, since April 2023 and the implementation of the Rist law, the remuneration of temporary doctors has been capped at €1,390 for 24 hours, in practice and under pressure, this is not always the case. The Villeneuvois Health Center (PSV) makes no secret of it: in the face of tensions, they often act urgently. "A reasonable rate is initially offered. But when the date approaches and we are still short, we increase the remuneration," admits Christine Bartou, head of the emergency center.

The Agen hospital, for its part, says it refuses to break the law. As a result, it struggles to recruit and sees replacement doctors leave for other, more generous organizations. "The system is absurd; temporary doctors sometimes earn more than €1,500 for a 24-hour shift, not including accommodation and travel expenses. While we earn €700 gross for the same period," laments Jean-François Cibien. He adds: "It's just a fact of life; doctors go to the highest bidder."

Another unique feature of the hospital center is its Mobile Emergency and Resuscitation Structure (Smur) antenna, located in Nérac. For several years now, due to a lack of staff, it has been forced to close its doors "sporadically" during the summer. Jean-François Vinet warns: "We've already suspended it once in the last 30 days. And we risk doing it again." However, for Jean-François Cibien, the role of this local service is crucial, on the one hand to ensure healthcare for the residents, 26,000 in the Albret region, but also because of its "pivotal role": "The Nérac antenna is essential. When colleagues in Marmande have to transfer someone to Agen, the Marmande Smur goes to Damazan and the Nérac Smur takes over."

And for the Marmande area, this also creates additional work in an already tense context. Laurent Maillard, departmental head of emergency services, explains: "Closing the branch can extend the coverage area of the Marmande Smur. The Nérac branch saves them 45 minutes."

"Today, with all these factors, medical teams are under pressure."

For the Agen Hospital emergency room, the challenges are twofold. They also have to compensate for the regular closures of the Esquirol Saint-Hilaire clinic's emergency room due to staff shortages. "There's an increase in activity because we're feeling the repercussions of the clinic's emergency room closing. Normally, we have 100 visits per day. Now, we've reached 140," notes the hospital director. Healthcare workers are feeling the impact. Jean-François Cibien agrees: "When the clinic closes, there's no reinforcement at the hospital. It makes me wonder!" He, who has just completed 72 hours of on-call duty in six days, doesn't hide his annoyance: "We're closing two lines in the Agenais region, the clinic and the Nérac branch, but we, behind the scenes, have to manage the flow. This isn't normal!"

The system's balance therefore depends on doctors being in ever-increasing demand. "This summer, the organization is like a three-dimensional Tetris!" exclaims Jean-François Cibien. Some emergency physicians are working overtime and are therefore, in return for compensation, working more than 48 hours of on-call duty per week. This practice remains voluntary: "I can't force any doctor to work extra shifts," assures the hospital director. For Jean-François Cibien, faced with difficulties, the choice is quickly made. "I have colleagues who sometimes work up to 96 hours. But we're not machines," he worries.

"Today, with all these factors, the medical teams are under pressure," notes Jean-François Vinet, who tries to put things into perspective as best he can: "The situation is not alarming, but not everything is under control. There have always been constraints in the summer, and this is not specific to our emergency department."

At the Agen-Nérac hospital, everyone is hoping that the summer storm will pass without incident. "We're keeping our fingers crossed and hoping there won't be any problems this summer, such as sick leave among our teams, because right now we don't have the resources to replace each other," Jean-François Cibien bitterly says. The director concludes: "We're going to do what we do every year: we're going to look forward to the start of the school year."