Medical deserts: "It's not a problem of distribution, but of the number of doctors"

While a cross-party bill aimed at regulating the establishment of doctors in France has just been adopted by the National Assembly and must now be studied in the Senate, Mohamed Amin Ben Kraiem, representing medical students from Lyon-Est, has expressed his opposition. A guest on 6 Minutes Chrono , he strongly criticizes a text that he considers " harmful " for patients and " based on a bad premise ."

The proposed law in question aims to better distribute doctors across the country by limiting their establishment in certain so-called "over-supplied" areas, in favor of those suffering from low medical density. This rebalancing objective, which Mohamed Amin Ben Kraiem considers misguided, is a misguided goal.

"This bill will serve no purpose. It assumes that we have enough doctors in France, which is false. The real problem is that we don't have enough, everywhere," he asserts. According to him, it is not so much the distribution as the lack of health professionals that fuels the medical deserts, which are currently present in " 87% of the country ."

The student representative is also concerned about the concrete effects of such a measure: "If it is adopted, we will prevent doctors from setting up in 5,000 municipalities. I am not sure there are 5,000 mayors in France ready to deprive themselves of doctors." He also warns of the risk of weakening territories already in an unstable balance: "These famous 'over-endowed' zones do not exist. These are normally endowed zones that are holding up as best they can, but which will be in difficulty if we block the arrival of new doctors."

Faced with those who advocate for regulating the establishment of doctors in exchange for state funding of their studies, Mohamed Amine Ben Kraiem opposes the reality on the ground: "Our first moral contract is with patients. But we also fulfill the one with the state: three years of externship and four to six years of internship working for the public hospital with salaries below the minimum wage. We already give between six and nine years of our lives to the hospital."

He also rejects comparisons with other healthcare professions whose establishment is regulated, such as pharmacists or nurses: "It's not comparable, they don't have the same place in the healthcare system. Other European countries have tried to regulate the establishment of doctors, but it doesn't work."

Asked about alternatives to this proposed law, Mohamed Amine Ben Kraiem insists that the profession has not stood idly by. "We've been proposing solutions for 20 years," he recalls.

These include short-term measures to free up medical time: increased collaboration between caregivers, hiring medical secretaries, prevention reform, and better patient education. In the medium term, he advocates making certain areas more attractive to students. Finally, in the long term, he discusses the need to diversify profiles: "We must promote the university education of areas, allowing young people from these areas to study medicine. That's the key to effective local recruitment."

While the Senate is due to consider this text, the student profession intends to continue to make its voice heard. For Mohamed Amine Ben Kraiem, the urgency lies elsewhere: "The problem will not be solved with a magic wand. We need time, resources, and a structural reform of our health system."

Read also: Survey: shortage of general practitioners even in the heart of Lyon

Read also: "A 4th year of internship will not solve the problem of access to care" (Video)

The full transcript of the show with Mohamed Amin Ben Kraiem:

Hello everyone, welcome to the 6 Minutes Chrono program, the daily meeting of the Lyon Capitale editorial team. Today, we're going to talk about medicine and a cross-party bill currently being studied in the Senate, after being passed in the National Assembly. It aims to combat medical deserts—currently, this affects approximately 87% of the country. This bill seeks to direct doctors to settle in areas where healthcare provision is deemed insufficient. To discuss this, we welcome Mohamed Amin Ben Kraiem, representative of medical students from Lyon-Est. Hello, thank you for joining us. We'll get to the heart of the matter without further ado. Why do you think this bill is a bad, even counterproductive, bill?

This is a bad bill because it will serve no purpose. First, it is based on the wrong premise: that there are enough doctors in the country and that they would choose to set up only in certain areas, neglecting others. This is false. There simply aren't enough doctors everywhere in the country. It's not a problem of distribution, it's a problem of numbers. We see this with all the figures that the Health Insurance can provide. General medicine is the specialty that is best distributed across the country. The fact is that we don't have enough doctors, and that's why today 87% of the country is a medical desert. This bill is therefore based on the wrong premise and seeks to play on distribution. The problem is that this will be harmful to patients. If this proposal is adopted, there will be 5,000 municipalities in which doctors will be prevented from setting up. I'm not sure that in France there are 5,000 mayors ready to deprive themselves of doctors.

Do you mean that in these municipalities where new facilities will be prevented - which are perhaps already on the verge of becoming a medical desert - we risk seeing negative effects with this new distribution?

Exactly. These are the famous 13% of the territory that we consider to be "over-equipped" areas. But in reality, this doesn't exist today. I assure you, these are normally equipped areas, which have what it takes to survive today, but which risk being in difficulty if we prevent new doctors from setting up there.

But isn't this a bit of a privilege that doctors have, after all? We know that pharmacists can't set up wherever they want; there's a map. It's the same for nurses, and even for other health professions. Aren't doctors defending an exception here, somewhat against the grain of history?

This isn't a privilege specific to doctors. First of all, it's not comparable with other healthcare professions, because they don't have the same place in the healthcare system. We see this very clearly for pharmacists, nurses, etc. It doesn't work. Other countries in Europe have tried to regulate the establishment of doctors: it doesn't work. The greatest danger isn't for us, for our little comfort as doctors. The greatest danger is for patients. We're going to disrupt an already ailing healthcare system, and it's the patients who risk paying the price.

And isn't that already somewhat the case? I know that on average, there are 11 days of waiting in France to get an appointment with a general practitioner. Do you think it will be worse if we redirect the facilities to other areas?

In fact, this proposal is demagogic. Parliamentarians are making the French believe that this will solve the problem. This is false. Today, we must be honest with the French people and tell them clearly that we have a problem with the number of doctors. We are currently training more, but they will not arrive until 2035. So the problem will begin to resolve itself between 2030 and 2035. But between now and then, we have five to ten complicated years to get through, and a magic wand won't change that. It will take collective efforts, collaboration, and a reform of the health system.

A bill that would change everything won't be enough. I have one final argument, often raised by the public: there should be a kind of moral contract between the state and the profession. The state funds your studies, funds consultations through Social Security, so it should be able to regulate the profession as it sees fit. How do you react to this?

Already, as a doctor, our first moral contract is with patients, more than with the State. Our goal is the health of the population. Then, of course, there is a moral contract with the State. But we already respect this contract. During the externship, we work for three years for the public hospital. During the internship, we work there for another four to six years, with a salary below the minimum wage. We'll skip over the remuneration, but we already give between six and nine years to the public hospital during our studies, where we work for it. So we already honor our part of the contract with the State.

Very well. One last question about the proposals. The government is proposing, somewhat as a counter-measure, that doctors spend two days in the most stressed areas. But beyond that, what does the profession propose to resolve this problem—not of distribution, but of medical deserts—which affects a large part of France?

We've been proposing solutions for 20 years. This isn't new. For 20 years, we've seen the problem coming, and we've been proposing solutions based on short-, medium-, and long-term policies. In the short term: free up medical time through collaboration between healthcare professionals, hire medical secretaries, and reform healthcare prevention. Patients need better health education so they know when they should see a doctor and when not. We need a more educated population capable of taking care of themselves. In the medium term: improve the attractiveness of certain areas for medical students, allow internships in these areas. In the long term: increase the number of doctors trained and diversify their geographic origins. Do they all come from big cities? Or do we promote what's called the universityization of the regions, by encouraging young people from the regions to study medicine?

Local recruitment, so they already know their territory and return there. Thank you very much, that's the last word. We're already at the six-minute mark. Thank you for joining us. As for you, thank you for following this program. More details on current events and this proposed law can be found on the lyoncapitale.fr website. See you soon, thank you all.