Medical demography and community-based practice

Dr Jean-Paul ORTIZ, président de la CSMF

Voyage d’étude de la Fédération Internationale des Hôpitaux

Assemblée nationale – Mercredi 18 septembre 2019

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Overview(source : Atlas démographie médicale 2018 - CNOM)

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Overview(source : Atlas démographie médicale 2018 - CNOM)

Overview(source : Atlas démographie médicale 2018 - CNOM)

87 801 general practicioners in regular activity: -7% since 2010

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85 647 medical specialists (without GPs) et 24 632 surgicalspecialists

Overview(source : Atlas démographie médicale 2018 - CNOM)

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Overview: self-employed practicioners(source : Atlas démographie médicale 2018 - CNOM)

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104 944 self-employed (libéral) orpart-time self-employed part-time employed (mixte) practitioners on 01/01/2018

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The attractiveness of the departments(source : Atlas démographie médicale 2018 - CNOM)

Practionners can choose where theywant to practice: some places are more attractive thanothers

Terms of exercise (source : DREES)

• Nearly 42,000 self-employed doctors work in health care institutions in 2016, representing 40% of all self-employed doctors

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Terms of exercise (source : DREES)

Nearly 70% of doctors of the younger generations (under 40 years old) are in group practice in 2015 Generational change

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36 500 private practices

(Source : DGOS 2017)

Terms of exercise(source : DGOS, mars 2017)

Health house

Health centers (practitioners are employed)

Health Networks (organizationssupported by virtual tools)

Virtual RegionalNetwork

Health Regional Professional Communtities

Terms of exercise(source : DGOS, mars 2017)

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Number of active Health houses

Number of planned new Health houses

Total numberHealth houses

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Conventional Interprofessional Agreement (ACI)

(source CNAM 2018)

On average, out of the 910 healthhouses

Focus on the Health Houses (MSP)

Societal demands :

❖ Accessible and local global care provision

❖ Access to standards for different types of disabilities

❖ Continuity of care in line with urban living patterns

❖ Quality of care and service around patient care

Professional expectations :

❖ A strong desire for collective and coordinated exercise : work in a team

❖ A controlled and organized schedule (feminization, but not onlywomen, most young people)

❖ An organization to support and delegate administrative tasks

❖ Access to IT platforms as a group

Changes in societal and professional demands

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Today’s challenges:

❖ Underserved areas (cf. map)

On 1 January 2018, the average departmental density of doctors in regular practice for both private and mixed practice was 137.2 doctors per 100,000 inhabitants. This represents a decrease of 3.9% between 2018 and 2017.

❖ Difficulties in accessing a specialist doctor (cf. infographics)

Average time to obtain an appointment with a private specialist increased from 48 to 61 days between 2012 and 2017

❖ Support for settlement (cf. infographics)

➔Triggered the support for young professionals who want to open their ownpractices

Access to healthcare

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Number of GPs for 100’000inhabitants(source : Atlas démographie médicale 2018 – CNOM)

→Mostly rural areas have a decreasing number of GPs

Access to healthcare

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Access to healthcare

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New organization of private practices

New organizations and new missions:

❖ Patients’ participation:

➢ Information, therapeutic education

➢Personalized health plans

➢Help to support the supporters, assistance with administrative procedures

❖Working in pluriprofessional teams

➢Multi-professional consultation meeting

➢Pluriprofessional protocols

➢Coordination with other regional stakeholders

➢Security of care

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Groups

❖ Social and professional expectations

❖ Technical expectations: increasing financial support needed to have access to technology

❖ Increasing trend towards overspecialization

Territoriality

❖ Geographical access to healthcare: needs equity dimension

❖ Healthcare provision adapted to the local demography

❖ Continuity of care: according to the patients’ expectations

The future of private practices

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Leads to face the challenges

1. Status❖ Self-employed ? Employed ? Or mixed ? => Shared status

❖ Full-time ? 35 h ? Or 58 h ? => Evolving working time

❖ A the hospital? Private practice ? Combined locations ? => Shared working locations

❖ During the whole professional carrier? => Career profile

2. Clinical entrepreneur❖ Through territorial gathering => management, organization, team management

❖ Grouped medical doctors = healthcare providers = private ambulatory health facilities

❖ Contractualization : CPOM, SISA, CPTS, PTA

3. Tele-medecine❖ Tele-consultations

❖ Tele-expertise

Change of paradigm: from Mr. Bovary to Watson…