Démographie

Pénurie médicale : une priorité

dimanche 15 septembre 2002

Des mêmes auteurs

 
Parmi les dysfonctionnements actuels de la profession, la plupart sont imputables à la pénurie d’effectif.

Que ce soient les difficultés d’organisation des gardes et urgences, le dépouillement de certains services hospitaliers, les spécialités en voie de disparition, les praticiens souvent débordés par un rythme de travail excessif à la limite du cadre sécuritaire, les délais et attentes parfois insupportables pour le malade, le temps restreint accordé à la prévention, les vaines recherches de remplaçants, d’associés ou de successeurs, et même les inégalités de répartition géographique voire certaines désertifications, et aussi la fragilité inquiétante d’un système de retraite par diminution des actifs.
Tous ces problèmes, entre autres, ont un point commun : le manque de médecins.
C’est le résultat de trente années d’imprévoyance, par répétitions d’un numerus clausus insuffisant, ne répondant pas à un désir de planification de la démographie médicale face aux besoins du pays, mais trop souvent à un choix polarisé sur le budget de l’assurance maladie du moment.

Le résultat de trente années d’imprévoyance

En fait la pénurie est favorisée par certaines évolutions du personnel médical non compensées par le flux de formation. Ce sont surtout les vagues importantes de départ à la retraite qui déferleront encore dans une décennie. Mais aussi le développement du temps partiel et la diminution de la journée de travail qui témoignent du souci légitime de nouveaux arrivants, de se donner moins intensément à leur vie professionnelle que leurs aînés. Et puis ce sont des changements importants décidés sans avoir été précédés par le moindre coup de pouce du numerus clausus, telle l’application des 35 heures pour les salariés, et surtout la réforme de l’internat prévue en 2004, car pendant les années de stage de la promotion initiale, il n’y aura aucune installation de généraliste !
Cependant si la formation de médecins stagne, la demande médicale s’accentue de façon incontestable car les Français de plus en plus nombreux, vivent plus vieux. Et sans faire d’hypothèse fumeuses, certains événements sont susceptibles d’augmenter l’activité médicale actuelle. Ce peut être l’amplification des risques liés à la pollution, aux transports, loisirs, sports, aux catastrophes naturelles ou terroristes, et aussi les complications consécutives au déploiement de l’utilisation de drogues, dopants et de toute autre chimie, ou bien l’application des techniques génétiques, le déchaînement de demandes de chirurgie esthétique, ou la multiplication d’expertises médicales.
Le problème est que les chiffres des organismes statistiques officiels, ne sont pas à la hauteur de l’importance, ni de l’aggravation inéluctable de la pénurie que nous subissons...


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