The Annual Report of the Court of Auditors has been filed and, once will not hurt, is to index the management of health expenditure, each player attacking the system's behalf.
Without comment 444 pages report, I felt it was nevertheless appropriate to point out that according to its authors, medical demography would not be a problem in itself, the problem is concentrated around a disparity of medical specialties and geographic areas.
Thus, concludes the report, the management of the curriculum of medical studies do not allow the release of a sufficient number of GPs while incentives to aid in the installation area under medicalized have not borne fruit, so it should, according to our sages, of focusing on negative incentives calling into question the principle of freedom of installation as suggested by a few days earlier the president of the UNCAM.
Things are heard, there are not enough GPs because is - he said, management of supply restrictions and hardships national ranking does not guarantee, including the release of a sufficient number of Students in this discipline.
I am delighted at being made of the fact that our countries lack of GPs, but I remain circumspect about the reasons given for this deficiency. The
Reading the report of the Court relies on this specific question misses a key factor never mentioned in all reports and official records: Man.
And yes! Pardon said, but the management reforms of the numerus clausus and the national ranking examination, may also be useful - be they should not make us miss the real important issue, and finally only: the profession of doctor GP attracts - t - he still medical students?
This is crucial as it affects the very foundations of medical school but it is painful because it forces us to think about the image that we all, at our level, conveyed the general practitioner.
Everyone knows that general practice is, with the medicine work, discipline last selected by students, which suffers from an obvious and overt disaffection and whose reasons are undoubtedly the organization of graduate studies in medical studies, but certainly not exclusively.
The medical student is struck that throughout the meandering course that is his, the lessons are taught by teachers teaching hospital - university, by definition, are not GPs since this discipline is not hospitable.
This means that all courses and studies based on medical specialists and medical students will, unless very specifically listed, never matter to the general practitioner, noting that cases are generally subject almost always cases hospital and non-medical.
Without comment 444 pages report, I felt it was nevertheless appropriate to point out that according to its authors, medical demography would not be a problem in itself, the problem is concentrated around a disparity of medical specialties and geographic areas.
Thus, concludes the report, the management of the curriculum of medical studies do not allow the release of a sufficient number of GPs while incentives to aid in the installation area under medicalized have not borne fruit, so it should, according to our sages, of focusing on negative incentives calling into question the principle of freedom of installation as suggested by a few days earlier the president of the UNCAM.
Things are heard, there are not enough GPs because is - he said, management of supply restrictions and hardships national ranking does not guarantee, including the release of a sufficient number of Students in this discipline.
I am delighted at being made of the fact that our countries lack of GPs, but I remain circumspect about the reasons given for this deficiency. The
Reading the report of the Court relies on this specific question misses a key factor never mentioned in all reports and official records: Man.
And yes! Pardon said, but the management reforms of the numerus clausus and the national ranking examination, may also be useful - be they should not make us miss the real important issue, and finally only: the profession of doctor GP attracts - t - he still medical students?
This is crucial as it affects the very foundations of medical school but it is painful because it forces us to think about the image that we all, at our level, conveyed the general practitioner.
Everyone knows that general practice is, with the medicine work, discipline last selected by students, which suffers from an obvious and overt disaffection and whose reasons are undoubtedly the organization of graduate studies in medical studies, but certainly not exclusively.
The medical student is struck that throughout the meandering course that is his, the lessons are taught by teachers teaching hospital - university, by definition, are not GPs since this discipline is not hospitable.
This means that all courses and studies based on medical specialists and medical students will, unless very specifically listed, never matter to the general practitioner, noting that cases are generally subject almost always cases hospital and non-medical.
It hear neither in the first or the second round about general practice, which ultimately he does not know much, recalling that the practice of medicine internship city can easily be overlooked.
All he knows is that this is a very demanding profession combining OOH, home visits and opening hours very important, often requiring work on Saturday morning at the much lower value added intellectual important than other medical disciplines.
There is no doubt that this, added to career opportunities ultimately bleak, affects the choice of medical students.
The question thus arises naturally from the redesign of the curriculum to enable a medical profession, the linchpin of the health system to take its place.
But whatever reforms that will be implemented, I fear for my part that they remain inadequate, as it is clear that what is at issue through the disaffection of the art GP is finally more or less the core value that our society places on self-sacrifice as a model of social construction and personal.
Indeed, we can not escape the question of what image we convey the general practitioner, and look what we are led to focus on it?
But behind this question a lot more demanding, more painful, confronting us, which is to know what career model we propose to those who one day decided to study medicine?
The GP is the backbone of the health system in that it is the physician's daily, one today and now: let us abolish it, and the whole health system 's collapsed like a house of cards.
It is the one to whom patients turn first, and before being human pathology, it is the patient, because nobody knows him as his patients, confirms that the choice of the it as a doctor in more than 95%.
This medicine is about challenging because it requires to listen, develop a sense of clinical diagnosis so refined that it must transcend the grievances of patients often unable to express them.
This medicine is also demanding in terms of sacrifices and the sacrifices it requires, more particularly in rural areas where the medical practitioner is so that he ended by becoming man band at the expense of a balanced personal and family who, sooner or later will break, then placing it in a big and deep solitude.Dans a society of immediacy, in a world of neologisms (RTT, CET ...) it must be said, the profile of the doctor working 6 days out of 7 patients, and 7th day for sickness , forced to justify permanently embedded in the middle of paperwork, no longer recipe, many students moving toward careers hospital, free from all constraints of the private practice of medicine on the one hand, and do not particularly want to be overexposed on a permanent basis as is the general practitioner on the other.
For there is the crux of the problem: medical hub of the health system, it is also shown publicly singled out as responsible for the soaring costs of health, prescribing too many stoppages, yielding too easily to pressure patients on medication use, etc. ...
Thus was born the myth of the doctor gently irresponsible legislators having enjoyed over the years to provide tools increasingly coercive to health insurance organizations, specific to just put GPs in step.
course, I hear the criticism that is sure to create such a connection, and especially the fact that the texts do not aim GPs, but are common to all practitioners.
course, but do not hide behind his finger, and experience shows conclusively that the first general practitioners remain concerned, because undoubtedly, they are the first stop of Prescribers working example, which is closely related to their quality physician.
Finally, what about the emergence probably happy with the specialty of general medicine, with its discipline-specific DES, like other specialties, which was nevertheless accompanied by a refusal leveling fees on those other specialists, true?
What about when a minister ordered a full report on the question of whether the listing of the basic act of specialists in general medicine must be equal to that of other specialists?
And what about when this report comes to the conclusion that the GP can not be an expert like others, in that it remains a general practitioner, and that therefore he can quote his fellow professionals as CS?
The only thing to say is that we can hide behind our finger as we want, and propose any reforms in the curriculum of medical school we want: as long as we have not changed our view of those who give themselves tirelessly to others, truth, humbly, without fanfare, we fail to GPs.
Now, how to change our view of these "humanists" when our institutions self - give them only half - reforms to appease the spirits more than actually recast the status of general practitioners?
proof is with the Social Modernization Act of January 17, 2002 implemented by Decree No. 2004-67 of January 16, 2004 after which all medical students who wish to do a postgraduate medical education must stand for national ranking of the internship.
The competitive internship is therefore common to all students and the general practice is therefore recognized as a specialty.
This reform would have been interesting if it took into account all aspects of upstream and all the consequences that the recognition of general medicine as a specialty academic results.
Now there are more than two classes of doctors, including GPs on one side and the other medical specialists, but rather a single class of practitioners adopting the name of specialists. This recognition
general medicine as a specialty in itself, however short, is a first step it is important not to take three steps back, quite the opposite, which is unfortunately taking place.
It must allow, eventually, given the same privileges enjoyed by specialists in historical specialties to medical specialists in general medicine, especially in scoring.
It is on this aspect that hurts the bottom since the listing in CS, listing specific medical specialists, is refused to medical specialists in general medicine on the grounds they are primarily general practitioners.
In a state where public law contains an obligation to treat people equally who are in similar situations, the refusal to allow these experts to rate their actions in CS is more disturbing.
Students intending to the specialty of general practice follow the same academic curriculum as their peers to graduate medical education that leads to a specialized diploma (DES) or a diploma Additional specialized studies (DESC): they must present themselves for examinations in order to recognize their ability to practice medicine.
The Order of 22 September 2004 establishing the list of identifiers clearly general medicine as a specialty as well as other disciplines such as medical specialties, surgical specialties, occupational medicine, etc ...
Thus, it requires physicians intending to general practice to submit the same requirements as those choosing a specialty at the same historical time they are denied the quotation of their actions in CS.
However, this right is recognized by medical specialists in accordance with the NGAP.
The report of Mr Pierre - Louis Lancry on the consequences of reform in January 2004 on general medicine offers an alternative to the stock CS: This is the quotation in CG. The
- it admits that it could be less than the listing CS, in which case, why complicate the mechanism?
The answer to this question lies in the same report: "The specialist in general medicine is a specialist by title and by a GP practice. "
It is unacceptable that the DES general medicine is one of the cheap and that the general practitioner or a medical specialist with a separate status. What
- to make of these texts on one side provides for the recognition of general medicine as a specialty and the other refused the benefits of this recognition except that they are the result of unfair and therefore unacceptable considerations?
should not lose sight of the difference in scoring base between C and CS is ultimately only a Euro so it would be naive to believe that the dithering around the recognition of the status of specialist in general practice would be justified only by financial considerations alone, posing openly and legitimately question the motivations and misgivings?
ask the question is to answer it, and those who have decided to rate CS know that this fight is none other than the dignity inherent part of the public service mission assigned to the physician, requiring that each takes its part thereof, entering the necessary resistance that transcends their sole person but relates to what is most fundamental: the future of the specialty, as it is undisputed that at this rate, it is indeed one that is threatened ...
All he knows is that this is a very demanding profession combining OOH, home visits and opening hours very important, often requiring work on Saturday morning at the much lower value added intellectual important than other medical disciplines.
There is no doubt that this, added to career opportunities ultimately bleak, affects the choice of medical students.
The question thus arises naturally from the redesign of the curriculum to enable a medical profession, the linchpin of the health system to take its place.
But whatever reforms that will be implemented, I fear for my part that they remain inadequate, as it is clear that what is at issue through the disaffection of the art GP is finally more or less the core value that our society places on self-sacrifice as a model of social construction and personal.
Indeed, we can not escape the question of what image we convey the general practitioner, and look what we are led to focus on it?
But behind this question a lot more demanding, more painful, confronting us, which is to know what career model we propose to those who one day decided to study medicine?
The GP is the backbone of the health system in that it is the physician's daily, one today and now: let us abolish it, and the whole health system 's collapsed like a house of cards.
It is the one to whom patients turn first, and before being human pathology, it is the patient, because nobody knows him as his patients, confirms that the choice of the it as a doctor in more than 95%.
This medicine is about challenging because it requires to listen, develop a sense of clinical diagnosis so refined that it must transcend the grievances of patients often unable to express them.
This medicine is also demanding in terms of sacrifices and the sacrifices it requires, more particularly in rural areas where the medical practitioner is so that he ended by becoming man band at the expense of a balanced personal and family who, sooner or later will break, then placing it in a big and deep solitude.Dans a society of immediacy, in a world of neologisms (RTT, CET ...) it must be said, the profile of the doctor working 6 days out of 7 patients, and 7th day for sickness , forced to justify permanently embedded in the middle of paperwork, no longer recipe, many students moving toward careers hospital, free from all constraints of the private practice of medicine on the one hand, and do not particularly want to be overexposed on a permanent basis as is the general practitioner on the other.
For there is the crux of the problem: medical hub of the health system, it is also shown publicly singled out as responsible for the soaring costs of health, prescribing too many stoppages, yielding too easily to pressure patients on medication use, etc. ...
Thus was born the myth of the doctor gently irresponsible legislators having enjoyed over the years to provide tools increasingly coercive to health insurance organizations, specific to just put GPs in step.
course, I hear the criticism that is sure to create such a connection, and especially the fact that the texts do not aim GPs, but are common to all practitioners.
course, but do not hide behind his finger, and experience shows conclusively that the first general practitioners remain concerned, because undoubtedly, they are the first stop of Prescribers working example, which is closely related to their quality physician.
Finally, what about the emergence probably happy with the specialty of general medicine, with its discipline-specific DES, like other specialties, which was nevertheless accompanied by a refusal leveling fees on those other specialists, true?
What about when a minister ordered a full report on the question of whether the listing of the basic act of specialists in general medicine must be equal to that of other specialists?
And what about when this report comes to the conclusion that the GP can not be an expert like others, in that it remains a general practitioner, and that therefore he can quote his fellow professionals as CS?
The only thing to say is that we can hide behind our finger as we want, and propose any reforms in the curriculum of medical school we want: as long as we have not changed our view of those who give themselves tirelessly to others, truth, humbly, without fanfare, we fail to GPs.
Now, how to change our view of these "humanists" when our institutions self - give them only half - reforms to appease the spirits more than actually recast the status of general practitioners?
proof is with the Social Modernization Act of January 17, 2002 implemented by Decree No. 2004-67 of January 16, 2004 after which all medical students who wish to do a postgraduate medical education must stand for national ranking of the internship.
The competitive internship is therefore common to all students and the general practice is therefore recognized as a specialty.
This reform would have been interesting if it took into account all aspects of upstream and all the consequences that the recognition of general medicine as a specialty academic results.
Now there are more than two classes of doctors, including GPs on one side and the other medical specialists, but rather a single class of practitioners adopting the name of specialists. This recognition
general medicine as a specialty in itself, however short, is a first step it is important not to take three steps back, quite the opposite, which is unfortunately taking place.
It must allow, eventually, given the same privileges enjoyed by specialists in historical specialties to medical specialists in general medicine, especially in scoring.
It is on this aspect that hurts the bottom since the listing in CS, listing specific medical specialists, is refused to medical specialists in general medicine on the grounds they are primarily general practitioners.
In a state where public law contains an obligation to treat people equally who are in similar situations, the refusal to allow these experts to rate their actions in CS is more disturbing.
Students intending to the specialty of general practice follow the same academic curriculum as their peers to graduate medical education that leads to a specialized diploma (DES) or a diploma Additional specialized studies (DESC): they must present themselves for examinations in order to recognize their ability to practice medicine.
The Order of 22 September 2004 establishing the list of identifiers clearly general medicine as a specialty as well as other disciplines such as medical specialties, surgical specialties, occupational medicine, etc ...
Thus, it requires physicians intending to general practice to submit the same requirements as those choosing a specialty at the same historical time they are denied the quotation of their actions in CS.
However, this right is recognized by medical specialists in accordance with the NGAP.
The report of Mr Pierre - Louis Lancry on the consequences of reform in January 2004 on general medicine offers an alternative to the stock CS: This is the quotation in CG. The
- it admits that it could be less than the listing CS, in which case, why complicate the mechanism?
The answer to this question lies in the same report: "The specialist in general medicine is a specialist by title and by a GP practice. "
It is unacceptable that the DES general medicine is one of the cheap and that the general practitioner or a medical specialist with a separate status. What
- to make of these texts on one side provides for the recognition of general medicine as a specialty and the other refused the benefits of this recognition except that they are the result of unfair and therefore unacceptable considerations?
should not lose sight of the difference in scoring base between C and CS is ultimately only a Euro so it would be naive to believe that the dithering around the recognition of the status of specialist in general practice would be justified only by financial considerations alone, posing openly and legitimately question the motivations and misgivings?
ask the question is to answer it, and those who have decided to rate CS know that this fight is none other than the dignity inherent part of the public service mission assigned to the physician, requiring that each takes its part thereof, entering the necessary resistance that transcends their sole person but relates to what is most fundamental: the future of the specialty, as it is undisputed that at this rate, it is indeed one that is threatened ...
Fabrice DI VIZIO
