Between direct and constructive exchanges, Var health stakeholders face the director of ARS Paca Yann Bubien

Yann Bubien, director of the Paca Regional Health Agency (ARS), was the guest on Wednesday, June 18, at the closing ceremony of the 2024-2025 season of the Var Matin Health Club. Almost a year after his appointment, this event allowed him, for nearly two hours, to share his vision of the region's challenges and respond to comments from local stakeholders regarding the essential changes to our healthcare system. Here are some excerpts from these direct and constructive discussions.

Panorama of the Var

The situation of the health system in the Var "is not bad at all" , comments Yann Bubien. While the department is doing rather well compared to the overall situation in France, the ARS director points out significant contrasts: "The PACA region has the highest number of doctors per 100,000 inhabitants, but also of dental surgeons, physiotherapists, midwives... It is also the region with the most medico-social establishments and private for-profit establishments. But the differences are very marked between coastal areas and rural areas, with healthcare provision being significantly higher on the coast. The disparities are also great between departments: the Var is less well-endowed than the other departments in the region, even though it is the most dynamic in terms of demographics. The number of general practitioners, which is a marker, is the lowest in the region - even if it remains higher than the national average of 147: 158 per 100,000 inhabitants in the Var compared to 179 in the PACA region."

Remarks on the validity of the indicators

Several interlocutors have tempered the scope of these indicators: "50% of doctors are over 60, 25% are over 65" , recalls Dr Laurence Pallier , member of the Council of the Order and director of CODES 83.

"We also need to question the primary function of these doctors," adds Stéphanie Dagain , a nurse and trainer at the Varois Public Training Institute for Health Professions (IFPVPS). "If dermatologists don't do dermatology, who should we consult in a region that is facing an increase in the number of carcinomas?" "How can we evaluate this data when we don't know the level of activity of independent health professionals?"

"It's a real issue and for all specialties," confirms Yann Bubien, before responding to questions arising from this remark.

An obligation to care?

Should we consider forcing private practitioners to devote at least part of their time to their specialty? This is particularly true of dermatologists, many of whom prioritize cosmetic practices, in a context of major difficulties in accessing these specialists.

"We can't force them to do it ," replies the director of the ARS. "It's a presidential debate: the French people would have to decide. For the moment, our history doesn't allow it." He does, however, point out "the considerable increase in the number of health professionals in training: they won't be there right away, but they're coming! Starting next year, 500 young 4th-year interns will be in the field in the region, or 40 to 50 doctors present for a year in the department, while waiting for the next promotion."

Ending freedom of installation?

Regulating the establishment of doctors to combat medical deserts: "We are very far from that," asserts Yann Bubien. "Senator Mouiller's proposal, passed by the Senate and soon to be presented to the National Assembly, calls for territorial solidarity. This doesn't seem shocking to me. The idea is to ask doctors from denser areas to travel two days a month to less densely populated areas to help. In the Var, there is one less densely populated area: the Verdon."

Dr. Fadel Maamar, president of the medical committee at the Fréjus Saint-Raphaël Hospital Center, believes that coercion would be a bad idea regardless. "A doctor enters into a form of social contract. If we change the rules of the game, many will abandon the profession."

"Coercion is not the solution, but solutions must still be found, and doctors must assume a certain responsibility," Dr. Pallier adds. "We could imagine them being forced to participate in ongoing care."

"An interesting idea," said Yann Bubien, who also returned to the subject of the relevance of care.

Areas for improvement proposed by members

Rather than coercion, Dr. Maamar suggests "looking into optimizing working time and combating task creep." "The new profession of medical assistant allows general practitioners to be more efficient. This is one of the keys. In public hospitals, too, there is room to optimize time and delegate tasks. I'm thinking of health coordination professions that would save doctors valuable time."

Patrick Karsenti, president of the nursing association, also finds coercive solutions "unwelcome" "in a sector where two-thirds of professionals suffer from workplace distress" and instead advocates "incentive measures to address the loss of purchasing power and the lack of recognition of caregivers."

"France is the only country in Europe where doctors have complete freedom to set up their own businesses and where health insurance reimburses their care," emphasizes Yann Bubien. He points out that "It's different for nurses, physiotherapists or midwives whose establishment is regulated."

These restrictive measures for establishments applying to professions other than medical ones call for a remark from Dr Pallier on the subject of Multi-professional Health Centers (MSP): "This type of system responds very well to the expectations of caregivers and the needs of the population . But if tomorrow we have an MSP project in a neighborhood like Les Œillets in Toulon (a priority neighborhood, under-resourced, Editor's note) , we will not be able to accommodate a midwife in the team because of zoning rules."

"Zoning is done by the professionals themselves, but we have to be smart and grant possible exemptions in sensitive areas," replies Yann Bubien.