medical demography and community-based practice · (source : atlas démographie médicale 2018 -...
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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)
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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)
M
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
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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
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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)
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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…