The family doctor, is it over?

He was always there, available and attentive, even on weekends. He knows your case by heart, has seen your children grow up, has supported you through hardships. He is the family doctor… The term is enough to say the essential place and above all the symbolic charge assumed by this carer who often turns into a confidant. Until the dreaded retirement of loyal patients.

Years after that of her GP, Patricia still speaks of it as a blow. “He followed me since I was little. Each time, he took the time to explain to me what I had and I left reassured, she remembers. I will never find this complicity again. He even invited me and my sisters to his wedding! Since then, the fifty-year-old living in the Alpes-Maritimes has not found a doctor. “Young people don’t want to settle here because it’s too expensive, or else they set up medical centers as a group,” says this former letter carrier.

While health insurance conditions the increase in the price of the consultation to more availability, the question arises: the doctors of yesteryear, completely devoted to their patients, are they an endangered species?

The end of small neighborhood practices?

“Obviously, general practitioners who spend their entire career in small neighborhood firms like mine, it’s over”, act Bruno Fron, forty years of practice in the same Parisian building in the 5th arrondissement. Officially retired for a year and a half, he has the greatest difficulty in finding a successor. “Paying fees, managing compatibility: no one wants to have such a burden,” he notes.

Who to replace him, him and all this generation which is massively coming to the end of their career? “I am the attending physician for 2,300 patients. My anxiety is to leave them on the floor, ”he confides.

Stop working 12 hours a day

In the meantime – and because he is unable to win – he is playing extra time. And at 68, she gladly continues to roam the neighborhood to make house calls. “There is no better way to reach out to people. I see things in people that I would never see in the cabinet, ”smiles the general practitioner, who shares his passion in a book overflowing with humanity, A whole life for them (1).

The younger generation, Bruno Fron observes it with a mixture of admiration and circumspection. “They don’t want to work twelve hours a day anymore, and they’re right,” he says. He gave himself body and soul to his patients, not out of heroism or a sense of sacrifice, but “because I did not know how to do otherwise”. means that to replace me, you need at least two people, ”he calculates.

He points out that the context in which he started was very different. “When I moved in, in 1985, we were a lot of doctors. We had no choice but to work a lot, we had to go there, make our mark! Today, it’s the opposite: there are too many patients and not enough doctors. As a result, they can work thirty-five hours if they wish. »

Patients, but not only…

However, don’t count on him to blame his young colleagues – who are more and more often sisters, the profession having been largely feminized in recent years. He was a father, but a doctor above all. Juniors have a spouse who also works, young children they want to pick up from school. They yearn for a fulfilling personal life, without patient calls in the middle of Sunday lunch.

“Sunday…is Sunday. I need that time for myself, for my family, ”says Dr. Simon Frémaux, vice-president of the Reagjir union (Autonomous grouping of young general practitioners installed and replacements).

The face of the profession is changing

With his twenty consultations a day, this young employee of a municipal health center in Val-de-Marne is however very far from unemployed. “General practitioners who are drowning in work, there have always been and there still are. Me, I believe that at some point, it is necessary to be able to breathe. That’s not to say that I don’t have a strong bond with my patients and don’t care about them. »

Obvious in the eyes of Doctor Paul Frappé, for whom the “priestly” vision of local medicine reveals a paradox. “We expect the doctor to be there for us all the time, to treat us, but we accept that he does the opposite in his personal life, that he neglects his health and his own family”, points out this 43-year-old Stéphanois, at the head of the College of General Medicine.

“The face of the profession is changing because our society is changing, but the young people who get involved in medicine are also driven by passion and a desire to get involved,” he says. Let’s not oppose the generations. »

Changes in practices

According to Simon Frémaux, the nostalgia of some patients, often the oldest, is actually less related to the profile of young doctors than to the changes in practice that have taken place in recent years. “Today we have a more coordinated exercise. In my center, for example, each patient has his own referring doctor, but if I am absent and my patient needs an appointment quickly, he can consult one of my colleagues. »

A logic of interchangeability which can be disconcerting, but for which the patients are sometimes the first responsible, according to doctor Bruno Fron. “Many people no longer know how to wait. We see it with the success of teleconsultation. If people turn to this solution, it is not only because there is no longer anyone at the counter. It’s also because they’ve read terrible things on Google and want an immediate response. As a result, we have consumers facing service providers, ”he says.

For Paul Frappé, digital has above all played a decisive role in the image of the doctor, who has come down from his pedestal a little. “Before, we based our authority on knowledge, the fruit of long studies. However, with the Internet, this knowledge has been democratized, observes the president of the College of General Medicine. The doctor is no longer the sole holder of medical knowledge. »

Not to mention the potential future developments, in particular with the Rist law, which provides for direct access to paramedics, without going through the general practitioner. “Clearly, the doctor is no longer the little prince of the neighborhood”, sums up Paul Frappé. Like patients, the profession is groping and looking for “new benchmarks”.

So, better or worse than before? “There is no point in being backward-looking, pleads Bruno Fron. How to maintain the human in this new configuration is the only question that arises. Because general medicine is first and foremost: a human encounter. »

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An average age of 51

The number of GPs in regular activity has fallen by 9% since 2010. They were then 94,261, against 86,364 in 2021, according to the National Council of the Order of Physicians (Cnom).

57% practice as a liberal, and 24% both in town and in the hospital (mixed exercise), according to the statistical service of the social ministries (DREES).

The average age of GPs is 51. A quarter of them (26%) are aged 60 or over.

Women now represent half of the workforce, confirming the feminization of the profession.

The Provence-Alpes-Côte d’Azur region is the one with the highest density of GPs with 178.9 practitioners per 100,000 inhabitants, well above the national average, at 148.5. Haute-Normandie is the least well endowed, with 122.7 general practitioners per 100,000 inhabitants.

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