It is a small revolution that is taking place in the hushed world of dental surgeons: for the first time from January 1st, rules will limit the installation of professionals in certain already well-equipped areas, in an attempt to resolve the imbalances.
The inequalities are glaring: in France, 65% of the municipalities, often in rural areas, are "very under-equipped" with dental surgeons according to Cartosante, the digital tool of the Ministry of Health. Conversely, 3% of them, often in metropolitan areas, are "very well-equipped", and 0.2%, or 77 municipalities, are even over-equipped.
Among these 77 municipalities are the beautiful districts of western Paris, the 2nd, 3rd and 6th arrondissements of Lyon, and the cities of Strasbourg, Anglet and Neuilly-sur-Seine. This list is likely to grow, as data from the Provence-Alpes-Cote d'Azur region and overseas territories have not yet been communicated.
These are the latter municipalities which are affected by the measure: as of January 1, Health Insurance will refuse any new contracting of a dental surgeon, except to replace a retirement or cessation of activity.
In short, a practitioner who opens a new practice in Strasbourg could absolutely treat his patients there, but they would not be reimbursed.
A few days before its entry into force, this new regulation does not seem to frighten professionals already established.
"This responds to a logic that is understood by the entire profession," assures David Lafond, vice-president of the Regional Council of the Order of Dental Surgeons of the Grand Est, who himself practices in Strasbourg.
"And then it won't be impossible to set up: that means taking over a practice, knowing that there is a big turnover of practitioners to be expected. Here, many dentists are retiring," he assures.
But among students and young graduates, the measure is less well accepted.
"For us, this is the beginning of a coercive system," says Ralitsa Androlova, president of the National Union of Dental Students (UNECD). "This system puts an end to freedom of establishment, while we undertake these studies to practice a liberal profession."
– Installation aids –
The measure is the result of an agreement between Health Insurance and the two main dentists' unions FSDL (Federations of Liberal Dentists' Unions) and CDF (Dental Surgeons of France), which represent more than 951,000 members of the profession.
"If we could have avoided these provisions, we would have been delighted," admits Julien Cardona, deputy secretary general of CDF. "But every year, the question of the constraint on installation came up, and we noted that there is a real problem of access to care. We thought it would be better to negotiate these constraints, with a more reasonable impact, rather than having them imposed unilaterally."
In return for the implementation of regulations in a few dozen French municipalities, the unions obtained a doubling of the flat-rate aid for setting up in very under-resourced areas, increased to 50,000 euros.
And the map of these areas has itself been extended to cover a territory representing 30% of the population, against 7% previously.
– “It was about time” –
Ultimately, these measures "are balanced in the sense that they favour more dental surgeons than they penalise", believes Julien Cardona.
The system is also welcomed by elected officials and residents of medical deserts, who hope to see a reduction in imbalances.
"It was time we took measures," says Bernard Guy, mayor of Saint-Blin (zero dentists) and president of the Association of Mayors of Haute-Marne. "In our sector it is very complicated. The schedules are full, no dentist is accepting new patients."
"It's a very good thing," says Laure Artru, co-president of the Association of Citizens Against Medical Deserts. "Nurses, midwives, physiotherapists, but also pharmacists: many health professions are subject to rules for their installation. When will the same thing happen for doctors?" she asks.
On December 3, a bill signed by 237 MPs from all parties was tabled: it proposes, as for dentists, to authorize a doctor to set up in an area where the provision of care is already sufficient only when a practitioner of the same specialty ceases his activity there.
English 
French