To "facilitate" access to care, the leading union of specialist doctors is calling on Saturday for specialists to be allowed to refer patients to each other, or even to receive patients sent by a paramedical caregiver, an idea that has given rise to regular tensions with general practitioners.
Outside of emergencies, the average waiting times for appointments with a specialist are very long: "more than 30 days for a dermatologist, 40 days for a cardiologist", deplores Avenir Spe, in a "manifesto" presented on Saturday at its congress in Lille, which lists various proposals to improve access to care.
These difficulties can be explained in particular by the current organisation of the "care pathway", which "requires going first and always through the treating physician", while there is a shortage of general practitioners everywhere, the union believes.
"Without this step" the patient is "less well reimbursed" and the specialist doctor "less well paid", he regrets, deploring a "hierarchy" of doctors which according to him "slows down" access to care.
Avenir Spe therefore offers a "new type" consultation, billed at 60 euros, which can only be used in the context of "non-scheduled care" or a request for "rapid advice". The patient could be referred by another specialist, for example a pulmonologist who, faced with shortness of breath, would suspect a heart problem, he explains.
During negotiations in the spring between the health insurance and doctors' unions on consultation fees, this idea, slipped into an initial version of the draft agreement, nearly derailed the discussions.
MG France, the leading union of general practitioners, had threatened "not to sign", seeing it as a short-circuiting of the "pivotal role" of the treating physician. The text had been largely watered down.
Avenir Spe goes further: as part of this new consultation, it proposes that the patient can be referred by another health professional (nurse, physiotherapist, midwife), or even by a "referent" person such as a family carer, for dependent or vulnerable patients.
The specialists would commit to making appointments within a short period of time: "four days for unscheduled treatment", "three to four weeks for a specialist opinion". They would provide a report to the treating physician.
Avenir Spe also wants to deploy "specialized care teams" everywhere, groups of doctors with the same specialty, who organize themselves to respond more quickly to requests from general practitioners.
He also advocates the creation of specialist centres – on the model of “breast institutes” which bring together numerous professionals and cutting-edge equipment – in each specialist area and region.
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