French surgeons are set to strike

BMJ 2004; 329 doi: (Published 29 July 2004) Cite this as: BMJ 2004;329:249
  1. Brad Spurgeon
  1. Paris

    At least 2000 French surgeons planning strike action are expected to seek refuge in London in September to avoid being forced back to work by the police, in accordance with French employment law.

    The action is also symbolic, in view of the demand in Britain for French surgeons and of British patients seeking surgery in France.

    Since June the surgeons threatening strike action, a group called the Association de chirurgiens de France, have been exhorting surgeons to sign up for a return trip to London, from 30 August to 4 September, at a cost of €450 (£299; $548) each.

    Except for a small increase 15 years ago the tariff the healthcare system reimburses for surgery has not changed in 20 years, and the surgeons want the government to double it. Also, the cost of their insurance premiums has quadrupled over the past three years and now accounts for a quarter of their income.

    The surgeons are concerned that low pay at home and better financial prospects in countries like Britain are depleting their numbers, which, the health ministry estimates, will fall by about a quarter from 23 000 to 17 000 by 2010.

    The problems are most acute among France's 6000 independent sector surgeons, who will make up the bulk of the strikers.

    “Young people prefer to turn to other specialties, which pay more and are, above all, less restrictive,” Dr Philippe Cuq, the association's spokesman, said. “Today the hourly rate for a lawyer, an architect, or a manager is generally higher than that of a surgeon.”

    Surgeons in France fall into two categories: the first can charge only the rates set by the state healthcare system; the second can charge extra, but patients are not reimbursed.

    Specialists in the first group earn only as much as general practitioners—on average, €70 000 before taxes—complain the surgeons. Although specialists in the second category earn double that, it is still less than the earnings of dermatologists, radiologists, and cardiologists.

    “When we consider the increase of the cost of living and taxes,” said Dr Jacques Caton, president of the National Union of Orthopaedic and Trauma Surgeons, “all we're asking, by doubling the tariffs, is to be at the level of 20 years ago.” The tariff for a hip replacement is €460. “A television repairman earns more than that,” he said.

    The French government is debating the overhaul of its overspent healthcare system, but the surgeons have received little support from health minister Philippe Douste-Blazy. He said in June that the surgeons' demands were unrealistic but admitted that “the situation is serious.”

    Two weeks ago the government offered to pay for part of the insurance premiums, in return for professional accreditation. But the surgeons fear that insurance companies will simply charge more, and they have requested a freeze on premiums.

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