A report, drawn up at the request of the Ministry of Solidarity and Health, provides an overview of the child health care and pediatrics sector. This is proving to be “worrying” because of the demographic decline in liberal pediatrics with, as a consequence, a detrimental decline in preventive care.
In 2020 , France has around 8,500 pediatricians , 53% of whom work exclusively as employees in hospitals and 25% work exclusively in private practice.
Submitted on May 15, 2021, the report of the General Inspectorate of Social Affairs (IGAS) on pediatrics and the organization of children’s health care in France notes a shortage in the number of practitioners (pediatricians, childcare nurses, auxiliary nurses childcare, midwives). Faced with this situation, the authors propose a series of orientations both in the hospital sector and in the liberal sector.
85% of city pediatric consultations for general practitioners
In eight departments, there is less than one pediatrician per 100,000 inhabitants , notes the IGAS report to illustrate the shortage of pediatricians in city medicine. This drop in the number of practitioners is reflected in school structures and maternal and child protection services (PMI). The profession is also aging, with 44% of practicing liberal pediatricians over 60 years old.
85% of pediatric consultations in town are with a general practitioner, the report notes, while monitoring the child’s health by a specialist could improve disease prevention.
The vast majority of pediatricians work in the hospital sector where there is an increase in specializations linked to progress in research (neonatology, pneumo-pediatrics, neuropediatrics, etc.). However, the greater burden of continuity and permanence of care in pediatric services (on-call duty, on-call duty, requests from parents in emergency services), in connection with the critical size of the workforce, has a dissuasive effect on children. vocations.
The social and territorial inequalities in child health care are persistent despite the monitoring and prevention in childhood structures and early childhood. Infant mortality remains two to three times higher in overseas territories. Likewise, a child of a worker is six times more likely to be obese than a child of an executive. In addition to the greater shortage of pediatricians in certain territories, the report mentions a ” lack of readability ” of preventive medical examinations for parents with, as a consequence, an overload in pediatric emergency services.
In the paramedical sector, professional child care professionals (childcare nurses, childcare auxiliaries, midwives, etc.) suffer from a lack of recognition . They are also often underused, particularly in the outpatient sector.
Repositioning of roles
The rapporteurs suggest a series of recommendations to overcome these difficulties. Among these, we note:
- an enhancement of the role of actors in the health care of children , including by strengthening their presence within pediatric nursing homes;
- the development of the independent practice of nursery nurses ;
- the repositioning of the respective roles of general practitioners and urban pediatricians with, for the latter, a role of recourse and expertise vis-à-vis children with special needs or presenting risk factors;
- a better cooperation between city of pediatrics and pediatric hospital ;
- a change in the nomenclature of insufficiently priced pediatric care acts .
Other recommendations in the report relate to the territorial organization of pediatric workforce resources , the initial and continuing training of professionals in the sector and the sharing of information between the various health actors (general practitioners, pediatricians, nurses). .