Three months before the first round of the presidential election, Ma France 2022 deciphers the subjects that concern you on a daily basis. For several days we went to the Vaucluse, where access to care is becoming very complicated in certain areas of the department. We tell you why why we have chosen to highlight this territory.
There is a crisis in the Vaucluse. The Covid-19 health crisis, the 5th wave in full swing, the Omicron variant taking up residence… and the shortage of doctors. A fundamental problem, which has been growing for several years in France, and in particular in the Vaucluse. To understand this phenomenon of medical desertification, let us first recall the specificities of the department.
Covering an area of 3,567 km2, Vaucluse is the smallest department in the Provence-Alpes-Côte d’Azur region. It is a contrasting department between urban and rural areas, plains, plateaus and mountain territories.
The West, Greater Avignon and the Pays des Sorgues are highly urbanized plains, which bring together the five largest cities in the department: Avignon, Cavaillon, L’Isle-sur-la-Sorgue, Carpentras and Orange. Conversely, the country of Mont-Ventoux, to the east of the department, is an area of more isolated plateaus and mountains.
On January 1, 2021, according to INSEE estimates, the department had 560,719 inhabitants, an increasing demography 2.09% compared to 2013. The density is 156.9 inhabitants per square kilometer. However, this overall density hides significant increases.
Of the 151 municipalities that make up the department, 53 have, in 2018, a population of more than 2,000 inhabitants, 25 have more than 5,000 inhabitants, 12 have more than 10,000 inhabitants and only one exceeds 50,000 inhabitants: Avignon.
To simplify, more than two thirds of the population of Vaucluse live in one of the five main towns of the department. And as in all of France, the population of Vaucluse is aging. The largest part of the population between the ages of 45 and 50 is followed by people aged 60 to 74.
In 2028, according to INSEE projections, more than 77,000 people will be aged 75 or over in the department, compared to less than 55,000 in 2014. They then represent 12.8% of the population of Vaucluse.
as the note the Provence-Alpes-Côte d’Azur Regional Health Observatory, in 2028, more than 8,500 people aged 75 or over will be in severe loss of autonomy at home, and will therefore have an increased need for care.
The doctors established in the department, generalists and specialists combined, are on average 52 years old (51.9). This is above the national average (50.7). Also, more than half of the cupboards have been open for nearly 30 years (51.2% opened before 1995).
The average age even reaches 60 in the canton of Cadenet, in the south of the department, according to data from the Order of Physicians.
Due to a lack of replacements, more and more of them continue to work after the legal retirement age: 236 in 2021 throughout the Vaucluse, or 11% of the workforce and four times more than in 2010.
Another active figure speaking, the average age of retirement of doctors on December 31, 2020 is 70 years in the Vaucluse.
In France, “80% of the cantons have seen their medical density and for 30% the drop is more than a third”, can we read in the conclusions of “The study on the state of play of the health of rural areas“commissioned by the Association of Rural Mayors of France (AMRF) and produced by Emmanuel Vigneron, doctor at EHESS and specialist in medical deserts.
The Vaucluse is no exception. A particularly serious medical desertification, given the increasing medical needs, in particular due to the aging of the population.
They are today 838 in the department, that is to say 149 general practitioners for 100,000 inhabitants, against 317 on average in France.
But here again, some areas are particularly affected by medical desertification. If we take the example of the canton of Cadenet, there are only 10 doctors left for nearly 16,000 inhabitants in 2022.
And if no solution is found, there could be only 7 doctors left for 18,095 inhabitants in 2025, according to projections by the CPTS Santé Lub.
For small towns, like Lauris, where there are only two general practitioners left for 4,000 inhabitants, one of the solutions could be telemedicine. But the Vaucluse is lagging behind on this point.
According to “The study on the state of play of the health of rural territories”, there are between September and March 2020 less than 7,000 teleconsultations against 12,000 on average in France over this same period.
General practitioners are the first to be affected by the shortage, but the problem is spreading. In Vaucluse, there is a shortage of 6 radiologists to meet the needs for scanners, MRIs, mammography, the Dauphiné report. Waiting times of more than 6 months are therefore set up against one to two before.
The loosening of the numerus clausus does not have its effects until 2027, since it takes 10 years to train a doctor. In the meantime, some municipalities could find themselves isolated.
A survey conducted by the association UFC-Que Choisir in 2019 shows that nearly 8% of patients in the Vaucluse do not have a doctor to follow their care pathway. They then turn to emergencies, when they are not too far away…
In France, according to the Ministry of Health, most liberal medical specialists and the most common medical equipment are accessible on average within 20 minutes by road.
Regarding routine hospital care, 95% of the French population could access it in less than 45 minutes, three quarters in less than 25 minutes.
But rural people are increasingly further away from emergency services. More than 6 million people live more than 30 minutes from an emergency service and 75% of them live in rural areas.
In the Vaucluse, there are 24 health establishments including 16 public hospitals and eight private clinics. Most of these structures are found in the main cities, such as Avignon, Apt or Carpentras.
For the inhabitants of Lauris, whose Roquefraiche intercommunal hospital center is doomed to close in 2024, it will soon be necessary to drive 30 minutes to get to the nearest hospital, in Cavaillon.
To respond to this problem of medical desertification, Professional Territorial Health Communities (CPTS) have been formed throughout France and in the Vaucluse. Their role: to federate a network of health professionals to facilitate access to care in a territory with the ultimate goal of relieving congestion in the hospital.
On November 25, the CPTS Santé Lub, which notably covers the former canton of Cadenet, met in the presence of the mayors of the territory to put in place actions to quickly improve the situation.
Many retirements marked the transition to 2022 and thousands of inhabitants found themselves without medical follow-up in this territory.
In order not to find themselves in an impasse, nursing homes could be one of the solutions. This is what was set up in Beaumes-de-Venise, a health center supported by Olivier Véran alongside the president of the region, Renaud Muselier, on December 16.
This multi-professional health center (MSP), created with the help of the State and the region, brings together around twenty practitioners: dtwo general practitioners, 11 nurses, two physiotherapists, two osteopaths, a podiatrist/podiatrist, a speech therapist, a psychologist, a sophrologist and a reflexologist. A third GP and his nurse practitioner were to join the team soon.
The Minister of Health Olivier Véran was visiting Carpentras and Beaumes-de-Venise as part of the fight against medical desertification. He notably promised 1.5 billion euros for health establishments in Paca.
A sum that will mainly be used for renovations and construction of hospitals and nursing homes in the region. This is the case of the Avignon hospital which should receive aid of 60 million euros for its modernization.
According to the latest INSEE data, the average monthly salary of the inhabitants of the department is 2,123 euros net (14 euros hourly).
The working population in 2018 was 335,874 people, or 73.4% of the population. In the 3rd quarter of 2021, the Vaucluse unemployment rate was 10.5%. Executives and higher intellectual professions (CSP) constitute 11.7% of the active population.
The Vaucluse has 18,000 RSA beneficiaries. One inhabitant in five lives below the threshold of poverty, i.e. with less than 1,102 euros per month, according to the latest national statistics. The poverty rate is therefore 20%. What classifies thee Vaucluse ranked 5th among the poorest departments in mainland France.
In the last presidential elections, in Vaucluse, 53.45% of the population voted for Emmanuel Macron in the second round against 46.55% for Marine Le Pen. The turnout was 76.61%.
Three of the five outgoing deputies succeeded in being elected to the legislative elections: Jean-Claude Bouchet (LR), Julien Aubert (LR), Jacques Bompard (Southern League). Two En Marche deputies are also acclaimed: Jean-Francois Cesarini and Brune Poirson.
Access to care for all, lack of resources in hospitals, medical desertification… these concerns came back to us on Ma France 2022, a major citizen consultation selected to give the floor to the French on their expectations within the framework of the presidential election.
We will report on these daily concerns by meeting citizens in their neighborhoods. Each week, we will question the inhabitants on a theme that emerged from the consultation.
After going to the northern districts of Marseille, we continue this series My France 2022 by an immersion in the south of Vaucluse, more precisely in the former canton of Cadenet. A territory of approximately 17,000 inhabitants spread over seven municipalities particularly affected by medical desertification: Cadenet, Cucuron, Lauris, Lourmarin, Puyvert, Vaugines, Villelaure.
Until the presidential election, you have the floor in these two territories of the region, but also in the Hautes-Alpes to know their expectations before the electoral deadline.
At the end of each of our articles, you will find a form for you too to participate in this great consultation.