Roland Sicard, gerontologist, president of the Sainte Catherine Avignon Provence Cancer Institute. He is also the founder and director of La Valériane in Montpellier, a medtech publisher of e-health solutions, which gives him, as he points out, “ a good knowledge of American, European or Singaporean health practices, and not only of the French microcosm”.
LA TRIBUNE – What is the status of your establishment and who do you treat there with what human resources?
Roland SICARD – The Sainte Catherine Avignon Provence Cancer Institute is a member of Unicancer (national federation of centers for the fight against cancer and network of 19 private health establishments, Ed.). The status of Unicancer centres, which are exclusively dedicated to oncology, is special: they perform public hospital service missions but are, like a foundation or an association, non-profit and privately managed. But we operate budgetary speaking like a public hospital center, with a price in charge without exceeding fees and profits which are reinvested. The institute employs 550 employees, including 350 nursing staff, including 40 doctors, and we take care of around 10,000 patients per year, in an area that goes from Vaucluse to the south of Gard, north of Marseille and part of the Drôme. We treat all types of cancers. We are the only ones to do radiotherapy on this territory.
The Cancer Institute does not accept patients with Covid, but you say you are still affected by the health crisis. Comment?
Indeed, we are not on the front line on the Covid but when the hospital closes a service or the emergency services are overwhelmed, we have to supplement. Patients that the hospital can no longer take – and this is currently the case with establishments that have activated their white plan (mobilization of all available means in the event of a massive influx of Covid patients, editor’s note) – arrive at our house. In addition, some of our patients who would have gone to the emergency room will now have to come to us. In 2021, this translated into a 15-20% increase in activity. That is to say that we went from 10,000 to 11,500 patients. And it’s been that way all year… There’s been so much delay in cancer care and treatment in 2020 that we’ve had a big year in 2021. People are coming later to get diagnosed, so it’s need to get them into treatment sooner. This means care that is done in continuous stress for the patient, for whom everything is complicated, and for the healthcare teams. You have to push the walls, the scanner slots, the appointment slots…
How did you do and how do you still do today to absorb this surplus of activity?
Initially, we started working overtime. But after a few months, we get to the point where the workforce comes to see us to ask us to recruit doctors, nurses and technologists (paramedical staff who take care of the patient in radiotherapy, Editor’s note). We advertised but received few applications. Everyone was on the school market, so we quickly exhausted the stock of new trainees, which is already insufficient compared to needs. Some candidates arrive, from other care structures because the conditions are better but as this poses a problem in the establishment they leave, often they ask to wait until a solution is found to join us… Since the start of the health crisis, we have recruited 40 to 50 permanent positions. We even have a pool of permanent replacements to secure staffing needs. Especially since we are facing another phenomenon: absenteeism which has doubled due to the Covid, exhaustion, constraints to look after the children. We went from an absenteeism rate of 5% to a rate between 10 and 15% today.
You say conditions are better where you are. Have you increased salaries and will this be enough to reduce the shortage in the workforce?
Just like the public hospital, as part of the Ségur de la santé, we increased salaries and that was a good thing. It has boosted the morale of the staff and we hope that it will encourage vocations. But I want to warn about the lack of nursing schools. We are paying dearly for the measures of forty years of a blind policy of numerus clausus medical (fixing the number of students admitted each year in the 2nd year of medicine, editor’s note). It has certainly been loosened (the numerus clausus reform was voted in 2019 and implemented in September 2021, with the objective of training more than 10,000 doctors within five years, Editor’s note) but it takes eight years for new doctors to arrive. Or there are more retired doctors than newcomers! We are going straight into the wall and we do not hear, in the political discourse, emergency decisions to compensate for this haemorrhage. At the Cander Sainte Catherine Institute, this is the case: we were supposed to open a 5th medical service in 2020 but that was not possible because we need at least three doctors for a 20-bed service, and we ‘we did not find. We may get there in March 2022… Previously, in three or six months, on the resource. And again, we are a benchmark establishment and despite everything, we have difficulty recruiting…‘did not anticipate the needs of our health care system. The Covid is accelerating the shock and the crisis. Today, everyone suffers from it: rural areas but also the hospital. We need a real Marshall plan!
We are in the middle of the campaign for the presidential elections, it may be time to reaffirm your needs. A Marshall Plan that would include what?
We all share the diagnosis but we don’t take drastic measures. The hospital has the credits to pay for the posts but not the candidates on the labor market. We need more school with more places. It would also be necessary to reorganize the healthcare system, and in particular to delegate certain highly regulated and therefore very time-consuming medical tasks to a nurse, for example, in order to free doctors from their essential skills. This requires relieving the system while waiting for a new breath of skills… The hospital is very active and Unicancer too. We are thinking about how to allow this political awareness.