Pediatric Emergency: How Did We Get Here?

At a time when we are rightly concerned about our pensions, the crisis is also intensifying in hospitals. In recent years the world of pediatrics has suffered and with it the patients. But this autumn the situation has particularly worsened, as many carers testify.

Congestion to be expected in fall 2022

End of October 2022, a strong epidemic of bronchiolitis has suddenly saturated the wards of the children’s hospital throughout France. So the national emergency plan was triggered. For Déborah Ridel, a sociologist at the School of Advanced Studies in Public Health, this crisis was predictable :

Caregivers have been sounding the alarm for some time, especially in 2019 during the great collective inter-emergency and inter-hospital strike. There are fewer and fewer places and more and more requests. There are not enough pediatricians in private practices, parents whose children cannot be treated quickly enough are turning to emergencies. And with the onset of winter illnesses, the emergency services filled up very quickly. »

This is attested by Emma, ​​​​​​a pediatrician in a liberal practice in western France. ” This crisis lasts and has been denounced for some time. The demographics of pediatricians fell before that of general practitioners, pediatricians in the city are running out and emergencies make up for this shortage. »

A shortage of pediatricians

But why are there so few pediatricians in the city? “Many pediatricians subspecialize, for example, in gastropediatrics, and there aren’t enough general pediatricians left. Even many pediatricians remain in the hospital, most have only known that, because private placements are rare. AND it is also one of the least paid specialties in the city, consultations are long and rates are locked in at low rates. So you have to work a lot or work very fast and you lose the quality of care”Emma explains.

Part of the monitoring of children is therefore delegated to general practitioners: “It is very random, they have few pediatric courses during their course, some are trained in a complementary way if they are interested. Children are monitored less well, there may be undetected pathologies. Some children don’t even have a doctor and may not see anyone for years, or only SOS doctors when they are sick. »

disastrous consequences

Healthcare workers and paramedics are at the forefront of the aftermath of this profound crisis. Their working conditions are deplorable. ” We experienced grueling working conditions this winter Says @to.be.or.not.toubib, a pediatric emergency doctor at a hospital in the Hauts-de-France. ” Several epidemics have overlapped, this is what is feared every year. All of our units were full. This has led to at least one colleague burnoutwhich is slowly recovering. “And in addition to working conditions, those of patient care have also deteriorated,” he explains. “This year the epidemic was very strong, with an early start and a very high peak, the highest in the last 10 years, the winter was nightmarish complains Emmanuel, a pediatric intern at the Robert Debré hospital in Paris. ” Some children have had to wait 10 or 15 hours in the emergency room, others stayed there for several days waiting for a bed. Pediatric emergencies represent 30% of the total flow of emergencies, but at the budget level we are not at 30%. Since they are generally saturated for a short period of time, for 2-3 months every winter, politicians don’t see the point in investing for the long term. »

For her part, Emma warns that there is a lack of resources in pediatrics: ” we go by the adage ‘little kids, little problems’ which is totally false. Children sometimes require very technical care that is only done in public. Many work breaks are not or poorly replaced, paramedics end up with too many patients to handle each, so they have less time to spend with each child. The staff is exhausted, it’s a vicious cycle. »

A bandage on a wooden leg

In November, the Minister of Health, François Braun, allocated a budget of 400 million euros for hospital services under pressure, including paediatrics. But what can this temporary emergency measure really absorb? ” This envelope stalls and absorbs the surplus, but does not solve the underlying problem. Policy decisions should be reviewed globally, including citizens and professionals “, explains Déborah Ridel.

In the field, did this booster pack help, even temporarily? “We had a temporary update in December, but it’s not permanent, it was more like a communication operation” believes @to.be.or.not.toubib. “It didn’t change anything in working conditions or patient care” Adds. For Emmanuel, it was also an announcement effect with a barely perceptible feel on the ground. “Paramedics were able to have overtime paid better and doctors on call paid 50% more, but this is only a temporary measure. » Emma agrees: “A bonus from time to time is not enough, we need really attractive wages and decent working conditions “.

For the moment it would seem that the government remains deaf to the requests of carers: ” The government does not want to freeze the pass rate for nurses or nurse” Emma explains. ” The national welfare spending target, a budget set each year, is still too low. It is mainly awarded to the hospital, but this does not cover the needs of hospitals. There are fewer permanent jobs and more and more administrative paperwork to complete, which reduces treatment times. »

Caregiver requests

Some measures envisaged by the government scandalize caregivers, such as the delegation of pediatric visits to nurses, or the obligation to consult a general practitioner before being able to consult a pediatrician. So what should be put in place? Three main axes emerge in the requests of caregivers, to avoid reliving this cyclical crisis forever, revealing deeper difficulties.

The first concerns the number of doctors and paramedics, still too low. ” It’s a recurring request that seems impossible to satisfy says @to.be.or.not.toubib. ” Due to the limited number, we can expect a situation that will worsen until 2030, as physician demographics are declining and turnover takes time. What is happening in pediatrics will soon also affect all other areas of medicine, it is already starting to happen “Explains Emma.

Work must also be done in terms of Pedagogy with parents. ” Some parents consult quickly out of concern, therapeutic education workshops should be offered a few months after the baby is born, to teach them about the signs of gravity, how to rehydrate a baby, etc. This would help unblock surgeries and emergencies offers Emma.

” Informing parents is important, the new health card has been designed in this sense, but we must continue to develop these means of communication Emmanuel explains. @to.be.or.not.toubib even proposes organizing a public health campaign: “ we need to educate about health, and also educate about the new vaccines available, the one against gastroenteritis is now reimbursed, and there is an injection of antibodies against bronchiolitis “.

And there is of course and above all a lack of financial resources in pediatrics. ” It would be necessary to reevaluate the acts, make pediatrics more economically attractive so that more doctors are established in the practice, and therefore increase the quality of care and alleviate emergencies Emma advances. She is also concerned that the situation in child psychiatry has worsened even more than in pediatrics.

“We need to stop drowning general practitioners in liberal practice under certificates and administration, they are hitting the flow and we need to preserve them to relieve ourselves” alert @to.be.or.not.toubib, but “Given the ongoing negotiations, things are getting off to a very bad start, the government has absolutely nothing to do ». Emma proposes in this sense of “replace certificates of sick children with affidavits. This would free up time and consultation. But it would also be necessary to sanction appointments that were not honored without justification, which is unacceptable in this context of a shortage of doctors. »

More personnel, economic resources and pedagogy, this is what pediatric caregivers are asking for to desaturate the system. The Paediatrics and Child Health Assizes (a collective work of inter-ministerial reflection) conclude in April. Caregivers expect lasting solutions, but without high hopes.