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The 25th Congress of General Medicine Interns, on February 6 and 7 in Lille, put global health at the heart of the discussions. With an evocative slogan, “from human to world, weave the care”, the event addressed important subjects such as eco -responsible practices, the fight against discrimination or the management of exiles. But behind these constructive exchanges, a brutal reality continues to impose itself: that of the working time of the interns and its disastrous consequences on their mental health. The recent figures resulting from the surveys carried out in particular by the ISNAR-IMG, the inter-union representative of the interns of general medicine, are overwhelming.
According to a 2023 study carried out by student unions with 2,277 interns, their weekly working time reached 59 hours, against 58.4 hours in 2020, well beyond 48 legal hours. And it’s just an average. More than 80 % of interns exceed this limit each week, 75 hours in certain specialties and up to more than 80 hours for 10 % of them. The 24 -hour consecutive guards, still largely assured despite their theoretical ban, add to overwork. The fact that only almost one in two intern has a service board in accordance with the regulations complicate the compensatory rest and also accentuates accumulated fatigue.
These untenable working conditions are accompanied by a silent health crisis: that of the mental health of the interns. Presented at this congress, a national survey conducted in 2024 by ISNAR-IMG, ISNI and ANEMF with more than 8,300 medical students establish that 52 % of them show symptoms of pathological anxiety . Another terrifying figure, more than one in five students (21 %) share suicidal ideas during the past year. A significant proportion also suffers from severe depression. These psychological suffering largely exceeds in proportion those observed in the general population. To this must be added an often deleterious environment: sexist and sexual violence (mainly in the hospital), hierarchical humiliations and financial precariousness are widespread in the medical environment.
In this very tense context, a reform adds oil to fire: the creation of a fourth year of boarding school in general medicine, acted in 2022 within the framework of the social security financing law for 2023. This more year, which is due to come into force in 2026, was sold as a remedy for medical desertification, granting future general practitioners a status of doctor junior. But for the interns and their union representatives, this reform is perceived as poorly prepared. It is even “forced and sloppy” for the Isnar-Img, the main union in the arena, which emphasizes that a fourth year “does not improvise”: absence of clear regulatory texts, insufficient compensation, uncertain internship grounds , vague on the status – subject to question, even contemptuous -, insufficient supervision … As a reminder, there were only 42 university professors in 2022 for nearly 10,000 interns in general medicine!
The human cost is immense, but the repercussions go far beyond individuals. The hospital system itself is in danger. Faced with these extreme conditions and lack of real help (the national coordination of support for health or CNAES students, created in 2019, is only known by 4.1 % of doctors in training!), A number Crescent of interns choose to abandon their studies or envisage a conversion before they even finished their curriculum. If nothing is done to improve their conditions, the hospital system could find itself in critical shortage in the years to come. The quality of care is also penalized on a daily basis: how to treat effectively when those who wear the white coat are themselves on the knees?
The Lille Congress was an opportunity for future general practitioners to express their anger at their future in a system that seems to make few cases. The formal posture of the government seems insufficient in the face of a reality marked by their exhaustion. It is not enough to recall the legal obligations and the theoretical conditions of exercise of the interns to drastically reduce their working time, prohibit their excessive guards, take into account their compensatory rest, strengthen their psychological support or even fight against sexist violence and morals they are victims of. And what about this fourth year that we still don’t know where she will lead them? If no concrete action is quickly undertaken, it is the whole health system that risks collapsing under the weight of a model disconnected from current issues.
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