Medical desert: this innovative remedy to attract doctors

The inhabitants of Barcus were hot. This Basque village of 600 inhabitants almost found itself without a general practitioner. Their doctor, who has been living in the town for 40 years, has spent his last ten years of practice looking for his successor before retiring at 73. His quest was ultimately not in vain. Juline Agnelli, a young 32-year-old general practitioner, took over in October 2021. And this, only two years after leaving Bordeaux medical school. Behind this story, hides a collective that works miracles.

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“I met the Présence médicale 64 teams during a day organized at the university for students at the end of their internship. I already had an idea of ​​where I wanted to stay, so they wrote down my details. From there, they contacted me every six months to hear from me”, says the young doctor from Annecy whose love life led her to the Basque Country.

A one-stop shop for preparing the next generation in medical deserts

If Juline Agnelli has taken up residence at Barcus, it is because she has benefited from tailor-made support in her installation process. “I already knew during my studies that I wanted to work in a rural environment. But at the end of the internship, I was both happy to have made it to the end and terrified to be let loose into the unknown. Because most medical interns train in hospitals, few are really prepared to deal with the administrative burdens of liberal practice.


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And this is where Medical Presence 64 comes into play. This collective, co-built by the Pyrénées-Atlantiques department and the Regional Health Agency (ARS), supports doctors throughout their installation process and even beyond. It is a kind of one-stop shop that answers doctors’ questions, tells them in which order to take the steps relating to professional civil liability or even registration with the Order of Physicians, at the primary insurance fund. illness, Urssaf and the pension fund. So many formalities that discourage some young doctors who are ultimately tempted by wage employment… Even if it means earning less.

Created in 2017 following a consultation to improve access to public services in the territory, the Présence médicale 64 collective – or “PM 64” – fights in its own way against medical desertification, which has won 87% of the Hexagon. A first experiment was carried out in the village of Garlin, which was of great concern: “A nursing home was run by a single general practitioner who was exhausted”, recalls Nadine Hiale, director of PM 64. The interns who spent their internship there without putting their suitcases there were then surveyed: “What was holding them back, among other things, was that the patient files were not computerized.” One problem among others which was quickly resolved thanks to the collective: three new general practitioners joined the Garlin health center in barely a year.

Twenty new doctors already installed

The strike force of Medical Presence 64 perhaps lies in the ability to listen to the staff who accompany the doctors. “We are not a simple one-stop shop that provides identical answers to our interlocutors. Instead, we rely on a unique personalized welcome because we strive to take into account the professional and personal life projects of the doctors”, underlines Nadine Hiale.


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A graduate in general medicine six months ago, Roxane Bailleul already knows how she wants to practice her profession: “I want to work in a team because it allows us to share different and complementary perspectives on certain cases. And we feel safer,” she says. In close contact with PM 64 when she officiated at the union of interns in New Aquitaine, this generalist called on the services of the collective to find the structure best suited to her life project. It has now been three weeks that she has been replacing the nursing home in Pontacq, a town of around 3,000 inhabitants. “Some doctors prefer to start with replacements to get to know the territory better, the professionals around them”, adds Thierry Carrère, Vice-President of the Pyrénées-Atlantiques Departmental Council delegated to Présence médicale 64. Often, between the first phone call and the laying of the plate, take 12 to 18 months.”

Thanks to Medical Presence 64, no less than 22 general practitioners have settled in the Pyrénées-Atlantiques. But once the plaque is laid, the link is not broken between the doctor and the collective. Alone in her office in Barcus, Juline Agnelli recovered the 500 patients followed by the former village doctor. “And I accepted 300 more. My days are full knowing that I am a mother”, specifies the general practitioner, who was wondering about her future when PM 64 contacted her to inquire about her situation. But his workload could be lightened, again thanks to the collective: “A couple of doctors want to live in the area. The woman has become my replacement and we are considering teaming up.”

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