A Doctor’s Tour de France, One ‘Medical Desert’ at a Time

https://www.nytimes.com/2021/08/28/world/europe/france-doctor-shortage-health-care-rural.html

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LES PIEUX, France — On a sunny but chilly June morning, Dr. Martial Jardel took his black motorcycle out of his camper van, put his helmet on and started the engine. For his last day on Normandy’s Cotentin Peninsula, he was ready to hit the road along the English Channel to visit a patient.

Michel Piquot, 92, standing on his doorstep in blue slippers, was waiting impatiently.

“When was the last time you had a blood test?” Dr. Jardel asked after arriving at the single-story house, speaking louder for the hard-of-hearing Mr. Piquot, a former employee of an aviation company. “I have no idea,” Mr. Piquot replied, looking at the young doctor with vacant eyes. “I tell you, it’s hell getting old.”

In March, a newly graduated Dr. Jardel, 30, decided to go on a five-month “Tour de France” trip. But unlike the prestigious cycling race, his journey took him to what the French call “medical deserts” — areas suffering from an acute shortage of physicians. There, Dr. Jardel offers an irresistible deal to overworked doctors: He replaces them for two weeks while they go on vacation.

Over the past few months, Dr. Jardel has traveled more than 2,800 miles with his camper van, sharing his experience on his website and with more than 1,500 followers on Instagram, hoping to change the minds of young doctors who are often reluctant to settle in rural areas that are full of patients but lack the appeal of big cities.

Despite France’s world-renowned health care system, about seven million people live in areas where access to a doctor is limited, according to a recent survey published by the Mutualité Française, a leading professional union of health insurance companies. Making matters worse, officials are bracing for a big wave of retirements over the next decade in France, where the average age of doctors is now 49, according to the government.

Normandy is one of the regions that is hit hardest by the shortage of physicians, according to a recent report by the French Senate, especially on the Cotentin Peninsula, where 40 percent of medical practitioners are already over 60.

The imbalance between underserved regions and urban areas where physicians cluster has fueled perceptions of a widening gap between a wealthy, well-connected France and one that is more peripheral and taken for granted. These divisions have fueled Yellow Vest protests and the anger of health care workers, who are exhausted by the coronavirus pandemic and staff shortages.

“We must act quickly,” said David Margueritte, the president of the authority that oversees Cotentin. “A territory cannot be attractive in the long run if there’s no possibility to seek treatment.”

For the sixth stage of his medical road trip, after stopping in central, eastern and northern France, Dr. Jardel replaced Mathieu Bansard, 32, a general practitioner in Les Pieux, a town of 3,000 on the Cotentin Peninsula where the main street is a hodgepodge of stone cottages and modern businesses, including a bakery, a creperie and a hairdresser.

“I wanted him to see that even here, we could have optimal working and life conditions,” Dr. Bansard said. “It is not because we are in the countryside that it stinks!”

More than 30 people, including midwives and psychologists, work at the health center where Dr. Bansard practices. Located roughly 60 miles from Omaha Beach, it is an exception on the Cotentin Peninsula, which is affected by a scarcity of specialists like dentists — only 33 for 100,000 inhabitants. The doctors in Les Pieux already have 1,800 to 2,200 patients each, while the national average is roughly 900, making it “impossible” for newcomers to find an attending physician.

“The waiting time is appalling,” said one patient, Didier Duval, 62. “To see one ophthalmologist, you have to wait at least six months, whereas when I was living in Paris, it took less than 48 hours and I had the choice between several.”

Following a morning of home visits and consultations, Dr. Jardel left with his motorcycle for a local nursing home. After an eight-minute drive along Normandy’s coast, he met Natacha Carlat, a nurse who took him to two elderly patients. The coronavirus pandemic has made staffing problems worse, she said.

“We never stop,” Ms. Carlat said. “A lot of doctors come in and leave because, like us, they are chasing time.”

To fix the doctor shortages in certain regions, the French government tried to increase supply last year by eliminating a cap on the number of medical students. But the gap between metropolitan areas and rural areas has been widening. According to the Senate report on medical deserts, Paris and the French Riviera have about 400 general practitioners and specialists per 100,000 inhabitants, while the national average is roughly 340.

Local authorities are trying to attract young doctors to underserved, rural areas with incentives like covering tuition for newly graduated physiotherapists.

“It is a charm offensive,” said Mr. Margueritte, the Cotentin official. “We hope they’ll have a crush.”

For some, the charm seemed to work.

Axel Guérin, 25, a doctor in training at the University of Caen who is working at the health center in Les Pieux, said he was planning to stay in the region after his six-month residency.

“I like the mentality, the rural life, the living environment,” he said as he contemplated the panoramic seaside view from his office. Doctors and interns sometimes enjoy lunchtime surf sessions, Dr. Bansard said.

But Dr. Jardel, the itinerant physician, was not smitten, even after two weeks and a farewell gift from Dr. Bansard — beer from a local brewery.

“You can come back anytime, and don’t forget to bring us some friends!” Dr. Bansard said as he waved goodbye.

“I’m taking my shot of rural life, but to settle here for the next 30 years, I can’t,” Dr. Jardel admitted.

He stowed his motorcycle in his camper van and drove past Mont Saint-Michel — the Norman island abbey that dominates the region — for the next stage of his trip, in Brittany.

Following in his father’s footsteps, Dr. Jardel studied medicine for nine grueling years. But he wanted to take a “breath of fresh air” after graduation, in the middle of the pandemic, by discovering France’s countryside and its small-town medical practices.

In Brittany, Dr. Jardel was replacing Dr. Marion Molié, 33, the only physician in Pleumeur-Gautier.

Originally from northeastern France, Dr. Molié fulfilled a dream by buying a stone house in this small town to live in with her husband and two children. Local authorities desperate for doctors paid for Dr. Molié’s secretary for a year and covered her office rent of about $600 for the first few months.

But after working there since September, she felt overwhelmed.

“There used to be eight doctors,” said Dr. Molié, who works at a care home that was established by two doctors in 2014. They quit less than a year later to open an office in a bigger town.

“Now, for the 8,000 inhabitants of the peninsula, we are only two,” she said.

Overburdened with the 1,800 patients she already treats, Dr. Molié has said since March that she could not take on new ones. The situation is becoming “more and more worrisome,” she added, especially now that the doctor in a neighboring town is about to retire.

After touring the care home and collecting the keys, Dr. Jardel looked for a place to park his camper van before sundown. Along Brittany’s foggy coastal landscape, he settled next to old men fishing.

Dr. Jardel took in the salty sea breeze and watched the waves. He has already thought of a new project: creating an organization to encourage other young doctors to discover underserved areas.

And would he embark on another Tour de France?

“It is not impossible,” he said. “I saw 10 of France’s 101 departments. I still have 91 left.”