On May 7, 2025, the French National Assembly adopted a controversial law proposal aimed at combating medical deserts, initiated by Deputy Guillaume Garot from the Socialist Party. The proposal, which received 99 votes in favor and only 9 against, introduces regulations on the establishment of medical practices across the country, particularly in areas deemed over-endowed with medical personnel.
The law's primary feature involves requiring prior authorization for doctors wishing to set up practices in areas where the medical supply meets or exceeds demand. In regions identified as medically underserved, however, this authorization will be granted automatically. "Our health cannot depend on our postal code," Garot emphasized after the vote, highlighting the urgent need for equitable healthcare access.
The legislation is a response to growing concerns over the accessibility of medical services in rural and underserved areas, where many residents struggle to find a healthcare provider. According to a UFC-Que Choisir survey published in 2024, nearly 7 million people in France do not have a treating doctor, and 45% of patients have given up on seeking care due to accessibility issues.
Despite the law's passage, it has faced significant backlash from the medical community. Following the initial adoption of Article 1 on April 2, 2025, which questioned the freedom of doctors to establish practices in certain areas, liberal doctors initiated a strike on April 28. This strike, primarily supported by interns and young physicians, was a direct response to what they viewed as an infringement on their professional autonomy.
On May 2, nearly all unions representing liberal doctors and interns, including Isni, Anemf, and CSMF, issued a statement calling for the rejection of any legislation that would end the freedom of establishment for doctors. They vowed to continue their strike until the Garot law was withdrawn, stating, "The doctors, on the front lines of access to care in France alongside other caregivers, will no longer tolerate these senseless and harmful reforms!"
In addition to the regulation of medical practice locations, the Garot law proposal includes measures to enhance the territorialization of health studies, restore the obligation of permanent care, and eliminate increased costs for patients unable to designate a treating physician due to insufficient healthcare availability.
In a counterproposal, the government suggested that liberal doctors should be required to consult in medical deserts for two days per month, a plan met with widespread disapproval from medical unions. François Bayrou, the Prime Minister, defended this approach, arguing that all doctors are funded by social security and should therefore accept responsibilities in underserved areas.
However, the response from the medical community has been fierce. The association Médecins pour demain criticized Bayrou's comments, stating that the medical profession has been filling the gaps created by successive policies that have led to a medical shortage. "It is the doctors who hold the care centers, the emergency rooms, and the deserted practices. They maintain a social and human connection where the state has often receded," the association wrote in an open letter.
Amidst the outcry from medical professionals, some voices within the medical community have offered a more nuanced perspective. The Syndicat de la médecine générale (SMG) expressed that while they do not oppose the principle of limiting installations, they do not support the measures proposed in the Garot law. The SMG emphasized that addressing healthcare deserts requires a systemic, multifactorial response, rather than a simplistic focus on medical demographics.
In contrast, two prominent medical professors, Didier Payen and Jean-François Payen, published a column in Le Monde, criticizing the revolt against the Garot law. They argued that the outrage from medical representatives regarding the government's proposals for regulating practice locations is misplaced. They pointed out that similar zoning exists in other healthcare professions without provoking such indignation.
As the debate continues, over 1,500 local officials have voiced their support for the Garot proposal, urging its adoption as a necessary measure to address healthcare inequalities. "We support the transpartisan law proposal currently discussed in the National Assembly. It is essential for regulating the installation of doctors, a strategy already applied to many healthcare professions," their statement read.
Following its approval in the National Assembly, the Garot law proposal is set to be examined by the Senate starting May 12, 2025. However, it faces potential competition from another initiative led by Senator Philippe Mouiller, which aims to improve access to care in under-served areas without imposing restrictions on practice locations.
In the meantime, the medical community remains divided. Some support the Garot law as a first step towards addressing the issue of medical deserts, while others fear it may exacerbate the decline of liberal medicine. As the discussions unfold, the outcome will significantly impact the future of healthcare provision in France.
In conclusion, the adoption of the Garot law proposal marks a pivotal moment in the ongoing struggle to address medical deserts in France. While it promises to regulate the establishment of medical practices and improve access to healthcare, the road ahead is fraught with challenges, as various stakeholders continue to voice their concerns and propose alternative solutions.
