Doctor's Orders-report

Rail workers do it, teachers do it, even judges did it earlier this year. Now top doctors are doing it, too: walking off the job in France to demonstrate against shabby treatment by the government. Some 2,000 French surgeons are threatening to spend a week in self-imposed exile in London starting on Aug. 30, during which time they'll invite recruiters from British hospitals to their protest meetings. "Our goal is to get France to realize how undervalued our profession is," says Dr. Philippe Cuq, a vascular surgeon from Toulouse who heads Surgeons of France, the 3,000-member organization behind the protest. "Young doctors aren't going into surgery. Why should they when they can earn twice as much working as radiologists, without midnight emergency calls and malpractice lawsuits?"

The surgeons' immediate complaint is about money. Cuq says that while rates for general practitioners have generally kept pace with inflation, government-mandated reimbursements for surgical procedures haven't changed in the last 15 years. "For a standard operation to remove varicose veins, a French surgeon in a hospital gets the same payment of roughly j80 that he did in 1990," Cuq claims. The Health Ministry has offered a 10% fee increase, conceding that the responsibilities of surgeons "have been insufficiently taken into account over the last 15 years." But the surgeons say that's not enough. The dispute is part of a larger government effort to control health-care costs. It's a struggle that's playing itself out across Europe: as populations age and demand rises for ever more complex and expensive treatments, health-care reform has become absolutely urgent ?- but it remains politically radioactive.

As recently as 2000, the World Health Organization called France's universal health-care system the best anywhere. Today its health-insurance scheme is in critical condition, and hemorrhaging money: this year it will rack up €12.9 billion more in costs than it takes in, mostly through payroll taxes. Reforms launched earlier this summer by the government of Prime Minister Jean-Pierre Raffarin only begin to address the problem. Before the next presidential election, in 2007, the government says it will force through almost €10 billion in savings by cutting back on reimbursements for visits to specialists, favoring generic rather than brand-name drugs (per capita, the French are the world's most heavily medicated population), and cracking down on liberal sick leave. On top of that, the government wants to haul in another €5 billion in contributions. Beginning next month, patients will pay a single nonrefundable euro for every consultation with a doctor.

Doubts have been voiced ?- even within the government ?- over whether these measures will be enough to put France's health-care accounts back in order. If the surgeons get their higher fees, the equation looks even more questionable. But veteran physicians such as Jean-Gabriel Brun, 57, a thoracic surgeon in Paris, say exploding malpractice-insurance costs, paltry fees and 60-hour workweeks are putting his profession on the endangered species list. He says he earns about €140,000 a year, but drives a Volkswagen Golf and has trouble making ends meet. And don't even think about invoking the magic word "solidarity," the idea that even surgeons should sacrifice to make the health system whole again. "Solidarity," he harrumphs, "has always been against us." In addition to the 10% pay hike, Health Minister Philippe Douste-Blazy, a cardiologist by training, has offered to invest more in equipment and compel insurers to stabilize malpractice premiums. But Cuq says that's not enough to stave off the protest. "We want immediate and concrete improvements," he says, including rolled-back malpractice rates and substantial hikes in surgical fees, though he hasn't said exactly how much.