PRESS RELEASE
9 December 2019
PUBLIC ENTITIES AND POLICIES
THE ORDER OF PHYSICIANS
After the National Council of Dental Surgeons in 2016 and the National
Physiotherapists Council in 2017, the Cour des comptes has audited the
National Medical Council (CNOM), 46 Local Medical Councils (out of 101) and the
24 Regional Medical Councils, of the Order of Physicians.
Created in 1945, the Order of Physicians is a private body entrusted with a public
service mission. Its role is to ensure that practitioners comply with ethical rules
and to uphold the profession’s independence and honour.
It possesses annual resources of around
€
85 million, provided by mandatory
subscriptions from some 300,000 physicians, reserves of
€
152 million and
assets valued at
€
110 million.
The Order has only taken marginal account of the recommendations made by
the Court in 2012 following its previous audit: it is still marked by problems of
governance, serious failures in management, continuing inadequacies in the
performance of its missions, and a lack of rigour in handling patients’
complaints.
Serious failures in management
As with other healthcare professions’ Orders audited by the Court, the Order of
Physicians is permeated by problems of governance that impact the quality of its
management. Overrepresentation of men (91%), elderly and retired men in particular
(40%), in the CNOM, along with the long duration of terms served, does nothing to
promote awareness of necessary change. In a number of
départements
, internal
conflicts have led to tensions and disorganisation harmful to proper performance of the
Order’s missions.
Decentralisation of subscription collection and accounting procedures, which are left
to the Order’s Local Councils with no oversight provided for, has resulted in the
appearance of numerous errors, above all at regional and local levels: irregular,
incomplete and even falsified accounting entries, resources not fully traced in profit-
and-loss accounts, undervalued assets, and numerous management excesses.
The Order frequently acts in defence of professional interests, so impinging upon the
role of the unions. At the same time, it fails to carry out many of its missions
satisfactorily. Although the most important of them, the keeping of the register in which
all physicians must be recorded if they wish to practice their profession, is correctly
carried out, others, such as monitoring physicians’ compliance with their continuing
professional development obligations and the profession’s ethical rules (as regards
relations with the pharmaceutical industry in particular) suffer from serious
shortcomings. Nor does access to care seem to be a priority.
Various managerial transgressions may result in referral to the judicial authorities via
the Court’s Public Prosecutor’s Office.
Mismanaged administrative and disciplinary missions
As regards discipline, patients’ complaints are not handled with sufficient rigour and
the impartiality of the bodies to which cases are assigned is not always guaranteed.
The Order does not regard the great majority of reports it receives as complaints, and
consequently they are not brought before its own Disciplinary Councils. In a number of
cases, the absence of disciplinary proceedings raises questions. Analysis of some fifty
decisions delivered between 2016 and 2017 (from a list of 90 decisions communicated
at the order of the Court) reveals procedural irregularities and lack of diligence in
handling complaints bearing on sexual misconduct.
These findings call for urgent restoration of order, with three priorities: making patients’
safety the Order’s central concern once again, opening up its governance to non-
physicians, and accomplishing the change in its disciplinary system, whose operation
has just been improved by a Decree of 3 December 2019. It is therefore a question of
completing the transformation of the governance of Orders of Health Professions,
started upon with the Ordinances issued in 2017 following the Court’s previous audits.
Read the report
PRESS CONTACTS:
Ted Marx
Director of Communication
T +33 (
0)1 42 98 55 62
ted.marx@ccomptes.fr
Denis Gettliffe
Press Relations Manager
T +33 (
0)1 42 98 55 77
denis.gettliffe@ccomptes.fr
@Courdescomptes
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Cour des comptes