CME publiques/CME privées : colère similaire, motifs différents

Pat. Seiler - Si tu savais comme je t'aime... - DH n°133-13

Il est peu de dire que les médecins, hospitaliers comme libéraux, sortent relativement perdants de la loi HPST. L’exemple de la Commission médicale d’établissement (hôpitaux publics) et de la Conférence médicale d’établissement (cliniques privées) illustre parfaitement l’état d’esprit des praticiens considérés.

Le projet qui a abouti au décret n°2010-439 du 30 avril 2010 relatif à la commission médicale d’établissement dans les établissements publics de santé, a cristallisé toutes les oppositions, provoquant même une remarquable intersyndicale ((Le Quotidien du médecin n°8784 du 7 juin 2010, Le décret sur les CME resoude les liens syndicaux.)), mais en vain.

Contrairement à l’ancienne mouture, la nouvelle CME est « consultée » sur certains sujets tels que le projet médical, le projet d’établissement (lequel a perdu beaucoup de son intérêt avec la loi HPST), les modifications des missions de service public de l’hôpital, le réglement intérieur, etc. Elle est simplement « informée » sur d’autres sujets comme la rapport annuel d’activité de l’établissement, les contrats de pôles, la politique de recrutement des emplois médicaux, le projet de soins infirmiers, etc.

La CME « contribue » désormais à la politique d’amélioration continue de la qualité et de la sécurité des soins, et aux projets en lien avec l’accueil et la prise en charge des usagers.

Sa composition est élargie et son président devient le vice-président du directoire, pour 300 euros bruts mensuels, montant considéré au demeurant comme méprisant par les syndicats de praticiens hospitaliers.

S’agissant des établissements de santé privés, la nouvelle Conférence médicale d’établissement n’est pas aussi nouvelle que son homologue publique, même si elle se trouve dotée des mêmes. Un décret serait en attente de publication. Toujours est-il qu’aucune indemnité n’est prévue pour les médecins présidant les conférences médicales d’établissement. La Conférence nationale des présidents de CME de l’hospitalisation privée s’est émue dans un communiqué de « la différence de traitement » qu’elle constate « une fois de plus » avec l’hôpital public ((Le Quotidien du médecin n°8772 du 19 mai 2010, Les CHU prennent la mouche et les « privés » en ont assez du bénévolat.)).

L’Union Régionale des Médecins Libéraux (URML) de Rhône-Alpes a évalué, il y a cinq ans, à 129 heures annuelles le temps bénévole consacré par un président de CME à l’exercice de sa fonction, ce qui paraîtrait inconcevable dans le secteur public.

Au-delà de la question de la rémunération du temps de présence en CME, il y a lieu de relever l’absence de reconnaissance financière du temps médical passé par les médecins libéraux au sein des structures internes des établissements privés, telles que les CRU, les CLAN, les CLUD, les COMEDIMS, ou encore le Conseil de bloc. Les aides à la contractualisation, quand elles sont versées très épisodiquement par les ARH/ARS, s’élèvent à un montant tellement dérisoire qu’elles méritent à peine d’être évoquées.

En somme, dans le secteur public, les praticiens crient à la perte de position centrale dans l’organisation hospitalière ; dans le secteur privé, les médecins veulent voir reconnaître financièrement leur temps de présence médicale.

Personne n’est satisfait.

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