Health: "There is a local consensus against a joint management of Marmande and Agen," says Philippe Meyer, who is leaving after nine years at the head of the hospital.

Succession, critical finances, changing practices... The health journey of the director, who is retiring this August, has not been easy.

He wanted to be a journalist, and that's what drove him to "do" Sciences Po. A training that ultimately led him to manage hospitals for nearly four decades, which he clearly didn't see fly by. A few days before his retirement in Clairac, the Lorraine native, who came from the Territoire de Belfort, takes stock of nine unusual years spent at the head of the Marmande Hospital Center, which, with 1,000 practitioners and other professions, represents the largest employer in the sector. He leaves his position, aware of the rather worrying prospects for the establishment with a capacity of just over 500 beds...

This is the question that has raised serious concerns since your retirement announcement last January. After your departure on August 8, who will take over from you?

My colleagues will take turns to ensure the interim until the end of September. After that, I don't know... I have received contradictory information. The minister responded to the member of the National Assembly saying that it would be an interim outside the department . The latest news is that in Lot-et-Garonne, it could be an interim carried out by a colleague from the establishment, the deputy director, for example . We were told that the director of Agen would not carry it out. For there to be joint management with Agen and Villeneuve, local authorities must agree with this principle, which was the case in Villeneuve-sur-Lot. However, here, in Val-de-Garonne, there is a consensus among elected officials and the medical community against it. When we look at population flows and in terms of health, the flow towards Agen is not natural.

What has struck you during these nine years of management in Marmande?

In my forty-year career, this is the first time I've found an institution so rooted in its territory. This was one of the missions entrusted to me by the departmental director of the regional health agency (ARS) upon my arrival, because the hospital was operating somewhat in isolation. It had to be opened up to the city and the outside world, and that's what we did. Sometimes under duress, because the private medical services offered in the city have deteriorated over the years, particularly with the closure of clinics. And not just general medicine, but also specialties, which have been replaced by... Almost nothing.

This is not a situation specific to the area, but it is becoming acute in Marmande and Tonneins compared to what we know elsewhere. There is no longer a cardiologist in town, no psychiatrist, no diabetologist, no pediatrician, no gynecologist, and it has been a long time since there has been a dermatologist. Added to this is the fact that the remaining patricians are absolutely not sure of finding successors for their practice, like one of the ENT specialists who is slowly heading towards the exit. If we remove the "multi-jobbers," that is, those who combine employment and retirement and who continue to practice, we find ourselves in a largely catastrophic situation. The hospital is becoming an essential passage, which puts enormous pressure on consultations.

Your time in Marmande will have been punctuated by several episodes of crisis, such as that of the emergency room...

The establishment suffered the departure of all the hospital's emergency doctors . The anxiety was how we were going to meet the needs of the population, knowing that around sixty people pass through the department every day, and that the nearest emergency department was an hour's drive away. Several times, at that time, the closure of the emergency department was discussed. The entire organization of emergency care could have been undermined by this type of decision.

In areas like Lot-et-Garonne, the issue of closing small maternity units also comes up often...

This is an issue that has been a source of concern for over thirty years. The number of births has been plummeting in recent years. The balance we could have achieved with this type of facility is being undermined. In Marmande, we will never reach more than 1,000 births per year, given the population of pregnant women in the area. A number that would ensure financial stability.

But gynecology isn't just about births. Even though we've stabilized the number of births at 600 per year, and we've even cut into market share for women who left and are now returning, alongside that, we've developed several strings to our bow in obstetrics, which had never been very present here, by introducing modern surgical techniques.

The institution has a deficit that now stands at between 8 and 9 million euros per year.

At the end of June, the mayor of Marmande pointed out a critical financial situation at the hospital. Can you confirm this?

We are considered a "small" but "strong" hospital. However, we are subject to changes in the way we treat outpatients by the public authorities. This means that an assessment that used to take two or three days is now done in half a day, which impacts billing. As a result, the establishment has a deficit that now amounts to between 8 and 9 million euros per year.

The deterioration is explained by a number of reasons. In addition to the end of subsidized employment, which led to a recruitment policy, we have been subjected to a number of national measures, such as the Ségur de la santé, which was not fully funded. Sound economic logic would dictate that we close the hospital, but if that happens, the consequences would be ten times worse than today's. I have tried to optimize management, but we may have to divest ourselves of certain unprofitable activities. In any case, it will be complicated... There will no longer be a honeymoon period for hospitalization and health in general, even though it is the primary concern of the French.