“If you have a doctor’s appointment and don’t come without warning, you pay.”Gabriel Attal warned during his General political speech, Tuesday, January 30th. Fines for missed appointments or “rabbit tax”, promised by the Prime Minister, aims at this “authorize” Patients while remunerating doctors.

This recurring demand from liberal doctors was put forward in January 2023 by a communicated Joint statement from the National Council of the Order of Physicians and the Academy of Medicine deploring this “Every week, 6 to 10% of patients do not show up for their appointment, which corresponds to a loss of consultation time of almost two hours per week for doctors of all specialties and, extrapolated, almost 27 million missed appointments per year.”

According to these two organizations, the “rabbits” are practitioners “serious impact on supply”, They disrupt the daily work of doctors and contribute to an increase in the number of patients using emergency services.

Where does this figure of 27 million unfulfilled consultations per year come from?

When asked about the origin of these figures, the National Council of the Medical Association refers to the Association of Liberal Doctors of the Regional Union of Health Professions of Ile-de-France (URPS-IDF), which is at the origin.

Indeed, this estimate “on the scale of France” has advanced for the first time in a press release in July 2022 of the URPS-IDF. It is based on the results of a survey carried out among private doctors in Ile-de-France. Of 16,000 doctors in the Ile-de-France region, 2,240 responded (including 855 general practitioners). On the question “How many missed appointments do you see on average per day? »They had a limited and imprecise selection “zero”, “one to two”, “three to five” Or “more than five”.

95% of respondents report at least one missed appointment per day. As explained by the URPS-IDF in WorldThis figure was multiplied by the number of private doctors in France (100,000 in 2022) and by the number of annual working days (forty-five six-day weeks) to arrive at the projection of 27 million annual consultations not recognized by the state were level.

Specifically, 43% of survey respondents estimate that missed appointments account for 0 to 5% of their physical activity, and 37% estimate that they account for between 6% and 10% of their physical activity. However, it is this last figure that was adopted by the National Council of the Medical Association and then by the amendment submitted to the Senate.

Why is it difficult to assess the phenomenon?

The estimate of 27 million “rabbits” derived from the URPS-IDF survey is not statistically reliable. Other organizations have attempted to quantify the phenomenon, as neither a comprehensive study among health professionals nor a statistical study with a representative sample of French doctors has been conducted.

– There are surveys with very limited representativeness

The Departmental Council of the Order of Doctors of the North conducted a survey of just 200 randomly selected doctors in January 2023. On average, “rabbits” account for 7.6% of consultations among the 150 respondents who conduct consultations, all specialties combined, or two hours lost per week. Only 15% of these are assigned to new patients.

A questionnaire was sent out in March 2022 URPS Private Doctors Grand-Est to 7,364 doctors. Only 517 responses were received, including 303 from general practitioners and a handful from specialists. The number of missed appointments in general practice is on average 3.83 out of 102 per week. The survey also publishes details of the number of weekly “rabbits” and their equivalent in “lost weeks of activity,” Specialty after specialty, but with a very small sample of respondents: 26 pediatricians, eight ophthalmologists, two gynecologists, etc.

The union of general practitioners MG France was also created a survey among its members in January 2024. According to initial results, the general secretary of the union, Jean-Christophe Nogrette, estimates that an average of 2.5 appointments per week with each family doctor are not kept, i.e. around 6 million appointments – 250 million are missed every year.

– More comprehensive statistical results, but with limited scope

The Doctolib platform also quantified the “rabbits” asked by users of its application. Based on the 30 million appointments in September and October 2022, Doctolib estimates 3.4% of missed appointments with general practitioners and pediatricians (without cancellation or prior information), 4.5% with other specialists and 6.2% with dentists.

The platform also analyzed the representation rate for late canceled appointments (less than 48 hours before the appointment) and found that this is over 75% for general practitioners and pediatricians, but only two for other specialties.

These numbers show a certain degree of reliability, but are only representative of the doctors represented on Doctolib – only a third of privately practicing general practitioners are represented on the platform.