On the 5 march 2021, Anne Moyal defends a thesis in sociology, the subject of which is : 

Freedom under constraints? Rationalization of self-employed primary care professionals’ practices in multi-professional ambulatory healthcare organizations in France.

Jury :

Henri Bergeron, Directeur de recherche CNRS, Sciences Po, Centre de Sociologie des Organisations (directeur de thèse)

Lawrence D. Brown, Professor in Health Policy and Management, Columbia University, Mailman School of Public Health

Patrick Hassenteufel, Professeur des universités en science politique, Université Paris-Saclay (UVSQ), laboratoire PRINTEMPS (rapporteur)

Christine Musselin, Directrice de recherche CNRS, Sciences Po, Centre de Sociologie des Organisations (présidente du jury)

Magali Robelet, Maîtresse de conférences en sociologie, Université Lumière Lyon 2, Centre Max Weber

François-Xavier Schweyer, Professeur en sociologie de l’Ecole des Hautes Etudes en Santé Publique, Centre Maurice Halbwachs

Nadège Vezinat, Maîtresse de conférences HDR en sociologie, Université de Reims Champagne-Ardenne, laboratoire REGARDS (rapporteure)

Summary:

This thesis focuses on multi-professional primary care structures in France (called “Maisons de Santé Pluriprofessionnels”, MSPs), which we consider as a policy instrument that contributes to rationalizing the ambulatory healthcare sector. Introduced at the end of the 2000s and bringing together self-employed primary care professionals (mainly GPs and paramedics), these new organizations are presented by the State and a growing number of professionals as one of the main responses to the problem of care access, able to attract GPs to certain territories and facilitate the transfer of tasks to paramedics – making it possible to attenuate the demographic crisis of the medical profession. 

In a predominantly private sector, the government has chosen an incentive and contractual policy to encourage – rather than constrain – healthcare professionals to regroup in MSPs, which involves the labeling of structures by the health administration and the allocation of new remunerations by the health insurance, in addition to individual fee-for-service revenues. Without calling into question their private status, this new contractual relationship with public authorities comes with rules and procedures, unprecedented in the private sector, which affect care access, types of care services and coordination between professionals. 

Why do self-employed practitioners willingly enter into a contractual relationship with public authorities that inherently limits their sacrosanct autonomy? What are the effects of these new rationalization procedures on their practices? Through a qualitative sociological analysis at both national and local levels in 6 MSPs, we show that self-employed healthcare professionals manage to maintain their autonomy by appropriating the new rationalization procedures in order to limit their constraining dimension, and even turn such procedures into a new resource that empowers them to develop new forms of practice. Moreover, we argue that the organizational context creates new situations of cooperation leading to a reconfiguration of professional jurisdictions at the organization level.