A regulation prevents emergency doctors from practising freely in Luxembourg

Red tape prevents even trained emergency doctors from working with first responders (Samu) in Luxembourg, where such crucial pre-hospital care roles are restricted to just two types of doctors: anaesthetists and resuscitators.

The Grand Duchy’s Ducal Fire and Rescue Service’s guidelines (CGDIS) currently ban otherwise fully trained doctors from handling critical situations such as road accidents, unexpected births or natural disasters, unless they are certified anaesthetists or resuscitators. This stands in stark contrast to neighbouring countries where emergency doctors are allowed to act as first responders.

Emilie* and Lucas*, two young emergency doctors from Luxembourg, have been working for several months to be able to practise their profession to the fullest.

“Emergency medicine is a relatively young speciality, created more than 30 years ago, and recognised since 2010 in Luxembourg”, says Emilie, who works for both Luxembourg Air Rescue and in the emergency department of a Luxembourg hospital.

Emilie trained in France to become an emergency doctor. “Since 2017, a specialised diploma in emergency medicine has been on offer. This is five years of specific training that trains us for both pre-hospital, i.e. the Samu, and in-hospital emergency services. It’s a real added value for the patient, and for the healthcare system in general”, says the young doctor. During this training, health professionals learn the ins and outs of disaster medicine and traumatology.

He moved to France to practise

But in the Grand Duchy, they are denied access to the emergency services. Although the law recognises and authorises emergency physicians to practise in the country, an internal document from the Grand Ducal Fire and Rescue Service (CGDIS) limits their activities.

“In the CGDIS guidelines, it is stipulated that only anaesthetists and resuscitators can work as Samu doctors,” says Lucas. This rule makes it impossible for the two young doctors, who have been specially trained to work in this field, to take part.

This situation has led Lucas to stay in France, so that he can practise his profession as he sees fit. Since 2020, the young professional has been working in the emergency service of a town in Alsace, where he was put in charge in 2022. “I work 80% of my time in France, and the rest of my time I work in a hospital in Luxembourg.”

Registered and recognised as emergency doctors in Luxembourg since 2020, Lucas and Emilie are determined to change the CGDIS regulations.

“Our aim is to be able to practise our profession, our passion. Not being able to take part in the Samu is a form of discrimination in recruitment, if you look at the [labour law] and the law on recruitment. We have specific training, but we can’t become Samu doctors”, says Emilie.

As part of her main mission as an emergency doctor for LAR, the young doctor works as part of the crew of Air Rescue 3, the Luxembourg helicopter that mainly operates in Germany. “It’s a paradoxical situation, because I’m authorised to work in Germany and I can even be diverted to Luxembourg during an operation. But I don’t have the right to be stationed in the Grand Duchy”, laments the professional, who points out that “foreign emergency doctors can intervene in Luxembourg when necessary under cross-border agreements”.

Two ministries alerted

In January, the two professionals contacted Health Minister Martine Deprez (CSV) to alert her to their situation. She replied to the two doctors in mid-March, stating that she had “taken note of [their] complaint”, while pointing out that the CGDIS does not come under the authority of her ministry.

She said she would consult with the minister of home affairs.

Léon Gloden (CSV) was questioned on this very subject by DP MPs Carole Hartmann and Corinne Cahen in a parliamentary question.

In his reply on 17 March, the minister pointed out that the resource and organisation guidelines for the Samu adopted by the Board of Directors specifically stipulate that “the SAMU doctor is a specialist in anaesthesia-intensive care or anaesthesiology authorised to practise medicine in Luxembourg by the minister responsible for health”.

He stated that “to date, there has been no decision by the CGDIS to the effect that a Samu doctor should have a different qualification from that of an anaesthetist-resuscitator”.

Gloden also added that the CGDIS’s health medical department is “currently working on its catalogue of skills in collaboration with representatives of Samu doctors”. If the latter agree, the change in pre-requisite qualifications will have to be recorded in the reference system.

Towards a shortage of anaesthetists?

“We don’t want to replace what is already in place, but to integrate the system without overturning it. I think this will be good for patient care, because we can all learn from each other, and together we’ll be better,” says Lucas. Eventually, the young professional hopes to be able to return to Luxembourg if the regulations change for the better.

“If we can start taking part in the on-call duties, I’ll reduce my working time in France to come back completely. But it’s not just the Samu that needs to be reorganised, it’s the whole of emergency medicine that needs to be reviewed in Luxembourg,” says Lucas.

The young professional doesn’t mince his words. He feels that “medicine in Luxembourg is a bit stuck in the 1980s”, and regrets that “other specialists don’t consider emergency doctors to be real specialists”.

In addition to their personal desire to join the Samu, the two young professionals point to a more general challenge facing the profession. “We’re probably going to face a shortage of anaesthetists. But if we lift this restriction, they will be freer to practise their core profession, i.e. operating theatre and intensive care,” says Emilie.

“Sooner or later, there will be a shortage of anaesthetists in Luxembourg – it’s inevitable. And we’ll also have a shortage of emergency doctors who will have stayed in France or Belgium, because they can’t practise their profession the way they’ve learned it,” adds Lucas.

*First names have been changed to ensure anonymity.

(This article was originally published by Virgule. Translation, editing and adaptation by Lucrezia Reale.)