The day after I returned from the September conference in the South of France, the postman arrived with the long-awaited signed-for letter from the speech therapy commission. I ripped it open in trembling anticipation, imagining that some minor – or major – error might have invalidated my entire dossier. But no, there it was – the Holy Grail! – ‘Attestation d’Autorisation d’Exercice’.
After months of planning and years of thinking about it, it took a while for the news to sink in. But there was no time to sit on my laurels: a long list of patients who my new colleagues had already handed over to me were waiting to be given appointments as soon as I was ‘official’. These were all elderly patients needing home visits, a couple post-stroke, but a number with memory problems in the absence of any other communication difficulty. These patients wouldn’t receive speech therapy at all in the UK, whereas they usually get weekly treatment here, for ‘stimulation‘, as they call it.
So I set about jumping through the administrative hoops in order to register as a speech therapist in my département of ‘Hauts de Seine‘. If you change region you have to go through the whole process all over again. I started with the ARS, the Regional Health Agency, who gave me a health professional registration number, and then went to the CPAM, the Health Care Insurance Fund, who regulate the health professions to some degree, but more importantly, reimburse them for each health care ‘act’ that they carry out. At every interview, I have to admit to a certain amount of trepidation at the thought of betraying myself by a simple grammatical error (anticipated reaction along the lines of “A speech therapist who can’t speak the language properly? Clearly a phoney!”) but surprisingly, all went off without a glitch. I returned from the CPAM with an envelope of forms bearing my name and number. Most of the paperwork is sent electronically now, but if this can’t be done for any reason, the practician has to fill one of these feuilles de soins detailing the number of sessions and send it off in order to get paid.
At the rehabilitation hospital which refers patients to our practice referrals were piling up, so I came straight out of the CPAM and went down the road to see a new patient while the ink was still drying on the feuilles de soins. Luckily for me, she had a voice problem, so I was well within my comfort zone. The patients themselves seem so far very forgiving of the occasionally odd things that come out of my mouth, but I’m much more self-conscious with other health professionals, wondering at what point in the conversation they will smell a rat. Everyone’s been very nice, though, whatever they may think. Having a non-French surname sometimes gives the game away even if my accent doesn’t. Occasionally, it even has its benefits. When I called the first patient on our waiting list to offer a visit I spoke to his wife at some length about the prescription (speech therapy here has to be ‘prescribed’ by a doctor, and if they don’t write ‘assessment and treatment’ you have to get it changed or you won’t get paid!) before she spelt her husband’s name, adding ‘it’s an English name’, and then hollering ‘c’est un Britannique!‘ down the phone, as though this was hilarious. Imagine her surprise, then, when I replied, ‘well that’s handy, Madame, because I am a Britannique as well!’ At this she laughed her head off before ending with ‘unteel lay-ter!’ I look forward to meeting meeting them soon.
Since the start of October it seems I’ve barely paused for breath, then. Looking at my records (which I have to keep meticulously as a self-employed person), I’ve seen a total of 34 different patients in 2 months, done 63 sessions in October and 83 in November (on 4 days a week as I’m still teaching at the engineering school on Tuesdays). I’m now sometimes packing 9 patients into a day – a far cry from the NHS! But I’m still way below the average for a self-employed full-time therapist here, which is more like 50 a week. Hard to manage with mostly home visits; I still have to build up my list of patients who I see at the practice, but as I’m only seeing adults for the time being, I haven’t filled the day I spend there. Not that I want to for now, since there’s quite enough admin and materials preparation to more than fill my time. But the good news is I’m earning enough to cover my living costs, which after a year of odd jobs is a welcome change!