`titrebHospitals are faced with the constraints of the demography of anesthetists-intensive care specialists`/titrebDemographic constraints should have been a driver for the modernization of healthcare and encouraged the restructuring of hospitals in order to enhance the efficiency of patient care pathways that guarantee their quality of care. But faced with these constraints, public hospitals have retained an organization focused on the care system and its regulation, and maintained their medical and surgical activities despite an evident lack of competent physicians. Paradoxically, demographic constraints have reinforced the “unbending” management of hospital structures and “site patriotism”, the sole aim being to maintain the possibility of surgical care in the largest possible number of healthcare establishments. This approach has led to an increase in the use of physicians from outside the EU in the context of the new procedure for authorizations to practice, the development of activities by anesthetists-intensive care specialists at several sites and above all the massive recourse to temporary cover, the consequence being a reduction in the quality of care and expenditure that is no longer controlled.