GP strikes, opposition to a new law, medical deserts and long-running shortages of staff in hospitals…France’s health sector is under pressure but how does it compare to other countries?
Amid the ongoing healthcare difficulties in France, the term ‘medical deserts’ is becoming more common. The government defines the term specifically as an area in which patients have access to fewer than 2.5 consultations with a local GP per year on average.
A recent report from the Senate revealed the following lists of departments with the most doctors (GPs and specialists) per inhabitant and those with the fewest.
The departments with the most GPs per the population were, as of January 2021: Paris, Hautes-Alpes, Rhône, Alpes-Maritimes, Bouches-du-Rhône, Hérault, Gironde, Haute-Garonne, Côte-d’Or and Pyrénées-Atlantiques.
Those with the fewest were: Mayotte, Eure, Ain, Mayenne, Eure-et-Loir, Meuse, Seine-et-Marne, Indre, Oise, Cher.
GPs and healthcare workers have also been on strike in recent months after negotiations have broken down between unions and national health body the Assurance maladie.
Worsening situation in France
And the situation has been getting worse.
Figures from the Conseil National de l’Ordre de Médecins and statistics bureau Insee show that only five of 96 metropolitan departments had a higher ratio of GPs to patients in 2022 than in 2010.
These five were: Savoie (up 5.1%), Pyrénées-Atlantiques (3.8%), Morbihan (3.3%), Finistère (2.9%) and Maine-et-Loire (0.4%). Every other department had seen a drop of GPs, with the exception of Hautes-Alpes, which had stayed the same.
More figures from le Conseil national de l’ordre des médecins (Cnom) suggest that the number of practising GPs dropped from 97,000 to 88,000 between 2007 and 2017.
Similarly, a report by Politico, from November 2022, highlighted the case of a medical centre in Le Vigan, southern France, which, like many similar medical centres, has been struggling to attract replacements for its soon-to-retire doctors for years.
In the same report, researcher Guillaume Chevillard said that nearly 30% of the population in France lives in a region with poor access to GPs.
It also showed that France had fewer doctors per person in 2021 than it did in 2012, partly due to the effects of the now-defunct ‘numerus clausus’ policy, which started in 1971. This policy limited the number of doctors that could qualify in medical schools in a bid to reduce health spending and GP competition.
Data from 2020 also shows that two thirds of doctors in France are aged 55 or over, with more GPs now retiring than setting up practice.
Figures from 2019, from the Agence Régionale de Santé and Insee, showed that 70% of communes in France have fewer than two GPs for every 10,000 people.
How does France compare to other European countries?
Is France alone in suffering from this issue? To cut a long story short, no. Other countries are even experiencing worse effects.
It can be difficult to find data that directly compares situations in different countries, particularly as some countries, like Greece, do not distinguish between GPs and other types of doctors in their data.
However, in late 2022, Europe-wide data showed that there was a two million healthcare worker shortfall across the continent, with the situation particularly acute in Greece, Portugal, Finland, and the UK. This shortage varied across GPs, nurses and paramedics.
In 2022, WHO regional director for Europe, Dr Hans Kluge, said: “Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions, and poor access to continuing professional development opportunities are blighting health systems.”
A 2017 report by the British Medical Journal, one of the most reputable reports on the issue, found that the average number of doctors per head of population in the European Union was 3.0 per 1,000 people.
And figures published in 2021 by the OECD show that France had 3.36 doctors per 1,000 people in 2019 (the latest available figures).
In Europe, that compares to:
France was ahead of just a few countries including Belgium (3.16), Slovenia (3.26).
However, it fared slightly better on nurses, with 11.07 per 1,000 people.
This puts it behind Luxembourg (11.72), , Ireland (12.88), and Germany (13.95); on an equal footing with Belgium (11.07), but ahead of Sweden (10.85), Austria (10.37), Denmark(10.1), Slovenia (10.28), Czech Republic (8.56), Lithuania (7.74), Italy (6.68) and Spain (5.89).
How does France compare to the UK?
The UK was found to be lacking in both doctors and nurses compared to France, with 3.03 doctors per 1,000 people, and just 8.45 nurses (compared to France’s 3.36 and 11.07). In 2021, the British Medical Association said that the NHS worker shortage was at “crisis point”.
In 2022, a report by the World Health Organisation (WHO) warned that Europe as a whole is facing “a very serious health worker shortage in about 10 years or earlier”, with the crisis having been significantly worsened by the effects of Covid (including burnout, overtime, and deaths).
WHO data in 2022 showed that there were 3.7 doctors per 1,000 people across its European Region, although this did not specify the number of GPs specifically.
Recent data shows that the number of GPs per capita has dropped particularly across most European countries, with GPs making up a smaller proportion of qualified doctors (about 20%) than in previous years.
In 2020, the Organisation for Economic Co-operation and Development (OECD) said that since 2017, more postgraduate training places were allocated to general medicine in France than in most other EU countries, it “remains a challenge to attract” enough students, given the “lower remuneration and perceived prestige of general practice”.
The same report said that while the total number of doctors in the EU had risen (including GPs and all kinds of specialists), the rise had been marginal for France and that this number did not necessarily mean there were more GPs.