Doctor numbers decline in France

THE NUMBER of doctors in France has dropped for the first time in 25 years.

The figures are down 2% on last year (199,736 from 203,855) which makes for 290 doctors per 100,000 inhabitants, down from 300.

Doctor’s body the Conseil National de l’Ordre des Médecins flagged up the trend in a new report. It says it is the first drop since it started compiling figures 25 years ago and more must be done to halt the trend.

One of its leaders, Dr Patrick Romestaing, said: "This is the first time we have seen a decrease and the problem is only going to accelerate.

"I think we will see a decrease in numbers every year for the next eight to ten years with the decreases getting bigger and bigger."

The problem is set to get worse as doctors get older and fewer young doctors go into general practice or work in less populated and lucrative parts of France. Doctors are becoming increasingly scarce in less favoured areas, especially in the north.

Doctors aged over 50 have increased by 53% compared to last year. The average age for French doctors is now 51 and for GPs it is 55. Doctors aged under 40 are down 12%.

Dr Romestaing said the problem was partly due to a drop in medical student numbers from the late 1980s through the 1990s which is still having a knock-on effect, even though numbers have started to rise again. Students passing into the crucial second year were at 8,500 in 1971 but dropped to 3,500 in the 1990s (they are now back to 7,000).

"The bigger problem though is they do not want to set up as GPs," said Dr Romestaing.

"They would rather take salaried jobs in hospitals or work as school or workplace doctors. Only one in ten qualifying are becoming GPs.

"During their studies students get used to hospital work and they are afraid to set up in general practice so stay on in hospital work. Others, about three out of ten, choose to be supply doctors.

"These other options seem less risky to them. GPs work long hours - 50, 60 hours a week. In salaried jobs you do less hours and you have fewer responsibilities.

"Also GPs have to do night duty and have more and more regulations to deal with."

The spread of doctors is unequal around France (see map). Dr Romestaing said: "They want to work in beautiful, sunny areas - the Pyrenees or the Mediterranean and some in the Rhône-Alpes, or they want to be in the capital."

The most popular is the Paca region in the south-east, with 375 doctors per 100,000 inhabitants (down from 385 last year) down to Picardy, with 238, down from 246. The areas with the fewest doctors also have the highest average ages, meaning the problem is expected to accelerate.

Dr Romestaing said one solution could be for the government to provide financial help to set up health centres where professionals like doctors, nurses and physiotherapists worked one location, so young doctors felt less isolated and pressured.

"We need financial incentives for doctors to work like this - rather than financial penalties for ones who don’t want to work in poorly-served areas, which is more what the government has talked about.

"To combat the problem of students who are not familiar with general practice the government needs to promote more use of the médecin collaborateur status which we created - this is where a young doctor goes and works alongside an experienced one."

The problem is not being resolved by an increasing recruitment of foreign doctors, as these mainly go to Paca and Ile-de-France. The UK has around 249 doctors per 100,000 residents, according to the latest European figures.