Speaker A
In 2012, there were an average of 326 physicians per 100,000 people in France. Ten years later, there are only 318.
Explains the causes and consequences of the doctor shortage in France and explores potential solutions to improve medical care access.
Key Takeaways
- France suffers from a shortage and poor distribution of doctors, worsened by past policy decisions.
- Aging population increases healthcare demand while many doctors retire, creating a workforce gap.
- Increasing medical school admissions and task delegation are key strategies to mitigate the shortage.
- Geographic and social origins influence where doctors choose to practice, impacting rural healthcare access.
- Restricting doctors’ practice location is a divisive proposal with significant opposition from medical professionals.
What the video covers
- France has seen a decline in physician density from 326 to 318 per 100,000 people between 2012 and 2022.
- The shortage is due to limited medical school admissions (numerus clausus) initiated in the 1970s to reduce healthcare costs.
- An aging population, especially the baby-boom generation, increases demand for healthcare and accelerates doctor retirements.
- Physician distribution is uneven, with urban areas like Île-de-France having more doctors, especially specialists, while rural areas face shortages.
- Doctors have freedom to choose where to practice, unlike other healthcare providers who face restrictions to encourage rural practice.
- Medical students mostly come from privileged urban backgrounds, reducing the likelihood of doctors settling in rural areas.
- The government replaced numerus clausus with numerus apertus in 2020, increasing medical school admissions by 20% to address shortages.
- Physician density is projected to improve starting 2030 but will remain low until then.
- Delegating tasks to nurses and other caregivers is proposed to free up doctors’ time and improve care efficiency.
- Restricting doctors’ freedom to choose practice location is controversial and opposed by doctors as ineffective and demotivating.
Chapters
- 00:00Introduction: Decline in Physician Density
- 00:20Diagnosis: Fewer and Poorly Distributed Doctors
- 00:36Root Cause: Insufficient Medical Training
- 00:58Historical Context: Economic Crisis and Policy Response
- 02:14Impact of Aging Population and Retirements
- 03:40Regional Disparities in Doctor Distribution
- 04:18Freedom of Practice and Social Origins
- 06:09Solutions: Numerus Apertus and Increasing Admissions
- 07:00Short-term Measures: Delegating Medical Tasks
- 07:43Controversy: Restricting Doctors’ Practice Locations
Full Transcript — Download SRT & Markdown
Speaker A
Here is how they are distributed around the country. The lighter the shade, the lower the density of doctors.
Speaker A
The diagnosis is simple. The French have fewer and fewer doctors at their disposal, and they are badly distributed.
Speaker A
The issue? It's not going to get any better. The prognosis is that the situation will continue to get worse until 2028.
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So, how did we get here and can we get out of it? Well, if France lacks doctors, it is firstly because it doesn't train enough of them.
Speaker A
The root of the problem is this: Good evening. The oil crisis continues to rage on.
Speaker A
France, like the rest of the West, is in a state of shock. The petrol stations are panicking, the price of oil is five times what it was.
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The double oil crisis of 1973 and 1979 made the world economy plummet. France also experienced an unemployment crisis and a deficit in the social security system.
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When there are 1,700,000 unemployed people, that's the same amount of contributions not being paid into the Social Security system.
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Faced with a growing deficit, the public authorities are worried about the excessive number of medical prescriptions.
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Doctors must now be made to understand that they have economic responsibilities. Social security is good. Abusing it sucks.
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So, in order to reduce expenses, they say they need fewer doctors, and in order to have fewer doctors, they say they need to train fewer doctors.
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To do so, the government starts limiting the number of places in medical school. This is known as 'numerus clausus'.
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From 8,281 new students in 1978, the number dropped to 7,121 in 1980. Then, it continued to nosedive until the 90s before it reached 3,500 admissions in 1993.
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The problem is that this measure does not take into account an important factor: the French population is aging, and one age group in particular, the baby-boom generation, those born after the Second World War.
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Since the 2010s, this generation has gradually been reaching old age. We talk about grandpa-boom. There are more old people.
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If you look at the number of physician visits by age of patient, you see that the older people, on the right, are visiting more.
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The grandpa-boom is causing an increase in the need for physicians overall. An aging population means more older doctors retiring, especially general practitioners, the first link in the access to care chain.
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The gap between the number of retirements and the number of new general practitioners is narrowing.
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Since 2020, there have even been more retirements than new arrivals. From a workforce point of view, there are fewer and fewer general practitioners.
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All this becomes significant when we compare the number of doctors to the population, and take into account the care needs of each age category.
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It's a question of standardized medical density, and this number is decreasing. Okay, so we have a problem of numbers, but we also have a problem of distribution.
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There are more physicians per capita in some regions than others. The concentration is highest in Île-de-France with 354 doctors per 100,000 inhabitants and the lowest in the Centre region with 241 doctors per 100,000 inhabitants.
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A point to note: the distribution is not quite the same between specialists and general practitioners.
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For example, in Île-de-France, there is a high concentration of specialists, but far fewer general practitioners.
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So why are they so poorly distributed? First of all, doctors can settle wherever they want.
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This is special treatment compared to other health care providers. Nurses, midwives, physiotherapists, and others cannot set up shop just anywhere.
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If a nurse, midwife, or physiotherapist sets up in an area where there are already too many of his or her colleagues, their patients will be less well reimbursed by Social Security.
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They are therefore likely to be fewer in number and the practitioner's business less profitable.
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The idea is therefore to push them to settle in less dense areas to better distribute access to care, but for doctors, this is not the case.
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Since there are no rules, they prefer certain areas: large cities, the south of France, Brittany.
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Places that offer better access to public services, leisure activities, and a good quality of life.
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There is a second reason for this unequal distribution: social and geographic origins. A large proportion of medical students come from privileged social classes.
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Thirty-nine percent of them have parents who are executives, while only 2% are children of farmers.
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However, nearly 90% of managers live in urban areas, while farmers are the most likely to live in rural areas, at over 70%.
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This is logical. It's a pity then that only 2% of medical students come from this social background, because according to this Directorate for Research, Studies, Evaluation and Statistics report: "The probability of settling in a rural area is two to three times higher
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if the doctor is of rural origin or was educated there." So much for the diagnosis. Now, what do we do about it?
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Are there solutions to address these shortages? Let's get back to the prognosis. This curve shows how physician density will change in the coming years if nothing changes.
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Except that something has changed and starting in 2030, it goes back up. Why? Because at the turn of the millennium, the government raised the numerus clausus.
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In 2020, it will put an end to it altogether. In its place, a numerus apertus, a minimum quota set by the medical schools according to the needs of the country.
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As a result, in 2021, they have increased second-year admissions by 20%. Thanks to the numerus apertus and the 20% more students being trained, we will catch up with the 2021 level a little more quickly, in 2033, instead of 2035 if we had kept
Speaker A
a numerus clausus. This also allows for an increase in physician density of 37% by 2050 instead of 23%.
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OK, but what do we do until the number of doctors has increased sufficiently? One idea advocated by health professionals is to free up medical time.
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This means delegating certain tasks to other caregivers, nurses, midwives, medical assistants, etc., which saves doctors' time, which they can then devote to other patients.
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These arrangements have already been implemented in part, but can still be made more widespread.
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On the problem of unequal distribution, one approach often comes up in the debates. This is, however, very divisive: limiting the freedom of movement of doctors to the most densely populated areas, as is the case for other medical professions.
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This proposal is strongly opposed by doctors. They counter with two points in particular: it would in no way respond to the problems of desertification, because dissuading a doctor from choosing an area that is already very dense does not mean that he will
Speaker A
be forced to settle in a medical desert. He can choose another moderately dense area.
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The second argument is that it would have a dissuasive effect on vocations. Well, in the meantime, access to care is deteriorating.
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About 40 departments are below the critical threshold of 40 specialists per 100,000 inhabitants, and 6 million people do not have a regular doctor.
Topics:doctor shortageFrance healthcarenumerus claususmedical trainingphysician distributionaging populationhealthcare accessmedical workforcerural healthcarehealth policy
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