The transformation of Hôtel Dieu is moving ahead with opposition intensifying

The Hotel Dieu sits just next to the Notre Dame Cathedral and is a symbol of health care to many in Paris. It is also a bit of an outdated facility largely unsuited for its current task of providing health care to patients. There have been many plans for its transformation, the latest being to convert it into an "Academic Public Health Hospital." That plan was announced by the Minister of Health last year. The current plan is to move the specialty and urgent care clinical work of the hospital to the Hôpital Cochin while maintaining beds at the current site for general medicine and preventive services. Labor unions and many on the staff of the hospital have resisted this for some time with a rising voice in opposition emerging in the last few months as the deadline for closing the emergency services come nearer. The issue is close to my work as the office of the EHESP in Paris have been in a small corner of the top floor of the Hotel Dieu. They will also be moved in the renovation work out to the Peripherique into another hospital that is being renovated, Hôpital Broussais.

Vacancies for Physicians in France; GPs and more surgeons needed.

The French jobs recruiting company Appel Medical reported a "sustained structural shortage" of doctors, at least in some disciplines, including general and emergency medicine. According to the study, as reported in Le Quotidien Medecin.fr, the firm analyzed thousands of jobs listed on the ten most popular professional recruitment sites and found exactly 4,356 posted job vacancies for physicians in France in September 2013. This is actually 7% lower than in May, but the decline of vacancies is interpreted as a "trompe l'oeil”, due to the fact that there are more replacement positions that open just before the summer, said Christophe Bougeard, CEO of Appel Medical. GPs are clearly in the lead of the most requested jobs with 1,524 openings (over a third of vacancies). Just behind, emergency medicine (300 openings, up 40%), anesthesiologists and gerontologists are also at the top of the list. Regarding emergency medicine, "These results demonstrate the difficulty of the job, characterized by a turnover greater than the average," was Christophe Bougeard’s analysis. Surgeons: according to the report, the number of openings for surgeons showed the greatest proportional growth between May and September 2013 (130%). But the total was much smaller, there were only 113 openings for surgeons posted, up from 87 in May.

The Physician Supply in France. The National Council of the Order of Physicians (CNOM) issued an Atlas describing the supply of doctors in France. The major points covered in the Atlas centered on feminization, growth in the number of retired physicians, a decline in the shoift to over-doctored regions and an increase in the number of doctors trained outside France. The total number of physicians enrolled in the Order was 271,970 as of 1 January 2013, with 215,865 fully active in practice and 56,105 retired or semi-retired. Part-time doctors are responsible for the small recent increase in the number of "effective" physicians with an increase of 8%, while the number of registered physicians in active practice decreased slightly (- 0.12%) in the last year. Specialists grew in number while generalists fell...this trend is anticipated to continue over the next decade. Of practicing physicians, 92,851 are in private practice and 85,876 are employees (65.8% of these are in hospitals); 20,558 have a mixed practice structure. The distribution of physicians continues to show a pattern of high density in the south and around Paris and lower density elsewhere.

It is Status Quo for the Numerus Clausus

The Official Journal of France (Our Federal Register), announced on January 11 the exact numbers of students who would be allowed to move into the second year of medical training in France in the coming fall. This number, the numerus clausus, effectively controls the supply of physicians in France as there is little immigration or emigration. The number is set by the central government after discussions with “experts” and politicians. The selection is quite rigorous as 56,000 students enter into a first year of preliminary health studies that qualifies them for consideration (première année commune aux etudes de santé—PACES). All the students take an examination and the numerus clausus sets the cut off point for selection to advance. The “success” rate of 13.5% for medicine is actually a bit misleading as pharmacists (3,095), dentists (1,200), and midwives(1,016) also are admitted from the PACES group. The numerus clausus is a very blunt tool to manage physician supply and it has created both potential surpluses when it stood as 8,600 places in 1971 then being cut back to 3,500 places in 1993 creating a perceived shortage. It was raised to 7,100 in 2007 and the current figure has held steady for the past 4 years. Overall supply is but one of the concerns in the French health care system. The very unequal distribution of physicians in France has generated ministerial attention to the problem of “medical deserts”, places in France with few, if any physicians. The minister of health, Marisol Touraine, in December presented a plan to eliminate these underserved areas with a “grande mobilisation” that would combine some limited inducements in the form of bonus payments with a series of structural reforms promoting team care, telemedicine, and support for the training of generalist physicians.