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.