The hospital lacks arms, medical deserts are under the spotlight at the National Assembly … And faced with this problem, the
end of the numerus clausus, quota of students admitted in the second year of health studies, is presented by the government as a miracle cure. “The lack of doctors is the consequence of this famous numerus clausus, assured Olivier Véran, interviewed Tuesday by 20 minutes. We deleted it three years ago. “
While it is true that Emmanuel Macron had announced in September 2018 his intention to bury the numerus clausus, the implementation took time. It was not until September 13, 2021 that the
arrested appeared. In addition, at the end of October, Anne Hidalgo, socialist candidate for the presidential election,
proposed to “blow up completely this idea of numerus clausus”. So is the revolution really underway, or is it a mere announcement effect?
A real increase?
Since 2010, the first common year of health studies (Paces pour les intimes) brings together all students hoping to become a doctor, midwife, dentist or pharmacist. In 2017, the start of Emmanuel Macron’s term of office, 13,472 students were admitted to the second year – including 8,124 in medicine – for 60,000 students registered for the competition.
We went to 14,620 places (all sectors combined) in 2019, then 14,800 in 2020. “In October 2021, 16,600 students started their second year in the four health sectors,” explains the Ministry of Higher Education, Research and Innovation. If we also count those who joined this formation by footbridges, we reach 17,284 places. “At the start of the 2021 school year, 11,180 of them will become doctors, against 9,300 last year.
The numerus clausus has therefore gradually given way to a numerus apertus – that is, a numerus clausus which may increase over time. This does not mean that we have tripled the number of doctors in training. And even less that we deleted the competition. “The government’s announcements were understood by high school students and parents as” it’s the end of the selection “, remarks Nicolas Lunel, president of theNational Association of Medical Students of France (ANEMF). Which is wrong. We are not able to train tens of thousands of doctors! “
How to stick to the real needs?
Beyond the numbers, the whole philosophy is changing. We are moving from a national quota admitted in the second year to a long-term objective (via five-year plans) and defined by the field. A national conference has in fact assessed the needs for the next five years: “on average, by 2027, 20% more students should be trained in medicine, 14% in dentistry, 8% in pharmacy and 2 in 4% in maieutics ”, specifies the ministry. But this is only an average that will have to be declined according to local needs.
“With this reform, it is the territory which is the prime contractor on the declination of the health policy,” resumes the entourage of the Minister, Frédérique Vidal. Field work was carried out by the regional health agencies (ARS) for these four health sectors, under the aegis of the Ministry of Health, to define the needs according to the facilities of caregivers, retirements, of demographic dynamics. It is not simply a photo at a time T, but a five-year forecast of needs, so that medical demography is more adapted to health needs. These figures are then crossed with the training capacities of universities and university hospital centers (CHU), in consultation with student representatives, to deliver regional objectives.
At the University of Caen Normandy, for example, “reception capacities have gone from 369 places in 2020-2021 to 436 for this new academic year”, confirms Hélène Bouraïma-Lelong, vice-president of the University Life Training Commission. That is an increase of 20%.
What means to ensure quality training?
Will this be enough to address the problem of medical deserts? “This is a step forward, started in 2010, but which has accelerated well in recent years, recognizes Nicolas Lunel. However, a student who goes to the 2nd year of medicine will only be practicing in ten years. We are in the bottom of the wave for a few more years… “Above all,” the increase in the numerus is a good idea, but it must be done intelligently and financed “, continues Nicolas Lunel.
Because behind the number of available staff, there is the need to train as well as possible and for years future general practitioners, gynecologists, psychiatrists … “It is necessary to set realistic reception capacities with the means of supervision”, underlines Hélène Bouraïma-Lelong. “We must put more resources, especially by renovating universities often in a wobbly state, pleads Nicolas Lunel. We lack mannequins, digital equipment to do simulations. The Ministry of Higher Education nevertheless ensures that 6 million euros were given to CHUs in December 2020, and 10 million are planned for 2021 to buy simulation equipment. Likewise, 50 additional academic positions are advertised per year for five years.
And the question of internships?
But the problems arise especially at the time of internships, which begin in the 2nd year of medicine. When a doctor suddenly has to train 10 externs instead of 5, it is easy to imagine that the quality and follow-up can deteriorate. “The government has increased the number of our supervisors, admits Nicolas Lunel. But when we look at the curve for students and that of supervisors, the gap continues to widen. If we train a doctor badly, he will practice badly. Who’s toast? The patients. The government’s ambition is to be able to send future doctors to be trained not only in university hospitals, but also in general practitioners, in nursing homes, in small hospitals… and in medical deserts. Where some might decide to settle at the end of their training.
“It is not a question of selling off training, but of diversifying the places of internships”, insists the Ministry of Higher Education. “The opening of internships on the outskirts makes it possible to de-clutter the CHUs and to discover other practices, greets Nicolas Lunel. The problem is that an external who receives 200 to 300 euros net per month will have difficulty paying two rents when he does a month of internship away from home. This is why the ANEMF proposes to create collective accommodation with rents limited to 200 euros per month. And its president to support: “It would be an opportunity to exchange views between externs, interns, nursing students, midwives …”