It will soon take ten years of study instead of nine to become a general practitioner. The government plans to include, in the Social Security financing bill for 2023, the addition of a fourth year of general medicine internship, we learned on Monday.
“The completion of this additional year of third cycle, carried out on an outpatient basis under the supervision of university internship supervisors, will be encouraged in the territories least provided with general practitioners”, indicates the joint press release from the Ministries of Higher Education and Health. A consultation will be launched in early 2023 to define the conditions for applying this measure, but we already know that the government is aiming for implementation at the start of the 2023 academic year.
Exercise “in supervised autonomy”
To justify their choice, the two ministries explain that general medicine is “the only medical specialty to have only three years of internship, without the consolidation phase (…), during which future practitioners can practice independently. supervised”. And for them, this absence of fourth year “does not favor an immediate installation at the end of the course”. The idea of extending the general medicine internship by one year has not come out of the government’s hat, because it was part of Emmanuel Macron’s campaign promises.
Benoît Veber, vice-president of the Conference of Deans of the Faculties of Medicine, believes that this fourth year is justified pedagogically: “General medicine is a cross-disciplinary discipline which requires time to be trained in it. However, it was the only specialty to have only three years of internship, the others counting four to six. This measure will therefore restore a balance between all disciplines”. Another advantage, according to him: “This will give residents one more year to have access to specialized cross-disciplinary training (FST) that they can follow in different fields: pain, palliative care, sports medicine, addictology…”.
“We are not here to overcome the difficulties of access to care”
But the lengthening of the course is far from unanimous. “This is not a request from the students, and we are already training GPs very well in nine years”, declares Théophile Denise, vice-president of Isnar-IMG, national union of general medicine interns. Another point of tension: the government’s encouragement to carry out this fourth year in areas with few doctors, knowing that at present, six to seven million French people do not have an attending physician. “We are not there to overcome the difficulties of access to care,” says Théophile Denise, who fears that this incentive is in fact only a disguised obligation. “Parliamentarians from different parties want to table amendments to make this year compulsory in the territories with the fewest general practitioners,” he fears.
If the Conference of Deans of the Faculties of Medicine is not in favor of the imposition of this measure, Benoît Veber considers that it is “normal that parliamentarians are concerned about access to care in France. But it has to be a win-win system.” To push interns to go into medical deserts, he considers that a bonus would be effective in addition to their current remuneration. Not enough, according to Théophile Denise. “It would be normal for us to be paid by the act,” he defends.
Only in a firm, without a tutor?
The conditions of exercise of this additional year of internship also arouse apprehensions: “We feared that the interns would be sent to under-dense areas without supervision. Will we have internship supervisors? Will we be able to seek advice when we need a counter opinion? asks Théophile Denise. Tutoring that Benoît Veber also considers necessary: ”It is necessary that any opening of a training ground is approved so that we can be sure of the supervision that the intern will benefit from”.
The interns’ unions also fear difficult working conditions for those sent to rural areas or disadvantaged suburbs: “They will have to provide consultations for complex patients who change general practitioners every 6 months. In addition, in under-dense areas, it is difficult to access paramedical examinations,” says Théophile Denise. Criticisms that may lead some interns to take to the streets. “We will decide on Saturday if we want to mobilize”, announces Théophile Denise. The National Intersyndicale des Interns (Isni) has already announced “a great mobilization” in October, which could go “up to the strike”.