Focus: Healthcare Mobility
France: Immigrant medics steadily increase
The number of medical practitioners in France is 216,000, among which 17,835 were trained elsewhere, representing almost 10% of the total, according to the Centre National de l’Ordre des Médecins (CNOM), which registers doctors in practice.
Globally, the total number of doctors is stable compared with 2012, as shown in the Atlas of medical demography recently published by the CNOM.
The proportion of foreign practitioners has increased significantly in recent years, a 43% jump between 2008 and 2013. By 2018, the CNOM predicts another 34% increase. All areas of France have experienced this growth. In the Région Auvergne, the central area of the country, the number of foreign degree holders has almost doubled since 2008.
As opposed to their French counterparts, these foreign doctors are mostly salaried practitioners (63.5% against 43.1%). Hospitals need them where specialists (e.g. radiologists and anaesthesiologists) are in short supply.
Some are French nationals because, as a result of a quota system in France that eliminates a great number of students after the first year of medical school, some medical students train elsewhere: Belgium, Romania or Bulgaria, CNOM president Michel Legmann points out.
In 2012, almost 25% of newly registered doctors at the Ordre des Médecins, had a degree gained in a foreign country (11.4% in Europe, 12.7% outside it).One third of practitioners holding a foreign degree gained it in Maghreb countries, the most prevalent is Algeria (22% of the total). Second comes Romania (17.7%) and Belgium (8.9%). Morocco, Syria, Tunisia, Germany, Italy and Spain follow.
One reason to choose settlement in France is often potentially better work environment and remuneration. In Hungary, for example, an intern’s salary is one fourth of his French counterpart. ‘Almost all doctors from outside EU countries arrived here to finish their studies in their speciality and they want to stay in France where they find a better environment for their trade,’ explains Renaud Gansey, a Bénin native, working as a nephrologist at the CHU (University Hospital) in Nantes. ‘Only a small number stay because of political problems in their countries.’
Official data do not take into account a ‘significant number’ of foreign doctors working in hospitals with a status of ‘associate’ and therefore are not registered by the CNOM, Michel Legmann stresses.
The CNOM ‘is not in a position to identify them clearly’, and is ‘a little problematic because these practitioners are hired illegally to fill vacant positions, often under the pressure of local politicians who want to maintain local hospitals in activity,’ he explains. ‘This is a problem because their degrees are not assessed and their salaries are less than those of French doctors.’
Since February 2012, new legal dispositions make it easier for doctors trained outside the EU, and who have had some experience working in French hospitals, to continue their practice, and opens for them the possibility of taking equivalency tests. Eventually they obtain the same status as their French counterparts and are officially registered by the CNOM.
‘It takes an average of 10 years of practice in France before doctors with a training outside the EU reach equality with their French counterparts, sometimes even more,’ explains an official of SNPADHUE, the union representing doctors with outside EU degrees. For a decade this union has fought for fair recognition of their qualifications, and the official adds ‘newly registered doctors’ according to CNOM statistics, are often experienced practitioners who have worked in French healthcare for years under the ‘associate’ status.
‘Foreign doctors don’t have difficulties finding positions in French hospitals, because they are actually needed, they enjoy excellent relations with their colleagues and patients, but regulations are the problem. The competence of foreign practitioners and their qualifications are unquestioned, but it takes a very long time for them to be considered,’ adds Salima Hanifi, of the SNPADHUE.
In spite of the boom of foreign doctors, France doesn’t have a coherent recruitment strategy. A small village will itself hire a GP to replace a retiring GP, or a small hospital will ‘go shopping’ for an anaesthetist… foreign doctors in effect act like an adjustment variable of healthcare policy. Additionally, there is no standard for French fluency.