La démographie médicale des anesthésistes réanimateurs est-elle encore compromise en France à l’horizon 2020 ?

Abstract

ObjectivesThe demographic decline in the Anaesthesia and Intensive Care practitioners predicted for 2020 may bring into question the speciality's vocation, and indeed peri-operative care as a whole in France. The objective of this study is to assess the French Anaesthetist and Intensive Care physicians’ demographics in 2010, and predicted numbers for 2020 taking into account recently initiated corrective measures. MethodsData originating from the CFAR-SFAR-INED French medical demographics survey11CFAR – French College of Anaesthetists and Intensive Care Physicians, SFAR – French Society of Anaesthetists and Intensive Care Physicians, INED – French National Institute of Demographic Studies., the French General Medical Council, and various studies and projections published by the INED and the DREES22French National Institute of Research, Studies, and Statistical Evaluation. were collected and analysed. Factors were then identified that were likely to affect personnel numbers, speciality training requirements and the demand for patient care. ResultsFrench General Medical Council data is the most reliable and reports 9692 Anaesthetists and Intensive Care physicians practising regularly in France on the 1st of January 2009. Of those, 9,391 (96.9 %) were practising on the mainland. Personnel growth reduced due to the effect of specialist training selection procedures: the percentage of doctors entering Anaesthesia and Intensive Care training dropped from 12.7 % per year in 1960 to 1.5 % in 1990. Since 2002, personnel in regular practice dropped by 1.1 % per year. Relatively few doctors were leaving the profession, the decrease was due to the reduction in the numbers entering practice: 222 per year on average from 1988 through 2004, compared to 355 per year for the two preceding decades (1971 to 1987). Anaesthetists and Intensive Care physicians are growing older; the average age increased from 42.8 years of age in 1989 to 51 on the 1st of January 2009. Further evidence of this trend is that the number of practitioners less than fifty years of age continues to decrease; just 47.5 % in 2005 compared with 80 % in 1989. 5,139 anaesthetists between 50 and 64 years of age will leave the profession before 2020, over half (52.3 %) of the total practising in 2005. Practitioner density increased from 13.1 Anaesthetists and Intensive Care physicians per 100,000 inhabitants in 1989 to 16.2 in January2006. If only those in regular practice are considered, density is stable at 15.3 per 100,000 inhabitants as of 1stJanuary2009. The most recent 2009 projections predict a 13 % decrease in the number of practitioners between 2006 and 2015, and a 16 to 20 % decrease by 2020. Initial projections in 1991 and further projections in 1999 predicted 50 % and 35 to 50 % decreases by 2020. Numerous factors could amplify this reduction in the absence of increased training efforts. These factors include population growth (+6 to 7 % by 2020), the increasing health care demands of an ageing population (+15 %), medical progress, the increasing feminisation of the medical workforce, projected retirements and reductions in migratory flows. ConclusionDespite increasing training throughput and increasing medical immigration, Anaesthetists and Intensive Care physicians in France are ageing noticeably and reducing in number. This foreshadows further personnel reductions in the future. A demographic catastrophe may well have been avoided; a more moderate reduction in personnel persists for 2020 with an ongoing risk of numerical inadequacy with respect to needs. This situation justifies a further increase in training throughput, along with adaptations in the provision of care, so as to ensure maintained care standards.