Numerus clausus et démographie médicale en France

Abstract

In France, the number of students admitted to the second year of medical studies is limited (numerus clausus) by law. In 1971 this limit was first based according to hospital training capacity and subsequently 1979 it has been based on demographic trends. An objective of 250 physicians per 100 000 inhabitants seemed reasonable and required 6 000 students to be trained each year. In 1979, it was decided to restrict the number of students temporarily because of a likely demographic slump after the year 2000. These steps were introduced progressively, in order not to unfairly treat a particular student class. The numerus clausus is also modulated geographically to take into account differences in medical density, as most students set up in the region where they did their medical studies. It is logical to practice preselection for admission to medical school, yet in France every baccalaureat holder can enrol any medical school, and students are totally opposed to preselection. This is why selection takes place at the end of the first year. In the late 1980s, the numerus clausus should have been increased by the health and education ministries, but this was in fact done only ten years later. Estimates of medical demography are complicated by three factors. First, many physicians from European Union member states (mainly Belgium and Romania) practice in France. Second, some students not admitted to the second year of medical studies go to learn medicine in aforeign country before returning to sit the French national examination at the end of the sixth year. Third, public hospitals hire foreign physicians from outside the EU (mainly Algeria and Morocco), who then stay in France permanently. Thus, EU-level decisions are needed to harmonize the medical numerus clausus across member states. The hiring of physicians from non EU countries by French hospitals should be more tightly controlled.