Two tiers of physicians in France: general pediatrics declines, general practice rises.

Abstract

5 The 40% to 50% of the medical students who, at the end of medical school, pass the rigorous entrance exami- nation to the internat (the residency track to train specialists) have higher status than those who enter the generalist track (the residanat). Specialists also spend a longer time in resi- dency training than do generalists (4-5 years as opposed to 2.5 years), earn more money when they enter practice, and have the possibility of becoming academic physicians. Most of the clinical training of medical students and residents, even of future generalists, occurs within university hospitals and to a lesser extent nonuniversity hospitals under the tutelage of specialists and subspecialists. Except for the recent require- ment for residents in the generalist track to spend 4 to 6 months in a generalist's private office, 6 French physicians have not started to move training into ambulatory settings. Generalists, who comprise 50% of all physicians and 60% of private practitioners, 3(p109) dominate primary care in France. Few specialists provide primary care, unlike in the United States and Germany. 7 Primary care physicians seldom take care of their hospitalized patients; this care is provided by specialists or subspecialists, who are either private practition- ers or salaried hospital employees (including the teaching fac- ulty in the university medical centers). The specialists and subspecialists in the hospital are not consultants, therefore, but rather assume full control. In this way, the French medical system is similar to those of England, Germany, and Italy. 4,7,8