If France does not have enough doctors, why not keep foreign practitioners who come to practice in the territory?
Gabriel Attal advocated this solution during his general policy declaration on Tuesday.
“Our compatriots cannot find enough doctors
,” pleaded the new Prime Minister, before confirming the objective of regularizing foreign practitioners active in France, as Emmanuel Macron announced during his two-week press conference earlier.
Gabriel Attal even announced the government's intention to go further by appointing an emissary
“responsible for seeking doctors abroad who would like to come and practice in France”
.
In France, in total, more than 25,000 European or non-European doctors (out of 300,000 doctors in total) are registered with the Council of the Order of Physicians.
But the regularization process concerns those not registered with the Order, who are colloquially called “padhue”, for “practitioners with a diploma outside the European Union”.
Coming from all continents, mainly from North Africa, most of them work in hospitals under the supervision of another doctor.
These “padhue” are estimated between 4,000 and 5,000 according to the unions (for 45,500 hospital practitioners in France), a third of whom work in Île-de-France.
Many arrived in the territory during the Covid-19 crisis, when the overloaded health system was in dire need of reinforcements.
“They sometimes hold our healthcare services at arm’s length and we leave them in administrative precariousness
,” regretted President Emmanuel Macron during his press conference on January 17.
However, the unions deplore the fact that many of them, who have already been working in France for several years, are not renewed and find themselves in administrative precariousness, without a contract or residence permit.
More candidates than positions
Several department heads in Île-de-France have warned: without the padhue, they will be forced to close their service.
A derogatory regime for a time allowed hospitals to maintain these non-winners under different precarious statuses, paid between 1500 and 2200 euros monthly, but this regime, extended several times, ended on December 31, 2023.
On January 17 in a column in Le
Point
, 220 practitioners, including many heads of emergency services, pleaded for their regularization.
Doctors deplore residence permits that must be renewed every year, and too great a restriction on positions granted to foreigners compared to needs.
“For example, in Île-de-France, out of approximately 1,250 positions requested, only 460 were granted and for a deserted specialty such as emergency medicine, only 28 positions received approval,”
illustrated the signatories, among including Mathias Wargon, head of the emergency department in Seine-Saint-Denis, particularly committed to the regularization of padhue.
Generally speaking, there are many candidates but few elected officials.
In 2023, 8,722 candidates presented themselves to the EVC for 2,700 open positions, and 2,100 winners began a skills consolidation process, the Order of Physicians tells us.
The total number of padhue practicing in France, however, remains approximate, to the extent that they are recruited directly by public health establishments or from training organizations.
System too selective
The 200 doctors who wrote the
Point
column also denounced an overly selective process with, in certain specialties, candidates
“failed with an average of more than 15”.
Because these foreign doctors are not welcomed under any conditions.
Their skills, diplomas and practice are evaluated by a competition called
“
knowledge verification tests
”
(EVC), the success quota of which is decided by the Ministry of Health.
They then follow a
“consolidation course”
, at the end of which their file is examined by the committee.
In 2019, as part of a law relating to the organization and transformation of the health system, a process of simplification and security was established in favor of padhue.
The idea is both to meet the recruitment needs of hospitals, and to better control the immigration and integration of these foreigners.
The statuses of attaché and assistant have been replaced by that of
“associate practitioner”,
to simplify and secure their employment
.
The time taken for the
“skills consolidation course”
at the public hospital was reduced from three to two years after successful completion of the EVC.
During this period, salaries vary between 36,000 and 41,000 euros gross per year, excluding bonuses and on-call duties.
Through this temporary simplification process - it ended on April 30, 2023, 3,200 padhue were able to be regularized, of whom around 50% are currently completing a skills consolidation course, according to the Order of Physicians.
Favor French students
LR MP Yannick Neuder, author of a parliamentary report on improving access to care last November, says he is
“surprised”
and somewhat
“shocked”
by Gabriel Attal’s announcement this Tuesday.
The elected official first fears the idea of regularizing padhue
“who have missed their EVC”,
placing the risk on the quality of care
.
He also refutes the argument, put forward by the President of the Republic and his Prime Minister, of a remedy for medical deserts.
“These foreign doctors rarely work as general practitioners in the territories.
They are rather in hospitals, and help to fill the 30% to 40% of vacant hospital positions
,” underlines the MP.
In fact, more than 10,000 doctor positions remain constantly vacant in French hospitals according to hospital practitioners' unions.
Above all, Yannick Neuder regrets that this announcement gives preference to foreigners, rather than simplifying the training course for young French doctors.
“We do nothing to ensure that our own French students who have gone to study abroad remain in France
,” said the elected LR, who identified around 5,000 students who went to study abroad to circumvent the restrictions of the French system, marked by a
numerus apertus
[This quota, which replaced the
numerus clausus
, is set by each university according to its reception capacities and its health needs of the territory] and, since 2019, the ban on repeating a year.
“Going to poach doctors from countries that are sometimes precarious is walking on the head
,” considers the MP.