Training more doctors for tomorrow?

Résumé 0

In France, as in many other countries, the question of the number of doctors to be trained is at the forefront of public debate, at a time when the notion of numerus clausus has disappeared and many voices are warning of the territorial inequalities responsible for “medical deserts.” The purely quantitative regulation of medical demographics by the numerus clausus, for over forty years, has failed to achieve a balance between supply and need. The ideal number of doctors to ensure access to quality care for all, throughout the country, depends on population demographics, medical demographics, but also the demographics of other health care professionals, and numerous epidemiological, technical, economic, and organizational factors, which are inherently unstable over time and specific to each population and health care system. With the abolition of the numerus clausus and the introduction of multi-year programming of the need for doctors, the reform resulting from the 2019 law on the organization and transformation of the health care system restores a long-term perspective to the regulation process. The multi-year national objectives approach thus marked a step forward in our thinking. The preparatory work for the national conference held in March 2021 concluded that we needed to continue to increase the number of doctors in training, and this was endorsed by the ministers responsible for health and higher education, who set multi-year training targets almost 20 percent higher than before. But to meet the ambition of matching up the need for health care professionals with the need for care, we have to go even further in taking into account the determinants of the need for human resources. Drawing on the lessons of the past, this article proposes new ways to move beyond the single issue of the number of doctors to be trained, to take greater account of the organization of the health care system, and better respond to local health care needs.