In its programme for the last presidential election, the National Rally clearly displayed its desire to “drastically reduce the number of doctors who obtained their diploma outside the European Union”. Since then, Marine Le Pen’s party has remained extremely discreet on this issue, already after the controversy sparked by its positions on dual nationals. But the fact remains: if the presence of caregivers of foreign origin were to be called into question at some point, the entire healthcare system would find itself in difficulty. And in particular the areas that are already most affected by medical desertification. Explanations with Yann Bourgueil, public health physician and scientific advisor to the health chair at Sciences Po.
L’Express: What is the share of foreign-qualified caregivers in the French health system?
If we refer to the statistics of theDoctor’s ordersin 2023 our country had 12.5% of doctors with a degree obtained outside France, including 7% from outside the European Union, mainly from Algeria, Tunisia and Syria. In total, there are 29,238. This is a fairly low proportion compared to other countries. Historically, the French healthcare system has not explicitly called on foreign labor, unlike other states that have always operated in this way, such as the United Kingdom and Canada.
Across the Channel, for example, there has always been a desire to ration supply in order to control healthcare spending. The number of healthcare professionals in training has therefore always been controlled even more closely than in France, and adjustments have traditionally been made by calling on caregivers from other countries, who today represent around 25% of the workforce. With its former colonies, the United Kingdom has a large pool of potential labor because the training system established during the colonial era has remained in place, with consequently equivalences of diplomas.
Before Brexit, the British had also become accustomed to calling on European doctors, particularly Polish ones, who alternated between periods of work on the island and periods of rest in their country. With the exit from the European Union, these flows were abruptly interrupted, and this caused significant operational difficulties for the healthcare system across the Channel.
Would France also face difficulties if the presence of foreign doctors were called into question?
Of course, because even if these professionals represent a limited part of the workforce, many of them work in areas where there are few caregivers, in small hospitals far from large cities where there are many vacancies, or in private practice in the most deserted sectors. A very recent study by the Institute for Research and Documentation in Health Economics (Irdes) shows that in 2023, the majority of “first-time registrants” in general medicine with the Order of Physicians, born and graduated abroad, are established in rural areas (41.6%), then in under-resourced peri-urban areas (21.5%). By way of comparison, 11.9% of their counterparts trained in France set up in rural areas and 22.3% in peri-urban areas. If these professionals qualified outside France were not there, access to care in the most remote areas would be even more difficult than it is today: our health system could therefore hardly do without them.
“University hospitals also welcome many foreign doctors in training”
University hospitals would also find themselves in difficulty, because they welcome many foreign doctors who come to train in particular in medical and surgical specialties in France as part of their curriculum, before returning to their country. They participate in the work of research teams, in cutting-edge services, but also in care. Even if these personnel do not stay in France, these flows are continuous, and their absence would pose a problem.
What about non-medical personnel?
There was an attempt about twenty years ago to bring in Spanish nurses, but it didn’t work very well and most of them didn’t stay. Dentists, on the other hand, are very concerned. Many French graduates have turned to implantology in recent years, because prosthetics were much more profitable than standard care, which had in fact become less accessible to the population.
In response, health centres have been created on the initiative of private investors, who often call on professionals trained abroad. And we must not forget the entire medico-social sector in the broad sense, with Ephad staff, home help and childcare, where foreign staff also represent a significant proportion of the workforce, with pay levels being particularly low.
At the same time, is it not penalizing for the countries of origin to see their caregivers go into exile?
France has long defended this point of view, increasing the number of professionals trained in our country (nurses and, with a certain inertia, doctors) and even pushing for the adoption of a code of good conduct at the level of the World Health Organization on this issue. But migration specialists now indicate that we should perhaps not reason only in terms of “brain drain“. Caregivers who move may not be able to work in good conditions in their countries where health systems are neglected. They often also send money to their families, which contributes to the local economy. The Philippines has thus made a specialty of training nurses, many of whom then go to work abroad. Migration should not always be seen as a problem, neither for the countries of departure nor of arrival.
For now, to fight against the medical desertsthe National Rally proposes to exempt retired doctors from income tax if they resume work. What do you think?
This is a good idea, but it is already in place, through mechanisms facilitating the combination of employment and retirement. So there is nothing new here, nor likely to change the situation for the territories concerned. In any case, we still have several difficult years ahead of us, before the effects of the increase in the numerus clausus begin to be felt.
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