What do two people from Orléans talk about when they meet? Of the shortage of doctors in the region, of course. If the subject fuels so many conversations, it is because the situation is now critical: overwhelmed emergencies, waiting for several months before being able to consult a specialist, glaring lack of general practitioners… 24% of the inhabitants of Loiret have no medical an attending physician. The department has 59 general practitioners per 100,000 inhabitants, against a national average of around 124. However, on January 21, the mayor (LR) Serge Grouard created a surprise by announcing the creation of a new training in medicine, piloted by the University of Zagreb. Designed to accommodate a maximum of 50 students, it will provide all its courses in English and partly remotely. Students will be required to travel to the Croatian capital at certain times during their studies and to take their exams. “We no longer had a choice, it was urgent to act”, insists Florent Montillot, first deputy mayor: “Our initiative was a particle accelerator. A real detonator which will have made it possible to move the lines!” The case is indeed explosive. For months, many influential actors from the health sector, the university community or the political class have denounced “inconsistencies”, a “complex and opaque legal arrangement”, and have worried about the future of the young people concerned. .
Despite all these outcry, the project continues to make great strides since, on June 7, the entrance examination was organized. “This one only attracted 30 candidates … for 50 places! Proof that people are not fooled”, says Alexis Loupan, president of the National Association of Medical Students of France (ANEMF): “Nothing is ready, nothing is done but we are already collecting the students’ money, which is totally outrageous!” The cost of studies – 12,000 euros per year – is particularly singled out. “The registration fees in our French faculties amount to only 170 euros at the bachelor’s level. We can be proud of being able to welcome all students, whatever their social origin. Which is far from being the case here” , explains Macha Woronoff, president of the health commission of France Universities (new name of the Conference of university presidents). The municipality replies that a large part of the costs will be covered by a system of scholarships allocated to students according to their resources. The brand new Loire et Orléans en Santé association, which brings together several local authorities and players, will provide this funding. In return, future doctors will have to commit to practicing for at least five years in the territory.
For Marc Gaudet, president (UDI) of the Loiret departmental council very involved in this project, all initiatives aimed at fighting against the medical desert are good to take. The elected official said he regretted the rain of attacks that fell on the Orleans-Croatian partnership: “Some have gone so far as to question the quality of the training provided by the faculty of Zagreb. However, this has largely has proven itself and the diplomas it issues are recognized by the entire European Union, and therefore by France.” And Florent Montillot adds: “In the Shanghai international ranking, the Croatian university is well ahead of those of Tours and Orléans. It therefore has nothing to envy us, quite the contrary.” For Didier Samuel, president of the Conference of Deans of Faculties of Medicine, the problem lies elsewhere. “I do not question the solidity of learning, he says. The big question mark concerns rather the question of practical internships: will the students who will follow this training all be able to be accommodated in hospital services, that whether in Zagreb or in the Centre-Val de Loire region? For the moment, it does not seem very clear. Especially since, in the coming years, the influx of a greater number of medical students in Orléans and Tours raises fears of a risk of traffic jams.
A government plan that reshuffles the cards
Because on February 22, a new announcement indeed came to reshuffle the cards: Jean Castex, Prime Minister then in office, announced the launch of a vast plan in response to the medical under-density of the territory. The university training offer will be strengthened in the Centre-Val de Loire region, particularly in Orléans where a new health department will be created, and in Tours. The goal ? Increase the number of trained medical students to 500, instead of the current 300. To support this project, the Orléans Regional Hospital Center (CHRO) will be transformed into a University Hospital Center (CHU). An anti-Zagreb initiative? “We have absolutely no connection with them”, cuts Eric Blond, president of the University of Orleans, confirming that he was never consulted on the Croatian file.
“The situation has really changed since Jean Castex’s announcement and the partnership with the University of Zagreb is much less justified. It even risks being counterproductive for students who could find themselves in a dead end”, advances Baptiste Chapuis, elected municipal (PS) opposition. Like many, the latter refers to the precedent of the “Pessoa affair”. In 2012, the Portuguese University Fernando-Pessoa had launched an almost similar experiment by opening establishments providing medical and paramedical studies in Béziers and Toulon. The initiative was cut short two years later when the courts ordered their closure, arguing that those responsible did not have the necessary approvals. Indeed, since the Fioraso law, dated 2013, any opening of a health training is now subject to the validation of the Ministry of Health and the Ministry of Higher Education and Research. “We are not in this scenario since we are not preparing to open a branch of the University of Zagreb. This is a cooperation agreement, and it exempts us from these famous approvals which would be much too long to obtain. The critical situation in which we are no longer allows us to wait”, replies Florent Montillot, who says he is very aware of the legal subtleties.
Be that as it may, the project could well be overtaken by the Fioraso law in the medium term. between the Croatian Faculty of Medicine and the hospitals in the Orleans region”, insists Didier Samuel. Florent Montillot is betting on the repeal of the Fioraso circular, which he describes as “villainous”. “There will be no break in the training program, he promises. Ideally, we would prefer that the internships take place in Orléans. But, if this is not possible, they can always be done in Zagreb”. From the first year, students will be familiarized with the country since they will finish their second semester there.
Of the 30 candidates who took the competition on June 7, seven have so far been admitted directly. A second session is scheduled for July 13. Officials are counting on a hundred new participants. Those disappointed with the Parcoursup procedure, in particular, could swell the ranks. To the great despair of Alexis Loupan, of the ANEMF: “We are betting on the distress of the students, it’s dramatic!” Will the latter seize the last chance to see their dream of becoming doctors come true? Or will they prefer to give up a program which still has many gray areas? The follow-up to the project, which could give ideas to other local authorities, will be carefully scrutinized as it risks upsetting, even more, the strained health training market.