The government plans to create a residence permit intended for the medical professions in order to facilitate the installation of foreign doctors in France and to improve its “attractiveness”. At the risk of aggravating the bleeding in countries with already fragile health systems.
Doctor Mamadou Demba Ndour warns: he may have to interrupt the conversation. This Senegalese doctor is the only obstetrician-gynecologist at the Matam regional hospital, located 600 kilometers from Dakar. With more than 1,000 deliveries a year, her phone can ring day and night. And his situation is nothing special. ” As soon as we move away from the main cities, we find entire regions where the needs in terms of health personnel are not met. “says the specialist, also secretary general of the Autonomous Union of Senegalese Doctors (SAMES).
Low salaries, huge workload, technical platform “ light years away from what is being done in Europe “…” Working in a public hospital in Senegal is a priesthood, concedes the forties. The working conditions are extremely difficult “. So some go private. And others are leaving the country for more lenient skies and health systems. ” Many go to do a specialization abroad and do not return “, he specifies.
The lack of data makes it impossible to assess the extent of this emigration to Senegal, but we know that, due to the history of colonization, France is one of the preferred destinations for these professionals. But the country is not an isolated case. Doctors who studied in French-speaking Africa represent the second contingent of doctors with foreign diplomas (outside the European Union) practicing in France, behind those from the Maghreb.
Foreign practitioners essential for the French health system
If the phenomenon is not recent, the secretary general of the Autonomous Union of Doctors of Senegal (SAMES) fears that ” the situation is no longer tense “. In question : the immigration and integration bill In France. Presented on 1er February in the Council of Ministers, it provides for the creation of a specific residence permit ” talent-medical professions and pharmacy “.
According to 2020 figures from the OECD, France had just over 26,000 doctors trained in foreign countries outside the European Union, or 11.5% of the total workforce. For its part, the National Council of the Order of Physicians (CNOM) indicated that the number of doctors with foreign diplomas (outside the EU) had more than tripled between 2007 and 2022.
The bill sent to the Council of State is intended to facilitate the administrative procedures for medical personnel to “ improve attractiveness ” from France. It provides that a foreigner, who has come to work for a year or more in a French health establishment, can be issued with a residence permit valid for one year, renewable for a maximum period of thirteen months.
► To listen again: [Appel sur l’actualité] the residence permit dedicated to foreign doctors is debated
For countries like France, these foreign practitioners are essential. They come to compensate for the shortcomings of the public health system. Anesthetists-resuscitators, gynecologists, emergency physicians, general practitioners… They fill the holes in a public hospital deserted by French doctors for lack of resources.
“ We are trying to solve the problem of medical deserts in France by creating medical deserts in Africa »
” These migratory movements have been observed since the 1970s, analyzes Christelle Fifaten Hounsou, sociologist specializing in migration and health issues. But this is the first time that there has been a public policy that specifically targets doctors. And in fact, this will accelerate this movement, by formalizing it, and thus also formalizing precariousness. »
Because, for their part, these practitioners with diplomas outside the European Union (PADHUE) often work for years in difficult conditions, with precarious statuses which give them remuneration well below that of their French colleagues. Even if it has been simplified a little by the 2020 reform, the exercise authorization procedure (PAE) takes on average five to six years. “ When we start, it’s a hassle “says Jad Zahnan. Originally from Lebanon, he has been a cardiologist at the Poissy hospital for four years. Like many, he stayed after his specialization year. He first had a status of “ Acting as an intern (FFI), paid 1,400 euros net; for a year, his situation has improved a little, he is ” associate practitioner “. The specialist hopes that his authorization to practice will finally be validated this year, but, despite the difficulties, he has no regrets. Beyond the salary, what makes France attractive is also the scientific and medical level and the living conditions.
” We must of course improve the working conditions of the doctors who are already there, but that is not a reason to siphon off Africa from its doctors., indignant Jean-Paul Vernant, professor emeritus of hematology, member of the committee of wise men of the French Office for Immigration and Integration (Ofii). Alongside the former president of Doctors of the World, Rony Brauman in particular, he is a co-signatory ofa column published in early January in the Sunday newspaper (JDD) and titled “ Do not deprive Africa of its doctors ». He asks for the withdrawal of the project. “ We are trying to solve the problem of medical deserts in France by creating medical deserts in Africa. While the responsibility of governments for years in these deserts is clear: it is the numerus clausus. We have to continue to train people rather than bringing them in already trained to exploit them,” he says, castigating “ a neocolonial attitude “.
” We won’t stop the sea with our arms »
Dr. Salem Ould Zein, president of the National Union of Practitioners with a Diploma from Outside the European Union (SNPADHUE) is more circumspect about the potential effect of ” call for air what this law could have. ” It will facilitate administrative residence procedures for those who are already there, which is a good thing, but as the text currently stands, it will not modify the conditions for authorization to practice for practitioners with foreign diplomas outside the European Union. », Estimates this anesthesiologist-resuscitator at the hospital center of Châlons-en-Champagne, himself from Mauritania. The issue is complex, he points out: These movements are closely linked to current events in the countries of origin. For example, in recent years we have seen many Syrians arrive. At the moment, we are seeing an influx of Tunisian practitioners due to the crisis the country is going through. »
” The exodus of Tunisian doctors is getting appallingly worse, testifies Houmeina Hassani, president of the Tunisian Organization of young doctors, we now speak of haemorrhage. The Council of the Order estimated that more than 900 doctors had left Tunisia in 2021, most for France or Germany. With around 14,000 active doctors, the country has one doctor for every 1,000 inhabitants. Three times less than in France, according to a study by the DREES (Direction of research studies, evaluation and statistics). ” It’s simple, among my doctor friends, there isn’t one who wants to stay. And we can’t blame them. “Lack of resources, insufficient infrastructure, increase in violence in hospitals… The dilapidation of the local health system is such that it has become ” a threat to the physical and mental health of young doctors “Explains the young woman, who no longer counts the stories of burnout, accidents, even suicides of caregivers. “ The Tunisian state offers nothing to encourage young people to stay in the country, rather it tries to keep us prisoners “, she believes, referring to the idea of extending the civil service, that is to say the obligation for young doctors to practice for a year in the least well-endowed regions of the country, all for a pittance (750 dinars, or 250 euros).
” We won’t stop the sea with our arms! underlines Mamadou Demba Ndour, pointing out the responsibility of the State in the Senegalese situation: What makes our young doctors leave even before they finish their studies? Everyone has to sit around the table and get to the bottom of the matter. “Despite the wear and tear, the gynecologist from Matam continues to hold on. ” We all consider giving up at some point, but the country needs us, recalls the Senegalese doctor Mamadou Demba Ndour. But we have a mission. If I let go, in a region that has a very high infant mortality rate, I know that it is the people who will suffer. »
For Christelle Fifaten Hounsou, there is no question of placing the responsibility for this situation on the doctors. ” You cannot put a whole arsenal of laws to orient social phenomena in one direction, summarizes the sociologist, and accuse people who are caught in these constraints, in these policies of trying to get out of it. »