More with less - THES reporters describe efforts around the world to meet the rising demand for trained medical staff without compromising quality
French medicine is facing imminent upheaval, with radical reorganisation of medical studies coinciding with a growing shortage of doctors and nursing staff.
Reforms are due to start next year after two years of discussions. A fundamental difference will be that all trainee health professionals will study together in a common first year.
A committee of experts will report in March with proposals to turn the "first year of the first cycle of medical studies" into the "first year of health studies".
The new medics will graduate at a time of growing staff shortages. There are nearly 200,000 doctors in France - on average 329 for every 100,000 inhabitants. But tens of thousands are due to retire over the next couple of decades, and from 2004 more will be leaving than joining the profession.
To counteract this demographic trend, the government is increasing the quota that for 30 years has severely limited the numbers admitted to second-year studies. It will rise from 4,700 this year to 5,100 in 2003.
The quota system enforces savage selection at the end of the first year - less than 20 per cent pass the exam for admittance to year two and only near misses are allowed to retake it the following year.
As the successful progress through the long and arduous training regime, they spend an increasing amount of time on hospital work, and are paid from their fifth year. As well as hospital duties, they do work experience with a GP.
All students follow a common programme for six years then choose whether to enter general practice or to specialise. Training ranges from nine years for a GP to 11 years for an anaesthetist.
During training, students can opt to study abroad, through either a European Union Erasmus or Socrates programme or an exchange partnership between French and foreign medical faculties at university level, said Colette Creusy, professor at the medical faculty of the Catholic University of Lille and a member of the Association of Medical Schools in Europe.
The reforms include giving each course equal status in the exam system and allowing transfers between courses. Crossdisciplinary teaching will be introduced in year five. From 2004, the "internat" exam, taken after year six to allow specialisation, will be compulsory for all students.