Doan Bui Dang Ha
Centre de Sociologie et de Démographie Médicales.
Cah Sociol Demogr Med. 2009 Jul-Sep;49(3):341-63.
Medical schools in France are all state-owned or state-controlled. Prior to the 70's, admission is open to all "bacheliers", i.e. the teenagers who have successfully completed their secondary schooling. For various reasons, the number of these newcomers was soaring starting the mid-60's. About 6 years later, the boom reached those who were in residency and 2-3 years later the move became a "graduate boom". The fears of inundation were shared by both the hospitals (as the available posts for young doctors were not sufficient) and the ambulatory care sector (where the practitioners were fearful of severe competition from the newcomers). As a matter of fact, there was a strong oversupply of young doctors but everybody thought that oversupply was general. The numerus clausus was established in 1971 and the annual number of students admitted into medical schools started to decrease in 1978, until 1999. After two decades of decrease, a clear shortage of young doctors appeared and a volte-face was decided: starting 1999, the annual number of young students admitted to medical training followed an upward trend. This number reached 7400 in October 2009, from 3400 ten years earlier. This time, a second confusion was made: the shortage of young-doctors is now understood to be a general shortage of all the medical profession. Consequently, a strong policy for increasing the numerus clausus is implemented. As things are, in 15 years from now, the health system will be again in the situation it has known in the mid-70's.
法国的医学院校均为国有或受国家控制。在70年代之前,医学院向所有“中学毕业会考合格者”开放招生,即那些成功完成中等教育的青少年。由于种种原因,从60年代中期开始,这类新生的数量急剧增加。大约6年后,这种增长态势蔓延到了住院医生群体,再过2至3年,这一增长变成了“毕业生潮”。医院(因为年轻医生的可用岗位不足)和门诊护理部门(从业者担心来自新人的激烈竞争)都担心人才过剩。事实上,年轻医生确实严重供过于求,但当时每个人都认为这种供过于求的情况很普遍。1971年实行了招生限额,1978年至1999年,医学院每年录取的学生数量开始减少。经过二十年的减少,年轻医生明显短缺,于是政策来了个大转变:从1999年开始,接受医学培训的年轻学生数量呈上升趋势。这一数字从十年前的3400人增加到2009年10月的7400人。这次又出现了第二个误解:现在人们认为年轻医生短缺意味着整个医疗行业普遍短缺。因此,一项大力增加招生限额的政策得以实施。照此情形,从现在起的15年后,医疗系统将再次陷入70年代中期的那种状况。