Huguier Michel, Romestaing Patrick
Bull Acad Natl Med. 2014 Oct;198(7):1367-78.
In France, the number of students admitted to the second year of medical studies is limited (numerus clausus) by law. In 1971 this limit was first based according to hospital training capacity and subsequently 1979 it has been based on demographic trends. An objective of 250 physicians per 100 000 inhabitants seemed reasonable and required 6 000 students to be trained each year. In 1979, it was decided to restrict the number of students temporarily because of a likely demographic slump after the year 2000. These steps were introduced progressively, in order not to unfairly treat a particular student class. The numerus clausus is also modulated geographically to take into account differences in medical density, as most students set up in the region where they did their medical studies. It is logical to practice preselection for admission to medical school, yet in France every baccalaureat holder can enrol any medical school, and students are totally opposed to preselection. This is why selection takes place at the end of the first year. In the late 1980s, the numerus clausus should have been increased by the health and education ministries, but this was in fact done only ten years later. Estimates of medical demography are complicated by three factors. First, many physicians from European Union member states (mainly Belgium and Romania) practice in France. Second, some students not admitted to the second year of medical studies go to learn medicine in aforeign country before returning to sit the French national examination at the end of the sixth year. Third, public hospitals hire foreign physicians from outside the EU (mainly Algeria and Morocco), who then stay in France permanently. Thus, EU-level decisions are needed to harmonize the medical numerus clausus across member states. The hiring of physicians from non EU countries by French hospitals should be more tightly controlled.
在法国,进入医学专业二年级学习的学生人数受到法律限制(定额录取)。1971年,这一限制首次依据医院培训能力确定,随后在1979年则依据人口趋势。每10万居民中有250名医生这一目标看似合理,每年需要培训6000名学生。1979年,由于预计2000年后人口可能出现下滑,决定暂时限制学生人数。这些措施是逐步推行的,以免对特定学生群体造成不公平对待。定额录取在地域上也进行了调整,以考虑医疗密度的差异,因为大多数学生毕业后会在他们接受医学教育的地区执业。对医学院入学进行预选是合乎逻辑的,但在法国,每个持有高中毕业证书的人都可以报考任何医学院,学生们完全反对预选。这就是为什么选拔在第一年结束时进行。在20世纪80年代末,卫生部和教育部本应增加定额录取人数,但实际上直到十年后才这样做。医学人口统计学的估计因三个因素而变得复杂。首先,许多来自欧盟成员国(主要是比利时和罗马尼亚)的医生在法国执业。其次,一些未被医学专业二年级录取的学生先去国外学医,然后在第六年年底回国参加法国国家考试。第三,公立医院雇佣来自欧盟以外国家(主要是阿尔及利亚和摩洛哥)的外国医生,这些医生随后永久留在法国。因此,需要在欧盟层面做出决定,以协调各成员国的医学定额录取。法国医院从非欧盟国家雇佣医生的行为应受到更严格的控制。