France — A recent Irdes study shows that the presence of foreign doctors born and qualified abroad partly fills medical gaps in French rural areas. But France is reluctant, compared to other developed countries, to resort to this option.
Study on liberal general practitioners
While the majority deputies and the government argue over the future of article 3 of the future immigration law, which allows immigrants from economic sectors in tension, including medicine, to automatically obtain a residence permit, a new study by Irdes calls for the recruitment of doctors born and qualified abroad in order to reduce the rural medical deserts.
This study, entitled “Liberal general practitioners qualified abroad contribute to strengthening the provision of care in under-resourced areas”, looks at the demographics of foreign doctors between 2007 and 2017 in various habitable areas in France: city center, peri-urban area and rural area.
The study also only focuses on self-employed general practitioners, ignoring other modes of practice, particularly salaried ones, and other specialties. “This research offers new perspectives for the French case by documenting on a fine scale the places of practice of liberal general practitioners first registered with the Order and, more generally, the location of all liberal general practitioners according to their nationality and their country of training. This involves identifying the contribution of doctors born and qualified abroad to the potential reduction of territorial inequalities in healthcare provision,” write the authors.
29,238 foreign doctors
Currently, 29,238 “doctors qualified abroad will be practicing in regular activity in 2023, i.e. 12.5% of the total workforce, a proportion below the average for Organization for Economic Co-operation and Development (OECD) countries” .
Among these foreign doctors, 55% are graduates from outside the European Union (Padhue) mainly coming from Algeria (37.4%), Tunisia (10.4%) and Syria (9.5%), while European graduates come mainly from Romania (42.6%), Belgium (15.3%) and Italy (14.6%).
These numbers of foreign doctors have experienced strong growth, especially since 2007, due to legislative changes: in 2005, the European Union established automatic recognition of medical diplomas throughout Europe.
“Doctors holding a European diploma can thus benefit from the free movement of workers and settle wherever they wish,” recalls Irdes. In the meantime, what’s more, the European Union expanded to include Romania and Bulgaria in 2007, thus mechanically increasing the number of foreign doctors.
Overrepresented in certain departments
In 2017, doctors born in France and qualified in France represented the overwhelming majority of doctors, i.e. 84.1%, even if “at the same time, liberal general practitioners born and qualified abroad are growing strongly”.
The study shows that doctors born and qualified abroad are over-represented in certain departments such as Nièvre, Cantal, Indre, Loir-et-Cher and the Eastern Pyrenees. Conversely, we find very few foreign doctors born and trained abroad settling – since 2007 – in the former Franche-Comté region, Oise, Somme, Marne, Meuse, Moselle, Ardèche, Lozère, Hautes-Alpes or Alpes-de-Haute-Provence. The authors of the study do not explain why doctors born and trained abroad prefer to settle in one department rather than another.
Establishment in rural margins
In 2017, “the largest share of doctors qualified abroad is located in city centers (30%), then rural margins (21.6%) and under-resourced peri-urban areas (16%). Establishment in rural areas appears specific compared to doctors trained in France, of whom only 10% are established there.”
The installation of foreign doctors in rural areas is even more significant among first-time registrants (to the Order of Physicians): “the majority of first-time registrants born and qualified abroad are settled in rural areas (41, 6%), then in under-resourced peri-urban areas (21.5%).” While foreign doctors tend to first work in rural and peri-urban areas, they also tend to migrate to city centers.
Nevertheless, “despite greater mobility after five years, the propensity of doctors qualified abroad to settle and remain in rural areas is greater than that of doctors born and qualified in France (20% vs. 8%).
Verdict: “For the 430 living areas affected by installations of doctors born and qualified abroad, and compared to the others taken as controls, the effect is positive but diminishes over time given the greater mobility of doctors born and graduated abroad […] In the current context of long-standing territorial inequalities in healthcare provision and the scarcity of medical supply in France, these results are interesting.
The authors recognize limits to this work: “firstly, the study population does not take into account replacements who contribute significantly to the provision of care in their first years of practice, nor employees, over-represented in urban areas and which are developing in rural areas, they write. It would also be appropriate to look at the sustainability of these installations over a period longer than five years.” Likewise, “the low numbers do not make it possible to document possible selection biases”.
The use of foreign doctors, a solution little valued in France
The authors of this study also note that the use of doctors born and qualified abroad, which is an inexpensive solution to the problem of medical deserts, is not facilitated in France unlike “many countries, [where] the doctors qualified abroad appear to be an inexpensive (no training cost) and quick solution to fill a deficit in a specialty or territory, particularly when obtaining a visa is conditional on practice in areas under-resourced as may be the case in Australia, Canada, or the United States.”
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