General practitioners: the fourth year of internship arouses tensions

Le gouvernement assure qu'il n'est pas question d'imposer une quatrième année dans les déserts médicaux mais de l'encourager.

Posted Sep 27, 2022, 7:06 PMUpdated on Sep 27, 2022 at 7:09 PM

At a time when shortages of doctors worry, the government would do well without a strike of white coats. Monday, the national intersyndicale of interns (ISNI) and the Young Doctors union promised the launch in October of a “great mobilization going as far as the strike of all interns”.

The organizations are concerned about the project to create a fourth year of the general medicine diploma, as part of the draft Social Security budget for 2023 (PLFSS) presented on Monday. This fourth year “would be encouraged in the territories with the fewest general practitioners,” the government said.

Leaving their family at 30

The executive has promised to provide, in the wake of the National Council for Refoundation, responses to the difficulties of hospitals and medical deserts in town and in the countryside.

Many doctors are however very attached to the freedom of installation. And the project to carry out a new study in areas with few doctors has made some young doctors jump. “We cannot impose [à des médecins généralistes en formation]at over 30, to leave far from their families,” write ISNI and Jeunes Médecins.

“Thinking that the fourth year would be the solution to the problems of medical demography is a mistake”, declares for its part the union of general practitioners, MG France, for which all of France suffers from a “global shortage”. On the other hand, the organization considers that general medicine “requires a professionalizing year like all the other specialties”.

Internship supervisors

Today, general medicine is the only medical specialty to have only three years of internship, indeed recalls the government. According to the latter, the current system “does not favor immediate installation at the end of the course”. The young general practitioners would not have enough experience of life in the practice to settle directly on leaving their studies and would prefer to be substitutes.

Hence the desire to have this fourth year carried out “exclusively with liberal doctors” with training as “university internship supervisors”. “This fourth year is made to improve the training of general practitioners, absolutely not to solve the problem of medical deserts”, assured the Minister of Health, François Braun, on Franceinfo on Tuesday.

Consultation mission

The Minister also denies imposing a destination on students. “It’s not compulsory, it’s a strong incentive for them to go to these territories,” he said, referring to incentives such as housing aid, etc. These measures will be worked “in conjunction with local authorities”, specifies the draft Social Security budget.

Anxious to “associate all the stakeholders in this reform”, he entrusted a “mission” to four experts on Sunday. Its conclusions are expected before the end of the year. The measure should apply from next year for those entering the first year of general medicine specialization.

In other words, there is no question of immediately encouraging young doctors at the end of their training to go to areas with few doctors.