General practice
in France
France has 64 million inhabitants spread
unequally over the territory: about 30% of the French population is living in
the Paris region or in the Mediterranean coast area.
Health care
is
organised
by two different systems: a public health care system managed by the government
and the Ministry of Health (mainly hospitals) and a private system with no
state-control made out of clinics, outpatient clinics and general practices. The
last two are known in France as ambulatory care. Since education is a
state-affaire, the training of physicians and also GP's takes place mainly in
public hospitals.
The public
hospitals have fixed prices, clinics and outpatient clinics can define their
own.
The French
population benefits of a rather extraordinary health insurance, called « sécurité
sociale » (social security). This basic insurance provides a 65% reimbursement
for
hospitalisations
and medical visit, as well as for complementary exams and most medical
treatments. Insurance companies provide complementary health insurances for the
remaining
35%, to cover all health expenses, and most of them also take in charge the
extra fees paid in private clinics or ambulatory care. People with a very low
income benefit of a complementary health insurance (called CMU) taken in charge
by the French government.
Expenses in
relation to some illnesses (like diabetes, myocardial infarcts, strokes and
cancers) are totally taken in charge as well by the French government, after
evaluation by physicians working for the social security system.
By history
GP's do not have a gatekeeper function in France: patients had free and
unlimited access to specialists and emergency rooms. However, the government is
slowly reforming this system. In 2004 all patients were obliged to point out
their referent physician, the one who will be coordinating the solutions for
their health problems. If patients do not visit their referent physician before
seeing a specialist, they pay a small extra fee, not taken in charge by any
health insurance. For the moment this is only a small fee, but it is supposed to
augment in the following years.
Of course, a
GP has the best profile for a referent physician, but any physician can play
this role.
At this
moment 110 000 GP's are working in France, but only half has a primary care
activity. They work in group practices, but the solo practice is still used a
lot, mostly in rural areas.
GP's are paid
for every consultation: the patient pays directly after having seen the GP and
gets reimbursed by the social security system. The salary of a GP thus depends a
lot on the number of patients seen every day and patients can be considered
clients, which have to be satisfied (or else they will just change their GP).
The
GP-training in France takes three years, divided in six practical courses of six
months each.
The training
of every student must contain some obligatory courses like:
-six
months in an emergency room (ER)
-six
months in adult medicine (internal medicine or geriatrics)
-six
months of gynecology or pediatrics
-six
months with a general practitioner
-six
months in another hospital department
One of these
courses should take place in the Academic Hospital.
There is one
optional course a student can use for personal professional project, like a six
months course of Intensive Care for the ER-training or a complementary six
months training in a general practice, but under indirect supervision (called
SASPAS).
Whereas laws
define the practical part of the training, and by these means is similar in all
of France, the theoretical part can be very different. The only obligation the
Department of General Practice has is to offer a minimum of 200 hours of
theoretical courses.
During the
training the GP-trainee should maintain portfolio, with written traces and proof
of all the different ways he or she has acquired the different competences
needed in General Practice.
At the end of
the training, the GP-trainee is judged on the content of the portfolio, the
practical courses and a presentation of a memoir (a small work of research in
primary care).
To obtain the
title of General Practitioner, the student has to present a thesis within six
years after having started the training. This title is necessary to install as a
GP, but a trainee without thesis can work as a locum until six years after the
beginning of the training.
Country Coordinator for France:
Andrea Poppelier
ISNAR-IMG
286 rue Vendôme
69003 Lyon
France
international@isnar-img.com
+33-6-29367581
France – HOST
PRACTICE
Dr Touzard
11 Avenue Hotel de Ville
79110 Chef Boutonne
tel +33-5- 49 29 62 92
dr.martine.touzard@wanadoo.fr
I am a female
general practitioner (GP) since 29 years in a rural practice between Niort(45km)
and Poitiers(75 km) in France. A younger GP has joined me two years ago. I have
been receiving GP-trainees for many years now.
In the little
town where we work live 2000 people and 5500 live in the rural district around
it. The main parts of this population are farmers and older people, but since
about ten years more and more British people are settling in.
This is only
the country where you can find farmers, little craftsman's trade, a rabbit farm,
tow public works for building construction, a wood factory and small production
of goat's dairy products.
The surgery
is on the second floor of a big house with three floors.
On the first
floor there is a consultation room for a nurse, she takes care of diabetic
treatment , blood pressure problems and cholesterol inquiries. Our practice
makes part of the ASALEE project, a unique network in France started up in 2004
using task rearrangement to improve the quality of care of patients in rural
areas with few GP's. We have, and it's a very important person, a wonderful
secretary called Roselyne.
I live on the
third floor of the house, a little flat with two bedrooms; one of these is free,
after my children’s departure. I can keep somebody; I have just an old dog with
me (an old lady).
For work, I
am a GP in the country and I receive all the primary care, including
emergencies, as a voluntary fire department physician, and home visits.
If you want
to come it will be a great pleasure to receive you! | 
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