Low medical density areas, so called "medical desertification", in France. Overview of the situation and concrete proposals

The severe shortage of physicians in France and its complexity have prompted the National Academy of Medicine to conduct a thorough assessment of the situation and to make the following recommendations: (i) urgent proposals: implement a one-year medical service for newly graduated physicians, as part of a contractual commitment based on ethical principles, and without constraints or regulations regarding their installation. This citizen medical service would strengthen medical services in under-resourced areas and provide practical experience for young physicians; encourage retired physicians to continue working while allowing their contributions to generate additional benefits; to combat medical deserts, encourage and give priority to multi-site practice, which has already proven successful in our country during the post-war health care shortage. For instance, a group of five doctors practicing together could provide one day of consultations per week in a decentralized practice, with support from the local community hosting the practice; raise public awareness of the proper use of medicine, respect for appointments and recognition of the service provided by the French healthcare system, given its complexity, cost and difficulties of implementation; (ii) implement the following measures as soon as possible: optimize the delegation of tasks to other health professionals (nurses, midwives, pharmacists) to free up medical time and ensure coordinated care within the scope of the physician's competence; simplify regulations, reduce administrative burdens, and recruit medical assistants, secretaries, and computer specialists; encourage early practice and installation in under-supplied areas by offering one-stop shops, incentives for combined employment and retirement, multi-site practice, off-site consultations, and effective use of telemedicine; strengthen physician security in sensitive areas; make home visits financially rewarding and technically easier; improve local interactions with hospitals; increase the number of available medical places by adapting them to the needs of the territories, based on an evaluation by local elected officials, physicians (private, hospital, university), health professionals and patient representatives; diversify the territorial and social origins of students through incentives and support measures starting in high school; develop internships in under-resourced areas starting in the second cycle by increasing the number of internships and internship supervisors and by creating tutors; avoid any coercion to enter private practice, both during the fourth year of the DES in general medicine and during the one-year medical service. & COPY; 2023 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.