France

Health systems in transition France 117
Medical training of physicians is divided into three phases. The first
phase takes place over two years, and a competitive examination at the end
of the common first year limits access to the second year of medical studies.
The second phase of medical training takes four years and includes both
theoretical and practical training. Since 2004, all students after these six years
participate in the ECN and subsequently choose a third-phase specialty training
programme according to their ranking. Prior to 2004, general medicine was
not subject to the competitive entrance examination for medical specialists
and thus was viewed as a default option. The ECN has also been used as a
tool to attempt to address regional disparities in allocating internship posts by
specialty and locality.
Midwives undergo four years of training and the practitioner’s licence
is granted by the National Midwives Association (Ordre des sages femmes).
Dentists undergo five years of training and the practitioner’s licence is granted
by the National Dentists Association (Ordre national des dentistes).
Training of pharmacists takes six to nine years, depending on the specialty.
At the end of the fourth year, students must choose among three available
specialization areas: pharmaceutical industry, retail pharmacy and hospital
activities. Students choosing pharmaceutical industry or retail pharmacy then
follow a two-year course of specialty training. Students wishing to specialize in
hospital activities participate in a competitive examination in the fifth year of
study to enter four-year hospital pharmacy or biomedical residency programmes.
Both pharmacists and physicians may specialize in medical biology, and 75%
of biologists are pharmacists. Pharmacists must be registered by the National
Pharmacists Association (Ordre national des pharmaciens) in order to deliver
controlled drugs.
Access to nursing schools is regulated by a competitive examination and
is subject to a regional numerus clausus. The basic training takes three years
with subsequent optional specializations in theatre nursing, paediatric nursing
and anaesthesia. In addition to the initial training, nurses must have two years
of clinical experience in a hospital setting in order to qualify for self-employed
status. Registration by the National Nurses Association (Ordre national des
infirmiers) is granted after graduation and is valid for life.
Other registered paramedical professionals generally undergo three years of
training, often in educational institutions under the authority of the Ministry
in charge of Health. Exceptions to this are: speech therapists (five years of