France

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Health systems in transition
France
2. In the middle is the interdepartmental programme of support for
individuals with disabilities or loss of autonomy (programme
interdépartemental d’accompagnement des handicaps et de la perte
d’autonomie), which translates the regional scheme for health and social
care sector organizations into authorization for capacity-building. It is
established by the ARS directors and the heads of the general councils.
3. At the bottom of the pyramid, the heads of the general councils design
departmental schemes for the disabled (schémas départementaux relatifs
aux personnes handicapés ou en perte d’autonomie) to plan health and
social care services in conjunction with the ARS commissions, the
representatives of health and social care services and service users living
in the departments.
Once this planning process is completed, a call for proposals is made by an
ARS selection committee to choose capacity-building projects that meet the
identified local priorities.
2.5.2 Human resources planning
The National Observatory of Health Professionals (Observatoire National de la
Démographie des Professions de Santé) was created in 2003 to provide figures
and guidance to the Ministry in charge of Health. Its annual reports provide
information on weaknesses in information required for the steering of human
resources in the French health care system by the Ministry in charge of Health.
It also identifies gaps in strategic planning at the national and regional levels.
At the national level, the numbers of doctors, and to some extent their areas
of specialization, are regulated by the numerus clausus, which is set by the
government annually and controls access to the second year of study in medical
schools. This numerus clausus is then applied at the regional level, taking into
account current inequalities in the geographic distribution of doctors. There is
also a numerus clausus limiting the entry of students in other health professions,
such as nursing, midwifery, dentistry, speech pathology and physiotherapy (see
section 4.2.1).
For doctors, after six years of study, all medical students undertake a
national competitive examination (épreuves classantes nationales; ECN).
Based on the results, students apply for open internship posts by area of
specialization and location. In recent years, the lack of interest in certain
specialties (anaesthesiology, intensive care, gynaecology and obstetrics, and
paediatrics) has led the government to block a number of places for these