Health. End of the numerus apertus, return of expatriate students... how the government wants to train more doctors

A new step in the long-term fight against medical deserts ? The Senate is due to debate this Tuesday evening the potential abolition of the numerus apertus , after an initial vote by the National Assembly in 2023. Since 2019, the numerus apertus has established a minimum number of students admitted to the second year of medicine, determined according to the capacity of universities and the needs of the ARS (Regional Health Agencies). A paradigm shift compared to the previous system: the numerus clausus , created in 1971, set a maximum number of future doctors in order to restrict competition and state health spending.

The numerus apertus has had its first effects on the student population in recent years: over the period 2021-2025, more than 50,000 doctors were in training, compared to fewer than 38,000 in 2016-2020, when the numerus clausus was in place. But selection has remained drastic. Proof of this is that 1,600 students who failed in France go abroad each year to other European countries (Spain, Belgium, Romania, Portugal, etc.) to continue their studies, according to an estimate by the Court of Auditors.

The shortage of caregivers throughout France has therefore pushed the executive to go further, by revisiting a bill proposed in 2023 by... Yannick Neuder , LR MP who became Minister of Health. In addition to the abolition of the numerus apertus , the new law also promotes the reintegration of expatriate French students and creates new pathways for paramedical professionals (nurses, childcare workers, physiotherapists, etc.) to medical studies.

From now on, the number of students would be defined by a priority indicator: the needs of the territory. The ARS and local elected officials within the territorial health councils will be able to "call on a university to increase its intake capacity," explains a Senate report. A simple solution on paper, but one that is causing concern on the ground. "The number of students has already increased significantly, going from 8,000 ^second -year students in 2014 to 12,000 in 2024, a 50% increase," emphasizes Isabelle Laffont, president of the Conference of Deans of Medicine. "To train so many , we already lack teachers, administrative staff, and premises." The bill that is due to be submitted to the Senate does not address this issue of the additional resources inherent in training with more students.

The representative of the presidents of medical schools is "sounding the alarm," because under these conditions, "the quality of training for doctors would be degraded." "Removing the numerus apertus or bringing back students who have gone abroad are not emergency measures to address medical deserts," she adds, emphasizing the 10 years needed to train a doctor. The Conference of Deans favors short-term measures, such as the creation of territorial assistant positions (young graduate doctors deployed in under-populated areas) and the territorialization of student internships "to encourage them to explore the regions and settle outside of major cities."

These proposals are shared by the majority of medical student unions, who also fear for the quality of their training in the event of an influx of students. For Lucas Poittevin, president of the National Association of Medical Students (Anemf), "universities are already underfunded, they no longer have their own funds, and so it's complicated to ask them to dig deeper into their budgets," while highlighting a "lack of internship sites." Infrastructure, "particularly for internships, is not at all adapted to accommodate many more students: when you have a lot of interns and externs in a department, the quality of training is not there," adds Anna Boctor, president of the Young Doctors union.