2023-06-13 15:40:07
“Strengthening general medicine as a specialty as such”. Monday, Francois Braun, the Minister of Health, recalled in a speech the objectives of the creation of a 4th year for the diploma of specialized studies (DES) in general medicine, on the occasion of the delivery of the mission report on the subject . Report of which he followed most of the recommendations.
Because to date, general medicine is the only specialty to have only three years of internship. This additional year was a presidential commitment ofEmmanuel Macron in 2022. The measure will concern future general practitioners who will begin their internship next September, and therefore their fourth year in the fall of 2026. 20 Minutes tells you what it will consist of.
What is the objective for this year in addition?
In his speech, François Braun insisted on the two ambitions of this 10th year of studies for future general practitioners. First of all, “strengthen the training and professionalization of general practitioners, to facilitate and secure their installation”. Because the course of general medicine does not include a year during which the students exercise as a “junior doctor”, in supervised autonomy. But the main concerned do not see a good eye this year more. “Students think they are ready to practice after nine years of study. Moreover, we do not know the educational content of this year, we see above all the opportunity to make us work in a more dense way”, thus declares to 20 Minutes Raphaël Presneau, president of Isnar-IMG, national union of general medicine interns.
The other objective is to “meet the growing health needs of the population, in particular in the more isolated territories and less endowed in terms of medical resources. “. What makes the same students jump: “It is not with the interns that we will solve the difficulties of access to care. The problem of medical deserts is not linked to the distribution of general practitioners but to their number, because France has lost 10,000 in ten years. The interns are not there to plug the holes, ”says Raphaël Presneau.
Where will the internships take place?
This fourth year will consist of two six-month internships, on an outpatient basis, in a medical office, under the authority of a university internship supervisor (MSU). The two internships will be carried out, with some exceptions, in the same cabinet “in order to truly immerse oneself and project oneself, with realism, over a fairly long period”, declares the Minister. And since the interns will be considered as junior doctors during this year, they will have to participate in the permanence of outpatient care (PDSA). Raphaël Presneau fears that the premises offered to junior doctors are not functional: “Many practitioners tell us that they do not have the space in their office to receive an additional doctor. We risk finding ourselves in rooms that were not dedicated to medical consultations with a bed, a table and a computer, period. »
The government therefore wants to encourage interns to carry out this fourth year in areas with few doctors, knowing that at present, six to seven million French people do not have an attending physician. “We are not making this choice of coercion to force doctors to settle in such and such a place”, insisted François Braun. “The under-dense areas now represent 40% of the territory,” says the minister’s entourage. As for the concern of students not to find an internship, the Ministry of Health defeats it: “everyone will find it”, he assures.
What about compensation?
In addition to their remuneration as a junior doctor (1,900 euros), the interns will receive a retrocession of fees of 20% of the amount of their consultations, within a range of 10 to 30 acts per day. And those who will carry out their internships in the territories least endowed with health professionals will receive an additional allowance (400 euros monthly) if they choose to complete this fourth year there. All combined, they will be able to receive up to 4,500 euros net per month. “The vast majority of junior doctors will reach this level of remuneration”, assures the entourage of François Braun.
What Raphaël Presneau doubts: “According to our calculations, according to the average rate of consultation that they will be able to ensure, the majority of junior doctors will receive around 3,000 euros net, which already constitutes a revaluation, but not up to the one announced by the minister. »
Will there be enough internship supervisors?
This is one of the concerns of the students. François Braun tried to reassure them by recalling his objective of “having 16,000 outpatient university internship supervisors (PAMSU) trained, starting in November 2026, that is to say around 13,000 PAMSU trained on January 1, 2023”.
According to the minister’s entourage, doctors already established will have every interest in becoming internship supervisors to better meet the needs of their patients and to “prepare their succession”. But Raphaël Presneau is not reassured: “Since the beginning of the year, some internship supervisors have not been able to be trained, due to an insufficient number of approved training courses. In addition, there have been retirements of practitioners.
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