The immigration bill provides for the establishment of a residence permit dedicated to medical professions. This measure is supposed to facilitate the arrival of foreign doctors on French soil.
“This law is good news for new arrivals. But what about us, who are already on French soil?” Kahina Ziani, a doctor of Algerian origin, who arrived in France in 2012, wonders, while the immigration bill provides for the creation of a “talent-medical and pharmacy professions” residence permit. A system intended to facilitate the arrival on French soil of health professionals and their families, “as long as they are recruited by a public or private non-profit health establishment”.
Around 4,500 practitioners with diplomas from outside the European Union (Padhue) already work in hospitals in France, according to the General Directorate for Healthcare Supply (DGOS), surveyed in June 2022 by 20 minutes . For the moment, upon their arrival, the authorities grant them a status “acting as an intern” (FFI), which gives them the same rights as French interns. To have the same conditions of practice as their French counterparts, they must pass the knowledge verification tests (EVC), a competition at the end of which they can obtain an authorization to practice. But this exam is very selective and practitioners lack time to prepare for it.
To better understand the particular daily lives of these doctors, franceinfo collected the testimonies of six of them, who look back on their administrative hassles, precariousness and work overload.
Kader*: “Why continue to fight for a system that puts a noose around its own neck?”
Diabetologist in the Paris region, 30 years old, arrived from Algeria in 2019. “I calculated: in a year and a half, after my arrival on French soil, at the end of 2019, I accumulated 286 guards. I officiated for two years in Alsace, in the midst of the Covid-19 crisis, with hotlines at the Samu control center. We received more than 5,000 calls per day.
I now work in the Paris region. Thanks to an agreement with the hospital, I can work as an ‘associate practitioner’ and therefore earn a little more than as an intern. But my contracts are precarious, renewed every six months. Until I got married, my residence permit stated that I was a ‘trainee’, which meant that officially I could not work. At the time, being in a civil partnership with a French woman, who worked as a manager, we were unable to own property. Because upon seeing my residence permit, no bank wanted to lend us money.
On a daily basis, everything goes very well. I have more resources and freedoms than in Algeria, where the political situation has become tense in recent years. There is good understanding in the department, as well as with patients. So much so that one of them, who told me he was a former elected official, offered to help me in my efforts. I didn’t dare to accept. He’s a patient, it’s up to me to treat him. He insists and repeats to me that he is tired of seeing new doctors parade every three months.
If the situation does not improve, I will leave for Switzerland. One of my colleagues did it. She earns the equivalent of 6,000 euros, with one day per week at university. When she told me about her situation, I said to myself: ‘Why continue to fight for a system that puts a noose around its own neck?'”
Régis Mbonimpaye: “It’s as if I no longer have an identity”
Geriatrician in Digne-les-Bains (Alpes-de-Haute-Provence), 34 years old, arrived from Burundi in 2021. “My colleagues say that coming to Digne-les-Bains is a bit like burying your life. Me, on the contrary, what I like here is the calm, which allows me to continue my research activity and to publish regularly in international journals. And the means too, which I did not have in my country of origin.
Professionally, I feel very good. I practice in geriatrics, which is a little different from what I did in Burundi. It took me some time to adapt, but I received a lot of support from my colleagues and my management, who supported my efforts from the start, because I have held a vacant position for years. But I feel like everything is doomed.
My residence permit is valid until July 2024. It’s like I don’t really have an identity. On the one hand, I am reminded that I do not belong to the Schengen area. On the other hand, they would like me to stay to treat patients, because there is a shortage of doctors. I am impatiently awaiting the results of the competition to obtain my authorization to practice. They should fall in the next few days.”
Baptiste*: “The hardest thing is seeing my children grow up far from me”
Pediatrician in Cayenne (Guyana), 43 years old, came from West Africa in 2019. “After two years in the Paris region as a neonatal pediatrician, I applied to Cayenne, to get out of my precariousness. With 1,400 euros per month, I was only able to return to my country of origin, in Africa, twice of the West, where the geopolitical situation forced me to leave. The most difficult thing is seeing my two children aged 8 and 5 growing up far from me. When we call each other by video, I have the tears in my eyes. My status is too precarious for them to be able to join me. For the moment, my contract runs until 2025. But after that? I don’t want to make my children dangle a life that can be stop at any time.
“I have proven my skills, my autonomy. The greatest gift that France could give me would be to give me an authorization to practice.”
Baptiste*, pediatrician in Cayenne, Guyanaat franceinfo
In 2021, I had to return to the country to see my son who became seriously ill. My colleagues from the Ile-de-France region, at the time, mobilized to ensure that he was treated in France. But he was refused his visa. We had to go to Tunisia, where his treatment cost 3,000 euros. Every day, I save the lives of premature children, and here I was not even able to treat my own son. I’m going to be on call for four days this week, because we have a severe shortage of doctors here in Cayenne, and I can’t leave all these children to their own devices.”
Merzaka Bounoua: “I always find the strength to fight”
General practitioner in Marseille, 52 years old, came from Algeria in 2012. “I never felt like a foreigner in France. So much so that I never felt the need to take steps to apply for French nationality. In Algiers, they called me ‘la Française’. If I I chose to study medicine in Algeria, it was to take care of my sick mother.
I have been in France for more than ten years now. I work in different hospitals accepting precarious contracts, of one year, maximum two. I’ve been wandering from Guyana to Apt, via Cavaillon, Nîmes and Marseille, since January. I accepted everything for the love of the profession. I am an associate associate practitioner, level 10, when I should be two levels higher. At 52, I live alone, without children, with 3,400 euros net per month, in a chalet of 42 square meters, with a little land, my old Twingo and my electric bike.
“I move around so much that I don’t even know when I’ll be able to get my residence permit.”
Merzaka Bounoua, general practitioner in Marseilleat franceinfo
Since the summer of 2022, I have lost seven kilos, but I still find the strength to fight. I was waiting for the response from the practice authorization commission, whose conclusions I feared. And there was no shortage of it. While I practice in general medicine and diabetology, I am asked to complete my file with two three-month internships in pediatrics and gynecology. How ? With what money and in what accommodation? It does not mean anything. Daily, I consult alone, I schedule hospitalizations and I validate the acquired skills of interns. No colleague has ever questioned my opinions.”
Sara Hmimina: “At the beginning, some patients allowed themselves a few remarks about my last name”
Vascular doctor in Cher, 40 years old, arrived in 2015. “I have just been naturalized, after eight years spent in France. I am originally from Morocco and I followed all my university studies in Spain, which saved me a lot of hassle when I arrived in France, in 2015. When I started my studies, II didn’t know where I was going to settle. It happened by chance. This Spanish diploma allowed me to settle in directly, without having to pass any tests. I just had to respond to a job offer from the Council of the Order of Physicians in the department.
I am a vascular doctor in an under-resourced area, Cher. When I arrived in 2015, there were five specialists, but after three retirements and the move of a colleague, I am now alone for the entire department. It’s unbearable: the pressure I have on my practice, the distress of patients, some of whom become aggressive, the phone that never stops ringing… And the sense of ethics, which prevents me from refusing certain patients, creating long days, at my expense.
At the beginning, some patients made a few remarks about my last name. Not always directly from me, but via my secretary, when making appointments. Fortunately, this is not the case for all patients. Having a good command of French played a lot in my favor. I gained their trust, little by little.”
Fatma Bouvet: “ I played the game of the Republic from start to finish.”
Psychiatrist in Montrouge (Hauts-de-Seine), 58 years old, arrived from Tunisia in 1994. “When I arrived in France, on October 28, 1994, all doctors with foreign diplomas were paid half as much as their French counterparts. This difference in salary was humiliating, I felt considered a ‘sub-doctor’ even though I I was valedictorian of my year in Tunis, which allowed me to obtain a scholarship from the World Health Organization to come and continue my studies in France. At the time, I didn’t protest. I had two young children and I didn’t want to depend on my husband financially. To compensate for this precariousness, I worked overtime, on call and shifts that no one wanted to do. I even completed a master’s degree in health marketing and worked for a pharmaceutical laboratory, because my work in the hospital was not enough for me to live on. But I wanted to return full time to my original job: helping patients.
My children were young, I was juggling between my corporate job, the hospital consultations that I had kept and my family life when I started to revise all of psychiatry again in order to pass the equivalence test. I played the Republic game from start to finish. Even before obtaining my authorization to practice, II opened the first alcoholology consultation for women at Sainte-Anne hospital in Paris, then I co-founded the Addict’Elles association, which organizes support groups for women sick with alcohol. I think I did more than my job.
Since I obtained my equivalence, I feel freed from a weight. I continued to work for years at the public hospital after this authorization, while practicing in my own office for almost fifteen years. Now that I have been granted this authorization, I feel considered as a ‘real doctor’ by certain colleagues.”
* The first name has been changed at the request of the person concerned.