REPORTING. In the Lot, the fight against medical deserts is organized from high school with Parcoursup

On this Friday afternoon in April, there is an unexpected tranquility in the playground of the Jean-Lurçat high school in Saint-Céré (Lot). Most of the 300 students who study there are already on the weekend, but Amaëlle, Nicol and Anna, first year students, wait on a bench with chocolate donuts before their chemistry class, which must prepare them for the first year of medical studies, which they hope to enter at the start of the 2025 school year. “I must admit that the extra classes on Friday afternoon almost discouraged me”confides Anna.

At his side, Amaëlle does not seem to agree. “I have known that I wanted to be a surgeon since middle school. But to achieve this, I will have to put money aside and fuel myself in school”says the high school student who swapped four days of school vacation for an internship in a cardiology department.

The final year students have their eyes fixed on Parcoursup, whose first admission phase begins on Friday May 30. Eight of them will finally know whether or not the medical school approved their application for registration.

In the meantime, everything is done to attract these aspiring medical students. Every Friday afternoon, there are around thirty (19 first year students and 11 final year students) to follow an option of three hours per week, combining reinforcement courses in life and earth sciences (SVT) or physics-chemistry, but also less conventional courses, such as interventions by doctors, surgeons, nurses or physiotherapists from the department . Hours of coaching are even offered to them to manage their future revisions, their stress and their diet., during this anxiety-provoking first year of study. University visits are also organized regularly.

“It was these courses and the internships that helped me the most. I knew what to expect and managed my revisions better”analyzes with a little more perspective Enzo Maillot, in his first year of medicine in Limoges (Haute-Vienne). “Initially, I wanted to be an osteopath. But it was by following a midwife in Saint-Céré that I wanted to enter medicine.”

“At first, I was afraid of not being taken, because I didn’t think I had the level. But by meeting those who had followed the option just before me, I saw that it was possible.”

Enzo Maillot, first year medical student

at franceinfo

Integrated into the National Education “ropes of success” system, these additional hours of lessons should encourage the vocation of students who grew up in the countryside and bring them closer to higher education. You have to drive more than an hour and a half to reach the university of Limoges and more than two to reach that of Toulouse. “The objective is to give them self-confidence, to break this self-censorship among young rural people who think that studies are not for them”summarizes David Auffray, SVT professor, who oversees the system.

Unprecedented, this initiative did not germinate in the heads of teachers, but within the community of communes of Cauvaldor. It is the municipal team which, still shaken by the health crisis, went in 2021 to meet the principal and teachers with an idea : create a health option for high school students from Lot to embark on medical or paramedical studies. With the idea that once they have their diploma, these young rural people, who grew up in the surrounding area, will return to practice there. This type of initiative is also acclaimed by the Directorate of Research, Studies and Statistics (Drees), which, in its December 2021 report on medical deserts (PDF)concludes that “the main lever” to combat the phenomenon “is the selection of students admitted to medical school, to increase the share of those who come from disadvantaged communities in terms of access to care”.

“We decided not to integrate social criteria, whether for scholarships or high school students admitted to the health option”says Raphaël Daubet, the president of the community of communes at the time. “We wanted to quickly implement this option and expand it to as many people as possible, with the idea that the more students we sent to study health, the more of them would come back to settle here”, continues the professional dental surgeon, today senator of Lot. For this, Thierry Chartroux, vice-president of Cauvaldor in charge of health, does not hesitate to put his hand in his pocket. The community of communes pays 10 000 euros each year to finance stakeholders outside National Education, such as coaches and health professionals. A homeopathic dose on the scale of the community of municipalities, whose annual budget amounts to more than 60 million euros, according to the elected official.

Some 50 000 euros annually are allocated to students enrolled in medical school, to whom the city grants a scholarship, the amount of which varies depending on the year. “We couldn’t create a health option and then leave them to fend for themselves. In the first year, we give them 800 euros at the start of the school year, with the only compensation being to sign up for tutoring [une association de soutien pédagogique gérée par des étudiants]“, explains Thierry Chartroux, a nut producer, trained late in these issues combining medical attractiveness, sociology and education.

“During my medical studies, I noticed that my classmates were all urban people from privileged social classes”, remembers Raphaël Daubet, who devoted his thesis to the social origins of dentists. What was true in 1997 is still true today. According to National Education, in 2022, only 8.5% of medical students are the children of farmers, 5.1% of workers, while they represent 18.9% of the French population, according to INSEE. Half (50.4%) come from parents who are executives or exercise a higher intellectual profession. If the figures remain the same in 2025, Amaëlle, who dreams of being a surgeon, will be one of the 9% of children of employees (26% of the working population) to continue these studies.

It is to reverse this trend that the option was created. In 2024, eight final year students out of the eleven who have followed these additional courses and requested a first choice medical university on Parcoursup. The previous year, half of the students following this option had expressed the same wish. All were accepted. At least one made it to second year. “It’s a source of great pride. In the twenty years that I have been teaching here, we have only sent one or two students per year maximum to medicine”, underlines David Auffray. These results attracted the attention of the Toulouse rectorate, which decided to extend this system to the seven departments of its academy at the start of the 2023 school year. She will soon no longer be the only : the law passed in December 2023 aimed at improving access to care, proposed by the Minister for Health, Frédéric Valletoux, aims to experiment with the system “for a period of five years” In “three voluntary academies”.

For the moment, with six general practitioners recruited in 2020, the community of communes of Cauvaldor “is not” a medical desert, assures Thierry Chartroux. At least, not yet. “This term is banned here. We have seven health homes, with 44 general practitioners in Cauvaldor for 47 000 inhabitants”, says the chosen one. With 147 general practitioners per 100 000 inhabitants on January 1, 2023, according to INSEE data, the Lot is placed just below the regional average (157 general practitioners per 100 000 inhabitants).

But the department is also the second oldest in France after Creuse, with half of its population aged over 51 (compared to 41 on average in France) and aging more rapidly than in the rest of the region. Occitanie, according to INSEE. As for the doctors practicing in the surrounding area, half of them are over 50 years old. This is why the elected officials did not want to wait to have the scalpel “under the throat to act”underlines Thierry Chartroux.

The elected official knows that this balance remains fragile and that the situation could change at any time. Thus, in addition to the option created at high school and the scholarships granted to young people from Lot, he and his team are working to attract general practitioners. “We don’t write them a check, we talk to them about life plans. When a practitioner wants to settle down, we pick up the phone, we find them accommodation, a place in a crèche… We make them understand that they are waiting.”

At least ten years will be necessary before the health option and the grants granted to future caregivers produce effects in the region. Until then, Thierry Chartroux and David Auffray must solve a more urgent problem : bring the pediatric ambulance into the school grounds, which is too high to pass through the main entrance. Coming from the Brive-la-Gaillarde hospital center (Corrèze) with a host of medical equipment, its siren and its flashing lights, it could inspire new vocations.