They are not giving up. Several hospital representatives and nearly 50,000 signatories (as of late Thursday) of an online petition are warning about the low number of interns who will be joining French hospitals this fall. Why is the number of positions decreasing in 2024 compared to last year? What will the consequences be for the health system? And what is the government’s response? Franceinfo takes stock, as the choice of interns’ specialties begins on Friday, August 23.
Why is the number of interns decreasing?
Interns are postgraduate medical students (from the seventh year to the twelfth). They work full-time in the hospital or as an outpatient, under the supervision of a senior physician. To access the internship, students pass a competitive examination in the sixth year. The ranking plays a decisive role because it allows them to choose, based on the rank obtained, the future specialty and the city in which they will do their internship. The number of open positions depends on the number of students who compete and the health needs of the territories.
However, this year, the number of candidates has decreased, due to the entry into force of a reform of the internship competition initiated in 2018 and coming into force in 2023-2024. It aims to better assess the practical skills and the students’ background. Among the new features, it introduces for the first time an eliminatory mark in writing, at the beginning of the sixth year, and an oral exam at the end of the year. Some fifth-year students therefore strategically decided to repeat the year (7%, compared to 3% usually, according to the Conference of Deans of Medicine), so as not to have to endure the rigors of the new competition. In the end, around 2% of candidates failed the tests, a figure similar to other years, according to what the resigning Minister Delegate for Health, Frédéric Valletoux, assured on Tuesday West France.
Due to increased repeats, fewer students took the exam. This year, only 7,974 positions have been opened for the new class of interns who will begin working in November, according to a decree published in the Official Journal on July 9. In comparison, 9,484 positions were available in 2023, or 1,510 more. The government “did not choose to decrease” the number of positions, stressed in West France Frédéric Valletoux. This number has decreased proportionally to the number of students registered for the competition, which was lower this year, the Ministry of Health confirmed to franceinfo.
The ministry also points out that only 833 interns will actually be missing from the roll call, and not 1,510. The 662 repeaters from last year who passed the exam this year will benefit from an assignment through a separate procedure, because they had remained affiliated to the old rules of the competition. They are therefore added to this year’s winners, explains the executive.
What do medical students say?
An online petition launched on Thursday, August 8 by Hélène Hérubel, a Parisian student, and signed by nearly 50,000 people, denounces a “deep injustice” for the 2024 class. The students, who have been dreaming of a specialty for years (surgery, cardiology, ENT, etc.), believe that the results of the “new formula” competition are distorted, since part of their class refrained from taking it, preferring to repeat the year.
“Do you think they repeated the year because they thought they were going to finish first or last? The places that no one wants to take would have been for them.”says Clara, a medical student, on the social network X. Having come 3,800th in the competition, she cannot claim any of her initial choices, unlike what she could have done last year, if she had obtained the same rank.
The number of positions has been reduced “without taking into account” the orientation wishes of new interns, decreasing for example “by half” plastic surgery positions, while other specialties are less affected, also deplore the signatories of the petition. “Too many students will have to choose a specialty out of spite in which they will be less invested and the quality of their care will suffer. After six or seven years of hard study, we are not allowed to choose our profession”the latter also report.
“Students – often the best – who played the game and passed the exam find themselves de facto penalized”, press in The Figaro Baptiste Sabatier, vice-dean of students at the UFR of Medicine Paris Cité. Believing that they are victims of the new competition rules, the students are therefore asking the government to reopen positions in highly sought-after specialisms.
What are the consequences for the health system?
Interns represent “40% of medical resources” in university hospitals, reminds franceinfo Marc Noizet, president of the Samu Urgences de France union.Their reduction therefore risks further increasing the workload and on-call hours of other practitioners, while the lack of staff is already being felt. The emergencies of “around fifty hospitals (…) are currently under tension” due to a lack of personnel, according to Minister Frédéric Valletoux.
The professionals “wonder how they are going to run their services” while “Interns work an average of 59 hours per week”Guillaume Bailly, president of the National Inter-Union of Interns, also explains to AFP. “This will inevitably involve a new workload for the internal” who will be in the services, also fears from franceinfo Yassine Bahr, vice-president of the same organization. According to him, this will also lengthen the waiting time of patients significantly “inevitable”.
The government nevertheless stresses that the “air pocket” linked to the lower number of interns in the coming months will be offset next year. In 2025, the effect of the loosening of the “numerus clausus” (the number of students authorized to move on to the second year), and the rebound in the number of candidates linked to repeaters from last year “should lead to a promotion of 11,000 interns, a rebound largely compensating for the workforce for the year 2024”according to the Ministry of Health.
What is the government’s response?
Despite the grumbling in the sector and the success of the petition launched by interns, the government does not intend to change its mind. “There is no loss of opportunity for the current promotion because the drop [du nombre de postes] is proportional to their numberunderlines the Prime Minister’s office. Therefore, a ranking from last year cannot be used as an argument to compare the specialties obtained.” Furthermore, and as every year, “the number of positions offered is 2% higher than the number of those admitted to give even the last ones a choice”.
As for the choice of deleted positions, “the distribution was made (…) to best serve the interests of the population” in function “staff tensions observed in specialties”. “Medical students know from the beginning of their studies that access to specialties and training areas is determined by the needs of the population and not by the preferences of students alone”also believes Matignon. “Some priority specialties have been preserved: the number of posts in pediatrics has decreased by only 6.9% and the number of posts in psychiatry by only 11.9%”notes the Ministry of Health. “This is offset by the contribution [la suppression de postes] of certain specialties, notably cosmetic surgery”justifies Gabriel Attal’s office.
To compensate for the shortage created by the drop in the number of interns, the government is considering temporarily using foreign doctors, commonly called “acting interns” (FFI). These practitioners, who are less expensive, are sometimes less well trained, according to interns.