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France: Medical Training

France: Medical Training

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Medical Graduates Per 100,000 Population, 2019: 9.5
Nursing Graduates Per 100,000 Population, 2019: 40.4
Percent Share of Foreign-Trained Doctors, 2019: 11.6%
Percent Share of Foreign-Trained Nurses, 2019: 2.9%
(Note: According to OECD, “Medical graduates are defined as students who have graduated from medical schools in a given year.” OECD also notes that data for Austria “include foreign graduates, but other countries may exclude them.”)

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.


“More than 45% of doctors in France in 2017 were aged 55 and over (including 13% aged over 65), raising concerns that their retirement may exacerbate the shortage of doctors, especially of GPs.

“In response to these concerns, the number of medical students admitted under the numerus clausus has increased substantially over the past decade, returning in 2017-18 to the level seen in the 1970s (Box 4). In 2019, the government announced a plan to abolish the numerus clausus policy. It also aims to increase the number of students admitted by 2020 by another 20% and to provide greater flexibility to universities in the admission process (Gouvernement. fr, 2019).

“About 40% of all new postgraduate training places in 2017 and 2018 were in general medicine to address concerns about shortages of GPs – a much higher proportion than in nearly all other EU countries (Figure 15). However, it remains a challenge to attract a sufficient number of new medical graduates to fill all the available training places given the lower remuneration and perceived prestige of general practice.”

Source: OECD/European Observatory on Health Systems and Policies (2019), France: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.


“At the national level, the numbers of doctors, and to some extent their areas of specialization, are regulated by the numerus clausus, which is set by the government annually and controls access to the second year of study in medical schools. This numerus clausus is then applied at the regional level, taking into account current inequalities in the geographic distribution of doctors. There is also a numerus clausus limiting the entry of students in other health professions, such as nursing, midwifery, dentistry, speech pathology and physiotherapy (see section 4.2.1).

“For doctors, after six years of study, all medical students undertake a national competitive examination (épreuves classantes nationales; ECN). Based on the results, students apply for open internship posts by area of specialization and location. In recent years, the lack of interest in certain specialties (anaesthesiology, intensive care, gynaecology and obstetrics, and paediatrics) has led the government to block a number of places for these specialties in the national examination. A 2011 decree (décret n° 2011-954 du 10 août 2011) prohibited students from sitting for the ECN if they failed to gain access to medical studies in France following the common first year (Première Année Commune aux Études de Santé) and pursued their medical studies in another EU country (see section 4.2.2). A Romanian medical school challenged the law, and in early 2013, the decree was overturned. Some unions of health professionals fear that allowing foreign-trained students access to the ECN will undermine regulatory effectiveness of the numerus clausus.

“After graduation, there is no restriction on the areas where professionals are allowed to practise. Hospital work is dependent on posts offered by institutions but self-employed professionals can establish their practices wherever they want. As a result, there are regional disparities in the distribution of self-employed doctors and other health professionals.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.


“Since the early 1990s, a range of tools and incentives have been developed that are designed to address the inequitable supply of physicians and to meet the objectives of the SROS [Regional Health Organization Plan]. Access to medical specialties in each territory is now regulated by quotas set five years in advance, and a system of financial incentives to encourage doctors to work in underserved areas was established. The public service commitment contract (contrat d’engagement de service public) may be offered to medical students and residents who receive a monthly allowance during their studies in return for the commitment to work in an underserved area without practising extra-billing (i.e. under Sector 1 agreements; see section 3.7.2). For nurses, a first attempt to implement a tighter form of planning was implemented following the 2007 national agreement of nurses with SHI. This includes financial and material incentives for nurses to settle in underserved areas and prohibition of settlement in overserved areas unless a retiring or leaving nurse is replaced (see section 4.2.1).”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.


“Tuition fees in France are relatively low compared with the rest of Europe. Most higher education institutions in France are funded by the state, therefore there is usually a nominal fee depending on the level of study.

“The average public university in France in 2017 charged €189 (£167) per year for a bachelor’s degree, €259 (£230) for a master’s degree, €393 (£348) for a PhD and €611 (£541) to attend an engineering school.

“Universities in France are known to levy administration charges, which causes some elevation in the price – however, the figure is far lower than in other countries such as the UK.

“To study at one of France’s highly selective private grandes écoles or grands établissments, you could pay between €500-€600 (£443-£532) per year, however some charge up to €10,000 (£8,864) per year. Some only offer postgraduate degrees, such as Ecole Normal Supérieure in Paris, which expects students to attend two years of preparatory school or to transfer across after two or more years of undergraduate study. It costs €750 (£665) per year and charges international students the same as domestic students – like most French universities.

“A private institution that teaches engineering, management or business can cost up to €30,000 (£26,592) per year.

“The average bachelor’s degree takes three to four years, so students should expect to spend €567 (£503) or for an average two-year master’s degree, €518 (£459).”

Source: Times Higher Education. The Cost of Studying at a University in France. Dec. 21, 2017. From the web at https://www.timeshighereducation.com/student/advice/cost-studying-university-france, last accessed Oct. 11, 2020.


Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.


Page last updated Oct. 24, 2022 by Doug McVay, Editor.

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