If we tell you “Medical desert”, you don’t necessarily think of Ile-de-France. And yet, the region is the most affected by medical under-density in mainland France, according to a study by the Directorate of Research, Studies, Evaluation and Statistics (Drees), published on Friday February 14.
All regions combined, this is the place where the increase in the share of the population in the so-called “under-dense” area between 2015 and 2018 was the most significant: 5.9% against 1.9% on the scale national. The term designates areas where the population has access to less than 2.5 consultations per year per inhabitant, according to an indicator that takes into account both the supply (availability and proximity of doctors) and the demand for care.
Inequalities by department
In total, in Île-de-France, 1.8 million people live in an under-dense area (2018 figures). Almost half of the national total, which then stood at 3.8 million inhabitants.
Within the region, there are inequalities. In Paris, nineteen out of twenty arrondissements are considered to be well endowed with general practitioners. In a still very rural department like Seine-et-Marne, most of the territories are moderately or under-provided. “In Seine-Saint-Denis (93), there is also a lack of doctors”, believes Jacques Gonzales secretary general of the Geographic Society. Former professor at the faculty of medicine Pitié Salpêtrière explains that the“Insecurity” and the “Difficult living conditions” discourage some doctors from settling there. In the small Ile-de-France crown, there are few municipalities classified as very well endowed.
Numerus clausus and vocation
To explain this overall observation, Drees highlights “The decrease in the number of practicing physicians as a result of many retirements, which the new facilities do not compensate for.” In Île-de-France, the number of general practitioners fell by 4.2% in three years, even as “Care needs” increased: the population increased by 1.3% over the period.
The numerus clausus, which determines the number of medical students who can be admitted in 2e year, is singled out. Raised in the years 1970-1980, it is at the origin of the significant number of doctors who retired during the decade 2010. Conversely, lower in the 1990s, “Fewer physicians are currently in mid-career”, according to Drees.
” But this does not explain everything “, insists Jacques Gonzales, who highlights a change in customs: “Doctors, especially women, whose numbers have increased considerably in the profession, want to preserve their family life and lead a well-organized professional life. They favor consultations by appointment and are less present on weekends. “
Last change, that of vocations: “The medical competition has become extremely difficult. So much so that successful candidates prefer to become specialists in order to earn a better living. ”, says the former professor. Today, France thus has fewer general practitioners than specialists.