health - immigration

Foreign doctors get second-rate treatment

Tuesday 17 June 2008

Faced with a lack of health professionals, France is looking abroad for doctors. Yet, the new recruits have a hard time with integration and are demonstrating against what they say are unfair salary levels. (Report: G.Desqueyroux-Quidu)

In the 1980s, France decided to reduce the number of students passing through to the second year of medicine by imposing strict quotas. At the end of the 1970s there were almost 9,000 medical students; that number crumbled to about 3,500 by 1993. The reasoning behind the decision was that if there were fewer doctors, there would be fewer prescriptions - and the health system would save money.  

At the time, the French government was seemingly unaware of the problems derived from a growing and ageing population. The number of elderly people over 85 is expected to double between now and 2020.

To make matters worse, soon many doctors from the baby-boom generation will be retiring. Currently, the average age for a surgeon is 51. France is thus forced to recruit foreign doctors, both inside and outside Europe.

15,000 foreign doctors

Today, there are about 15,000 foreign-educated doctors in France. Of those, 7,000 received their degrees outside Europe. They are called the PADHUE (Practitioners with Degrees from Outside Europe). A third of the PADHUE come from North Africa and another third come from sub-Saharan Africa. The final third is distributed between people from the Middle East and the rest of the world.

These doctors work exclusively in hospitals and they do not have the right to work in the private sector.

In theory, they can only work under the supervision of a department head. But, in reality, many carry the same weight.

Stature based on place of origin

Dr. Joseph Bakar, from Syria, is an OB/GYN. He has been working in the Paris area for five years. His title: Assistant Associate Specialist. He has the same competence and does the same work as his French colleagues, but gets paid half as much. This is despite the fact that his medical degree is the same as theirs. No matter. To obtain the same status as his French counterparts, Joseph Bakar has no other choice but to pass a series of written exams. Once he has passed those, he can enrol in France’s Medical Order Council.  

The situation of Dr. Sylviu Bouzatou, a Romanian anesthesiologist who has never worked in France, is better because his homeland became part of the European Union on January 1, 2007. His registration with the Medical Order Council only takes half an hour: a glance at his file and a quick French language test is sufficient.

Varying wages, difficulties integrating

The French government trusts Dr. Bakar with the lives of his patients but only pays him 2,400 euros a month, which is half of what his French and European counterparts make. Additionally, he gets paid 70 euros an hour for overtime, compared to the 200 euros an hour for his French and European colleagues.

The HALDE (High Authority against Discrimination) believes the situation is unjust and discriminatory.

It shouldn’t matter whether the doctors are European or not, the crucial element is language. Without French, it is difficult to give a diagnosis. Sylviu Bouzatou must improve his French. He was recruited via a special program within the Chateau-Thierry hospital, which desperately needs doctors. In this hospital, 50% of the staff are foreign-born, representing 15 different countries: Russia, Madagascar, Egypt, Benin…

After taking an intensive French course for 15 days, the Romanian doctor starts at the hospital, but it is not going to be easy. In addition to the language barrier, he knows little about his new workplace. But he has been recruited and they want him to stay.

Drama for the countries of origin

Without these foreign doctors, the French health system would be bankrupt. But for every foreign doctor that arrives in France, his or her homeland is deprived of yet another valuable asset.

The countries of origin suffer as a result of the emigration of their health professionals. In the already struggling African continent, this haemorrhage is especially dramatic. There are more Beninese doctors in the Paris region than in all of Benin. According to the World Health Organization (WHO), developing countries are missing 4.5 million health care workers.

Meanwhile in France, while waiting for the quota numbers to rise, the reliance on foreign-born doctors can only grow.