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Letter From France
September 23/30, 1998

Two Tiers of Physicians in France: General Pediatrics Declines, General Practice Rises

Author Affiliations

From the Departments of Medicine and Pediatrics, Albany Medical College, Albany, NY.


Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

JAMA. 1998;280(12):1099-1101. doi:10.1001/jama.280.12.1099

THE FRENCH medical system is characterized by a distinction between 2 tiers of physicians: generalists and specialists.1-4 This distinction is founded on the way physicians are trained. Postgraduate medical education in France has 2 unequal tracks.5 The 40% to 50% of the medical students who, at the end of medical school, pass the rigorous entrance examination to the internat (the residency track to train specialists) have higher status than those who enter the generalist track (the résidanat). Specialists also spend a longer time in residency training than do generalists (4-5 years as opposed to 2.5 years), earn more money when they enter practice, and have the possibility of becoming academic physicians. Most of the clinical training of medical students and residents, even of future generalists, occurs within university hospitals and to a lesser extent nonuniversity hospitals under the tutelage of specialists and subspecialists. Except for the recent requirement for residents in the generalist track to spend 4 to 6 months in a generalist's private office,6 French physicians have not started to move training into ambulatory settings.